Health on television

Jamie Oliver's new programme was on last night, in which he tries to provide some healthy eating education to schools in the US. In one memorable scene he holds up some tomatoes before the class and asks them what they are. Nobody can answer. He tries again, this time with an aubergine. Someone makes a guess: "is it a pear?".

While in the UK there's probably still some way to go before we're eating the way we should be, I'd guess that more people in a school class of that age would recognise the tomatoes, if perhaps not the aubergine.

But perhaps one of the reasons there was virtually zero obesity in my day (maybe one kid in the entire school) was because school meals were pretty much inedible. Every shop sold vegetables though, so anyone even going into a shop to buy sweets would still see tomatoes etc on sale.

These US school students will of course go on and learn a lot about the world as they grow up, and hopefully eat healthy as they do. As adults we have more than just a responsibility for our own health but that of our families as well. And there's lots that can be done - we can ensure that our intake of trans fats is as small as possible, we can try and get our five a day, etc.

I think the reality/ documentary style of show is a good way of doing health television as it shows how diet and exercise affect people's lives. It would be interesting to see how other celebrity chefs would have fared in this quest. Say, Gordon Ramsay or Marco Pierre White.

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Children's Health Insurance in Georgia

And now there are two . . .

As the Obamacrap imposed 9/23 deadline for change in the way children obtain health insurance approaches we now have two health insurance companies that are willing to play the game.

At least for now . . .

Blue Cross of Georgia will introduce new plans and rates in a few days. They will have only one plan for children who want stand alone coverage or who are otherwise uninsurable.

As of now, Kaiser will offer a full array of plans for children and final rate after the underwriting review is yet to be determined.

Starting rates may be favorable but I would not expect final rates (after underwriting) to be pleasant. What we have seen from other carriers for dependent child rates is enough to make your hair stand on end. Final (underwritten) rates will easily go north of $500 per month for a $2500 deductible copay plan.

Parents who want to include their children on their plan will have to sell an organ to pay the premium.

HHS Secretary Shebullshits can try to shift the blame but everyone in Washington who created this mess now have to own it. This is what happens when you put folks in charge who have no real world experience and no clue. November elections can't come soon enough.

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HHS Shecantbeserious Steps in it...

The reason that she's so dangerous is because she's so ignorant:

"There will be zero tolerance for this type of misinformation and unjustified rate increases," Health and Human Services Secretary Kathleen Sebelius said in a letter to the insurance lobby."

Now that may seem brave - after all, she's taking on the fierce and vicious health insurance industry - but it is, in fact, quite stupid. For one thing, she has no (zero, nada, zilch) power to enforce her little threat. For another, even if she was able to carry through, she would do far more harm than good in doing so.

Why's that, you ask?

It's pretty straightforward: insurance companies need to make a profit. It's how they (or any other business) stays in, well, business. Beyond that, though, there are statutory and regulatory regulations that require carriers to have a certain amount of reserves and liquidity. Under ObamaCare©, carriers are forced to cover an ever-expanding list of expenses; if they can't price for the increased risk, they'll lose money. That has the medium-term effect of draining reserves, but, as Moody's rating service reminds us, HHS Secretary Shecantbeserious' "warning to health insurers about “unwarranted” rate increases could raise questions about the insurers’ ratings." If a carrier's financial rating plummets, so does its ability to conduct business.

One begins to suspect that the folks in DC consider that a feature, not a bug.

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Grand Rounds, End of Summer edition, now online

Julie Rosen, proprietress of the Bedside Manner blog, hosts this week's round-up of medblog posts. Come for the beautiful scenery, stay for the insights.

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International Health Insurance Comparisons

There are many companies offering insurance packages for people living all over the world. You will have heard of nearly all of the big players in the market, here I am going to go through some of the most high profile names in this sector just to compare and contrast the basics that are offered in each case.

Aetna Global Benefitsare an american firm which specialises in insurance for expatriates, but that doesn't mean that other nationalities are excluded. The main areas of concentration are in Asia and the near East, and they have access to a large number of hospitals throughout that area.

AXA-PPP International Health Insurance are the result of the merger between the French insurance firm AXA, and the British insurers Guardian Royal Exchange. But as AXA are a truly international company they do not concentrate on any single part of the world having partnerships in the Americas, Africa and Asia, with their own network of partnerships with private hospitals and physicians throughout the world.

Bupa International are one of the best known private health insurers in the UK, but have only recently started to expand majorly into the far east. They too have partnerships in North America and in most of Europe, with specialist clinics etc.

Medicare International are a young British Insurance company who do not simply specialise in expatriate health insurance, they have set out to become a global insurer, offering insurance to all nationalities globally.

This list is not, by any means, exhaustive, and with a lot more research I could probably have unearthed some international brands from non-english speaking countries, but then I might not have been able to translate them very well.

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Changing times: health options?

It's not been a big week for news so far - a Vitamin B trial has shown some promise in dealing with Alzheimer's, an expert has called for the legalisation of cannabis (is it my imagination or does one of these experts pop up everly 18 months and do this...?) and there has been more talk of industrial action, with some heavyweigh politicians endorsing it.

But as the news plays out constantly on the radio and the television, some things remain pretty constant - the need to be prepared, while it might sound a bit like some kind of motto for the Scouts, is always a must. In times of uncertainty there's things we can do like make sure we have a savings account, and get online health insurance quotes, also things like making sure we have wall insulation to save a bit on the heating bill.

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1099's Hit the Radar*

*Or: Why it's called the "Stupid Party:"

"Many Democrats have joined Republicans in pushing for the repeal of a tax provision in the new health care law that imposes a huge information-reporting burden on small businesses."

The fact that Democrats, facing a potential tidal wave of electoral punishment, are on board with this is quite understandable. Anything to mitigate the damage would be, from their standpoint, a win-win.

But for Republicans to even entertain this idea is abhorrent: ObamaCare© wasn't foisted on us piecemeal, it was jammed down our throats all at once. And that's how it must be defeated, not by "a thousand cuts," but total and complete destruction. It doesn't need to be "fixed," it needs to be eradicated. And you don't accomplish that piece-by-piece, it must be eliminated all at once, as well.

Proof of concept:

"The White House is nervous about a repeal, fearing that it could set a precedent for rolling back other unpopular features of the law."

No, it isn't. The President knows full well that the opposite is true: identifying and lopping off one little piece validates the remainder. One hopes that what passes for Republican leadership understands this, as well.

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Not so bad after all ?

[Welcome Reason readers!]

Last week the Wall Street Journal carried this article. In it, we learn that Max Baucus has news for us about health care reform, via a recent town hall meeting with his constituents in Montana:

"Senate Finance Chairman Max Baucus, who wrote most of the bill, attempted this line at an August townhall in Billings, Montana when he tried to calm an angry voter by saying, "Mark my words, several years from now, you're going to look back and say, 'Well, that wasn't so bad after all.'"

There's a ringing endorsement for you.

In other words, Baucus is telling me not to worry about all the rattles I hear in this Cadillac he sold me (that I can't afford). I'm not to worry because in a few years I won't think they're so bad. After all.

Anybody else buy a Cadillac from this guy Baucus? Does yours rattle, too?

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On Grapefruit and Lemons

Despite its tart reputation, grapefruit may indeed be the sweetest of all (metaphorically speaking):

"New joint research by scientists at the Hebrew University of Jerusalem and Harvard University’s Massachusetts General Hospital (MGH) has demonstrated the mechanism by which a single compound in grapefruit controls fat and glucose metabolism ... causing the liver to break down fatty acids. In fact, the compound seems to mimic the actions of other drugs, such as the lipid-lowering fenofibrate and the anti-diabetic rosiglitazone."

In short, a team of American and Israeli scientists my have found a naturally-occurring treatment for diabetes. Not only that, but it may also help lower cholesterol. Dig in!

Some doctors, on the other hand, are more like lemons:

"San Diego anesthesiologist Adam Dorin, founder of PhysiciansAgainstObamacare.org, writes in the fall issue of the Journal of American Physicians and Surgeons that the AMA is more interested in its prestige and financial contracts than physicians' interests."

Well, dunh!

As we noted months ago:

"[G]rowing opposition (to ObamaCare©) makes the actions of the AMA, which represents only 17% of the doctors in the U.S., look very bad."

The good news is that fewer than 1 in 5 doctors actually belong to the American Medical Association. The bad news, of course, is that it's the "go-to" source for the media in its effort to drive the ObamaCare© narrative. As Dr Dorin notes, "the AMA makes $70 million to $100 million a year from its exclusive contract with the federal government for the sale of coding books that physicians use to bill insurance." This is the "billing bible" that health care providers use to determine pricing and reimbursement. By controlling this key tool, the AMA is in a unique position to profit from the 3rd party reimbursement system (aka insurance and Medicare).

It's enough to give one a headache.

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Paying for Obamacare

Does anyone know how Obamacare is funded? The tooth fairy? Manna from Heaven? Santa Claus? China?

We came across a secret transcript from a meeting of elected officials whose identity has been scrubbed to protect them from further embarrassment.

"We need a way to pay for this health care bill without actually raising taxes. Suggestions?"

Dumb ass #1: "Let's do a specific industry wide tax on medical equipment companies. I can't see that raising health care costs."

Dumb ass #2: "Let's eliminate using HSA's for OTC drugs to create more tax revenue. This package is going to be so good, everyone will be able to buy prescription drugs anyway."

Dumb ass #3 - "Let's require health insurance companies to issue coverage to anyone, regardless of their health. Sure, this will increase premiums dramatically but then we can tax people because their premiums are too high. We can also tax people who don't buy health insurance."

Dumb ass #4 - "Let's add a bunch of new benefits such as preventive care and tell everyone it is free. They will love it!"

Dumb ass #5: "Let's make huge cuts to Medicare and tell the public that coverage won't be effected. Oh wait..do you think the public will ask why we didn't do this earlier if we had the ability? Oh never mind, they're too stupid."

Dumb ass #6: "Let's just tell the clinics we'll pay them less, it worked for Medicare, why not for everyone? Oh, you're saying the under 65 market subsidizes the clinics through higher premiums? No problem, we're the federal government, they'll have to do more with less."

Dumb ass #7: "Why don't we increase Medicaid eligibility to more people and make the states pick up the tab. Well, except for Nevada and Florida since we want to get re-elected."

"Good work guys, next problem to solve? We need to find away to get more voters in our corner, why don't we give citizenship to everyone in this country illegally?" 

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Obama Smokescreen

Just when you thought their noses couldn't grow any more, Obama and Sebelius are tag teaming their way to blaming someone else for problems they caused. Rising health insurance premiums can't be blamed on Bush, so they pick another candidate.

Blame the health insurance companies.

But before addressing their bullshit, let's take a look at what Obamacrap is requiring health insurance companies to cover.

70+ preventive care benefits, many of which are not currently included in existing plans. All of these benefits are to be offered at NO COST TO THE PATIENT. That means either the doctors and labs must agree to offer their services for free or premiums must increase to take on this additional cost.

Obamacrap eliminates annual and lifetime benefit maximums. No more $5,000 drug caps or $100,000 annual benefit maximums. Striking caps is not a bad thing but it isn't free.

DAMN (drug, alcohol, mental and nervous) benefits must be covered as any illness. No more differentiation in copay's or separate benefits for DAMN coverage. These claims must be treated as any other illness.

Same for maternity. If your plan covers maternity it must treat that claim as it would any other illness. No more separate deductibles or limits.

No more HSA/HRA/FSA coverage for OTC drugs without a prescription. That means more office visits to get that required prescription and possibly even a change to a different, more expensive medication . . . since you are already visiting the doctor any way . . .

And let's not forget the health insurance equivalent of "no child left behind". As of 9/23/10 health insurance companies will be required to offer coverage to any child that applies for insurance without regard to pre-existing medical conditions. In other words, if you have a child, sick or well, health insurance companies cannot deny coverage, no matter how expensive treatment for existing medical conditions may be.

Take a moment to catch your breath and think about all these NEW benefits that must be paid for by health insurance companies. Benefits that were not covered 6 months ago.

Now for the Obama and Sebelius bullshit.

The AP is reporting that HHS Secretary Kathleen Shebullshits is taking aim at and declaring war on health insurance companies if they try and blame Obamacrap for increased health insurance rates.

President Barack Obama's top health official on Thursday warned the insurance industry that the administration won't tolerate blaming premium hikes on the new health overhaul law.

"There will be zero tolerance for this type of misinformation and unjustified rate increases," Health and Human Services Secretary Kathleen Sebelius said in a letter to the insurance lobby

Misinformation indeed. Obamacrap was built in secret, behind closed doors in spite of promises the public would have time to review the proposal before it was to come to a vote. This was part of a pledge to have the most transparent administration ever.

"Simply stated, we will not stand idly by as insurers blame their premium hikes and increased profits on the requirement that they provide consumers with basic protections," Sebelius said. She warned that bad actors may be excluded from new health insurance markets that will open in 2014 under the law. They'd lose out on a big pool of customers, as many as 30 million people nationwide.

Get a clue, Shebullshits.

Half the 30 million that are supposed to be covered will go on welfare and be assigned to Medicaid. If the other 15 million or so are "prizes", then why are so many health insurance companies running as far as they can from Obamacrap? Some carriers have already announced they are withdrawing completely from the individual health insurance market while others are making noises like they won't be here past 2011.

Doesn't exactly sound like they are chomping at the bit to play that game.

Although the law's big expansion of coverage under the law won't take place until 2014, several new benefits go into effect starting later this month. Lifetime dollar caps on coverage are abolished, and plans must allow parents to keep their children on the policy up to age 26. Many plans will also have to guarantee coverage for children regardless of a medical condition, and provide preventive care with no cost-sharing for the patient.

The administration estimates that those new benefits will raise premiums by no more than 1 to 2 percent.

Estimates are worthless, especially given Washington's track record on projecting costs. The ink on Obamacrap is hardly dry and already the CBO and actuaries at CMS are saying earlier cost figures for Obamacrap are low.

So far, very few Georgia health insurance companies have released post 9/23 rates. The few that have are increasing 5 - 8% with childrens' rates tracking much higher.

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Um, about those terrific ObamaCare© cost savings...

Not happenin':

"The nation's health care tab will go up -- not down -- as a result of President Barack Obama's sweeping overhaul."

Oh, those nasty Republican naysayers and awful bloggers! They just keep spouting the company line.

What?

It's not the GOP or IB saying this?

Well, then: whom?

"That's the conclusion of a government forecast released Thursday ... said economist Andrea Sisko of Medicare's Office of the Actuary, the nonpartisan unit that prepared the report."

Where's Emily Litella when you need her?

MORE: As the Fox item above notes, even the "modest" increase assumes certain levels of reduction in Medicare reimbursement rates, all the while "guaranteeing" seniors continued access to necessary health care.

Unfortunately, that prediction may be a bit, um, rosy:

"Richard Foster, Medicare's chief actuary, noted that Medicare payment rates for doctors and hospitals serving seniors will be cut by 30% over the next three years. Under the policies of the Patient Protection and Affordable Care Act, by 2019 Medicare payment rates will be lower than under Medicaid."

Ooops.

And remember, under ObamaCare©, more Americans on the Medicaid rolls is considered a feature, not a bug. And that's the good news; it actually gets worse from there:

"The drastic reductions in Medicare reimbursements under ObamaCare will create havoc and chaos in health care for seniors."

I must respectfully disagree with the gentleman making those remarks (Peter Ferrara, director of entitlement and budget policy at the Institute for Policy Innovation). "Havoc and chaos" are necessarily predicated on choice. Why would he assume seniors will have any?

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Georgia Health Insurance Challenges

If you live in Georgia, and have had difficulty finding health insurance (at any price) on your children, the BBC (British Broadcasting Company) would like to hear from you.

Also, if you live in Georgia, and are hoping to find affordable health insurance for your children once the Obamacare mandates go into effect, but have had trouble even finding ANY coverage, the BBC wants to talk to you.

I was contacted by a U.S. based correspondent for the BBC and questioned about the challenges and unintended consequences of Obamacare, particularly with regard to health insurance for children. They would like to interview parents of children with pre-existing medical conditions that have made it impossible for them to obtain health insurance in Georgia.

Your information will be kept private. We will need your contact information to relay to our contact at the BBC but do not provide any specific details about medical conditions. They wish to talk to parents of children under the age of 19 who have been unsuccessful in finding health insurance in Georgia.

If you would like to be interviewed, send us an email with your name and contact information. We will pass it on to the BBC.

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Rosh HaShannah 5771: L'Shannah Tova!

Happy New Year to all of our Jewish readers. For those not of the Jewish faith, Rosh HaShannah ("Head of the Year") begins this evening; it marks the beginning of what we call the "Days of Awe," a 10 day period of introspection and, hopefully, renewal, culminating in the fast day of Yom Kippur ("Day of Atonement").

As with all Jewish holidays, this one begins at sundown the night before, hence the afternoon posting.

Factoid: Reform Jews (by far the largest denomination in the US) celebrate but one day of Rosh HaShannah, while Conservative and Orthodox (among others) observe 2 days.

It is traditional to celebrate the New Year by eating apples and honey; I would encourage those who wish to do so to share their favorite apple and/or honey dishes in the comments.

And for those interested in a slightly off-beat (in the sense of strange and new), check out these new arrangements of traditional High Holiday melodies.



May you and yours be inscribed in the Book of Life.

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Stranger-than-fiction Life Insurance: Deja Vu edition

Regular readers may recall this story from 4 years ago:

"A pair of Los Angeles women may have insured the lives of homeless men, then arranged fatal hit-and-run “accidents” so that they could collect the death benefits, officials say."

As I said at the time, this was "sick."

But someone else (actually, four someone else's) have gone one, um, better:

"Federal Bureau of Investigation headquarters today highlighted a recent conviction in a scheme by four individuals in the Los Angeles area to invent a man out of whole cloth, hold his funeral, and then reap in the insurance benefits from his death."

This guy wasn't just homeless - he was bodiless, as well. The article lacks more than a few details, but we can infer that at least two carriers were involved, since the total amount at risk would have required at least some additional underwriting beyond an application. Makes one wonder, though, how many of these schemes are successfully pulled off.

[Hat Tip: Best of the Web]

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CDHP's: The Expanded Version

National Review health blogger (and FoIB) Avik Roy has written an insightful and helpful post on the role of Consumer Driven Health Plans (CDHPs). He examines the pro's and cons (including a link back to our own exclusive expose on network re-pricing problems).

His conclusion - that Consumer Driven plans will shine under ObamaCare© - may be a bit controversial, but it's certainly well-reasoned and supportable. Recommended.

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Clue for the Gray Lady: D'Uh!!

Full disclosure: several years ago, I had the privilege of being interviewed by the NY Times' Reed Abelson, a very nice lady. She apparently has (or shares) the "health beat" for the "Paper of Record," and seems at least interested in what the blogosphere has to offer.

That said, I really wish reporters like Ms Abelson would spend at least an hour or so boning up on simple economics:

"Instead of sharing the pain, as they have generally done in the past, employers chose to keep their costs steady by passing the higher costs onto workers."

Here's that clue, Reed & Co:

Employers don't pay any premiums. They don't share in them, they don't "pass them along."

Once more: Employers. Don't. Pay. Premiums.

They collect them and send them along to the insurer(s).

Of course, reporters aren't the only folks guilty of this ignorance: President Obama (and others) are currently touting a "tax break" for businesses, which is based on another false assumption; as with premiums, businesses don't pay taxes, they (you guessed it!) collect them.

By way of analogy:

A few years ago, I was treated to lunch at a fairly nice restaurant. As I was chewing my salad, I felt something cold, hard and metallic clatter against my teeth. Spitting it out, I saw that - along with the croutons - I had been served a nut (as in "nuts-and-bolts" nut). When I pointed out this faux pas to our server, she offered to take the cost of the meal off the check. Which was nice but, seeing as how it wasn't my check (but they were my teeth!), I failed to see how this helped me.

Just like me and my "free" lunch, businesses don't pay the tax tab, so offering them a "freebie" is of dubious value. What would be beneficial would be a "regulations" break; a respite, as it were, from the onerous new rules encompassed in Obamacare©. Now that would be a break worth chewing on.

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Cavalcade of Risk #113 now up and running

Host David Williams applies a "pretty tough filter" to this week's roundup of risk-based posts. The result is a terrific, on-target collection without a lot of fluff. Stop on by!

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In which we reflect that it really is important to see the right physician

One of the consistent themes at InsureBlog has been the inadequate participation of physicians in setting health policy, for lo! these past 40+ years. See here and here and here and here.

I ask you – what do you truly prefer? Medical policy guidance from physicians ? Or from Nancy Pelosi, Harry Reid, and Max Baucus? Insufficient physician participation over the years created a policy leadership vacuum. Nature abhors a vacuum. And just look what rushed in – Pelosi, Reid, Baucus, et al.

Yes, most physicians are kinda busy with other important stuff.

But here is just one illustration of what I mean by inadequate participation: ModernHealthcare's 2010 list of the “100 Most Powerful People in Healthcare”.

The top 50 in 2010 include 8 physicians – 16%. There is exactly 1 physician in the top 10. There are 5 politicians in the top 10, including the top 4 in the entire survey – the aforementioned Pelosi, Reid, Baucus, plus of course, the President.

So it is no surprise that PPACA - "health care reform" signed by the President - is a political instrument rather than medical reform; is power-driven rather than public health driven; will spend a trillion dollars, not save a trillion dollars; and creates bureaucracy but does not create ways to help physicians and hospitals reduce their cost. As Pelosi predicted, we are finding out what is in this law. And we are rightly appalled.

IMO, too few doctors have been constructively engaged in the health policy debate. As a result, the nation relied on the wrong “doctors” - - who made the wrong diagnoses and wrote the wrong prescriptions. In these circumstances, the patient's prognosis ain't all that rosy.

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Flooding the Zone

Comedienne Kathleen Madigan has a cute line about a farmer whose home along the banks of the Mississippi has been flooded (again): "And he's just as surprised this year as he was last year!"

Which also summarizes the folks who run the National Flood Insurance Program:

"In Wilkinson County, Miss., a home has been flooded 34 times since 1978 ... an insurer has paid claims every time, required no flood proofing, never raised premiums after a claim and vowed to continue insuring the house. Forever."

The home's valued at just under $70,000, but all those claims total over $660,000. It's been paid-for ten-times over.

By what brain-damaged insurance company, you ask?

The clueless folks at the McPaper want you to think it was "[t]he federal government."

But you and I know better: the government has no money. The correct answer is: thee and me.

The rocket surgeons at FEMA "manage" the National Flood Insurance Program (NFIP). This isn't our first brush with this brain-trust, either. As Bob wrote about NFIP almost 2 years ago:

"If you crash your car repeatedly, you can count on your insurance premium shooting up. Crash often enough and your insurer will drop you. But there's a special kind of insurance that doesn't punish you for having the same accident over and over again. And here's the punch line: It's a government program that's already left tax-payers like you on the hook for $17 billion—and counting."

The problem is that, although the goal is to be self-sustaining, the agency continues to run "deeply in the red." How deeply? How about almost $20 billion in crimson? But FEMA/NFIP isn't alone. As we also mentioned almost 3 years ago, Florida's "high risk" carrier, Citizens Property Insurance (a wholly owned subsidiary of the unfortunately non-profit Citizens of the State of Florida), has much the same structure, and (not surprisingly) similar results:

"[O]ver $400 billion (yes, billion with a "b") in liabilities ... [and] something like $3 billion in premiums."

Ooops.

These dollars are dwarfed, of course, by Hurricane ObamaCare©, which is slated to cost in the trillions, but serve as stark and sobering examples of government-run "insurance" programs which eschew risk for votes. We know that there are going to be at least a handful of hurricanes each season, and can infer, with some degree of accuracy, how many will strike land, causing "x" amount of damage. Same with floods. An exact science? No. A pretty good track record of estimates? Yep.

But how do you assess the risk for literally hundreds of millions of Americans - some smokers, some not; some fat, some fit; some healthy, some diabetic - and further, how do you price that risk with any degree of accuracy when you won't even acknowledge that the risk exists?

That is the insurmountable conundrum of ObamaCare©. Well, not "insurmountable," exactly. Feel better?

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Take me out to Grand Rounds

This (short) week's Grand Rounds is up at Dinosaur Musings. Make sure to bring along some peanuts and Cracker Jack!

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Medicare: Spend $10 Billion to Save $1 Billion

Under Obamacare, the folks in Washington are given the task of finding ways to make health care more affordable. Medicare Chief Donald Berwick, a fan of Britain's failing National Health Service, has been given $10 billion to find new ways to save dollars spent under the Medicare system. “I am romantic about the NHS,’’ Berwick said in the 2008 speech marking the 60th anniversary of England’s National Health Service. “I love it.’’

Berwick is using a tool that Congress included in the new health care law: an innovation center with $10 billion to spend over the next decade in a quest for the best ways of improving care and reducing costs.

The launch of the test sites by the end of 2011 is just a first step in changing the fundamental ways the government pays physicians and hospitals. Over 10 years, the innovation center’s work is expected to save $1.3 billion

Perhaps it is just me, but the math doesn't seem to work out.

But there is a potential silver lining here.

Unless he can win over some GOP senators, who voted uniformly against the health care law, Berwick won’t be able to win a 60-vote confirmation in the Senate and will be forced to leave office when his recess appointment expires at the end of 2011.

This guy is dangerous. Let's hope he does even less damage to Medicare over the next year than Obama has to the economy in less than 2 years.

“You can have all the authority in the law, but if you don’t have support in Congress, you are going to have trouble with your funding, you are going to have trouble with the way you are treated at hearings,’’ said a Berwick supporter, James Roosevelt Jr., chief executive of the Tufts Health Plan

Same can be said for Obamacrap.

Ask about information on Medicare supplement plans in Georgia.

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Will private healthcare benefit from NHS cuts?

The talk of cuts in the NHS is naturally worrying for some - there are bound to be a few bureaucrats concerned about their future - but also good news for others, eg companies who carry out healthcare in the private sector.

While private healthcare in the UK is set to grow in the coming years, it isn't necessarily at the expense of the NHS. In a lot of cases private healthcare actually reduces the burden on the NHS, for instance if I went private for a minor operation it would be the NHS who would benefit as I would still have paid my taxes towards the NHS.

So, it's not as simple as one set of professionals taking work off another. But as the new NHS takes shape durung the coming years, a clearer picture will emerge of what the balance of services is liekly to be.

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Cut Me a (Tax) Break!

Last month, we debunked an email which claims that folks will have to pay taxes on their group health benefits starting next year. That is patently false.

But it is true that new reporting requirements go into effect in 2011, and that's where I "missed the mark:"

"First, the relevant portion of Obamacare© doesn't take effect until 2018.

Second, only so-called "Cadillac plans" are subject to this provision."

Wrong, Henry.

Bob Graboyes, Senior Healthcare Advisor for the National Federation of Independent Business (NFIB), points out to me (in email) that:

1) The W-2 reporting provision does kick in in 2012. (That is, the form filed in 2012 on 2011 wages.) However, we believe the provision really starts earlier. If someone leaves his job in 2011, the employer must provide the W-2 – with the added info – within a few weeks of the employee’s departure.

2) It applies to all health insurance benefits, and not just to Cadillac plans. To my knowledge, there’s no difference in the reporting of Cadillac plan benefits and other insurance benefits.

Further research confirmed Bob's points. The reason that this is so important is that all of these additional requirements increase the actual cost of sponsoring a group health insurance plan (as if rate increases alone aren't onerous enough).

Now, I did get the third point correct: benefits aren't taxable - yet. But two outta three is not acceptable, so I'll dock myself a days blog-pay.

As long as we're on the subject of how ObamaCare© will increase the cost of doing business, it's worth noting another cringe-worthy provision that's been under the radar (but won't be for long), which "mandates that all businesses, tax-exempt organizations, and federal, state and local government entities will be required to issue IRS Form 1099 to vendors from which they purchase goods totaling $600 or more during a calendar year beginning in 2012."

Currently, the threshold is $2000, certainly a more reasonable number. This is particularly problematic for small businesses, which may have a number of vendors with whom they spend just at or above $600 (think business cards and letterhead, a new laser printer or fuel). Rotsa ruck, by the way, prying loose Office Depot's or BP's EIN (Employer Identification Number) in order to comply.

Now, one might think that accountant-types would view this new requirement (and the billable hours that would accrue as a result of it) as a major windfall, but one would be wrong. Noted tax-blogger Joe Kristan sets the record straight:

"Unless you are in the write-up business (basically, bookkeeper-for-hire), it’s an unmitigated nightmare. It generates an enormous compliance burden – for us, as well as for our clients – while generating paper that we will ignore in preparing business returns. The 1099s are cash basis, while most businesses are accrual, so matching the 1099s is pretty much impossible."

Of course, one might be tempted to believe that "hey, government-types are smart, surely they know what they're doing."

And again, one would be wrong. Christina Romer, the outgoing chairperson of the President's Council of Economic Advisers, said on Wednesday (September 1st) that:

"[s]he had no idea how bad the economic collapse would be. She still doesn't understand exactly why it was so bad. The response to the collapse was inadequate. And she doesn't have much of an idea about how to fix things."

And these are the kinds of people now in charge of our health care.

Is there a pill for that?

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Health Insurance Designed by Politicians

What does the Capitol Visitors Center and Obamacare have in common?

The CVC was supposed to make it easier for visitors to access Washington landmarks and make their visit more pleasant.

The CVC originally was supposed to take 4 years to build at a budget of $71 million. When completed it took 8 years and cost $621 million.

Obamacrap is supposed to make health insurance more affordable and accessible to everyone, regardless of their age, gender or existing medical conditions.

The initial estimate is the cost of Obamacrap will be less than $1 trillion over 10 years but those figures are already fading in the light of day as the Congressional Budget Office and others are wading through the bill . . . after the fact of course. The final cost will not be known for years.

This makes one wonder, if Washington can't even get a construction project to come in on time and within budget, how can we expect them to do any better with health care?

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Your Wyden Waffles Post

Apparently, Sen Ron Wyden (D-IHOP) agrees with us that the so-called Individual Mandate is evil. Previously, of course, he was all for it; in fact, it was a centerpiece of his own "Healthy Americans Act." But that was then, and this is now:

"Last week Mr. Wyden sent a letter to Oregon health authority director Bruce Goldberg, encouraging the state to seek a waiver from certain ObamaCare rules ... One little-known provision of the bill allows states to opt out [of the mandate] ... I believe that the heart of real health reform is affordability and not mandates..."

Last year, for example, we reported that he was not only "on board" with the mandate, but that it was integral to his proposal. This despite the fact that, as we pointed out at the time (and which has since been validated):

"[I]f one is required to buy insurance, it certainly follows that the market will be forced to offer it to them. And that, of course, sets up a whole 'nother set of issues."

Hence, ObamaCare©.

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Cavalcade of Risk #113: Call for Submissions

David Williams hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 6th). Please remember to 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.

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Health Wonk Review: In the Here and Now

I continue to be impressed with the quality of wonkery displayed by the folks whose submissions you'll see below. Looking back at the first 'Review I ever hosted, I was struck by how many wonk-bloggers [ed: is that even a word?] have left the 'sphere, but quite pleased to see names I recognize as still active: the Health Business Blog's David Williams, my favorite econ-blogger Jason Shafrin, and Workers Comp guru Jon Coppelman (all of whom appear in this edition, as well). I also noticed how short that review really was. I'm all for brevity when appropriate, but there's also no shame in piling on, especially when you read this week's entries.

In keeping with my newfound penchant for minimalism, posts appear in order of submission:

■ Rita Schwab has the sad tale - and important lesson - of little Taylee Blischke, who died at the hands of survived despite the efforts of incompetent, and unrepentant, physicians.

■ Bradley Flansbaum (aka The Hospitalist Leader) shares his comparison of The Great Emancipator and (what we at IB call) ObamaCare©. Guess who wins?

■ Peggy Salvatore uses an old (but timely!) joke to demonstrate the folly of government-supported EHR initiatives.

■ Rich Elmore at Healthcare Technology News reports on the Tiger Team on security and privacy recommendations regarding the handling of personally identifiable health information. Important stuff.

■ Joanne Kenen's post is about how CareOregon, a Medicaid managed-care plan, has created patient-centered medical homes and adapted to its own population a successful care coordination program for patients with multiple and/or complex chronic disease. Interesting.

■ HWR co-founder Joe Paduda weighs in on the cost of voluntarily forgoing necessary health care. While I disagree with his reasoning (high deductibles and/or co-pays are to blame), he makes a valid point:: delaying or forgoing primary care will increase future health care costs

■ Uber-wonk Dr Roy Poses posits that maybe - just maybe - having health care leaders' incentives actually aligned with patients' and the public's needs, and not so large as to elevate the leaders into the "Superclass," might work out better in the long run.

■ My favorite health care economist - Jason Shafrin - examines key provisions of ObamaCare@ from (you guessed it!) an economist's viewpoint.

■ Boston's Tinker Ready talks about "e-patient" Dave, and the contrarian's view of "positive thinking."

■ What does Joe's suddenly accelerating Camry have to do with HWR? Well, you'll have to click through to newcomer Michelle Woods' post on HIT (Health Information Tech).

■ Austin Frakt, The Incidental Economist, believes that Rep. Ryan's plan for Medicare is unlikely to control costs because it is too much like the current [ed: but soon to be "late"] Medicare Advantage program.

■ Maggie Mahar takes a look at former HCA honcho - and current Florida gubernatorial candidate - Rick Scott and finds him wanting.

■ Ken Terry sings the Motown Blues, taking to task the waste of dollars being thrown at Detroit's hospitals. Stop, in the name of...common sense!

■ Workers Comp Insider's Jon Coppelman reports on the case of Americans with Disabilities versus the Occupational Safety and Health Administration. Who wins? Guess you'll have to read the post.

■ Jay Norris, of the Colorado Health Insurance Insider blog, writes about the newly-created Early Retiree Reinsurance Program, which enables federal funding to help pay for retirees’ health insurance.

■ Avik Roy, of The Apothecary (and a featured NRO blogger, as well), takes the contrarian viewpoint in defending the FDA's position in the recent Avastin kerfluffle.

■ Over at the Health Access Blog, Anthony Wright points out that California was the first state in the nation to have its legislature pass a bill to set up a health insurance exchange under health reform.

■ Dr Jaans Sidorov compares and contrasts this Administration's most recent spins with academic writings that "say it ain't so."

■ The eponymous John Goodman's Health Policy Blog reports that the the NCPA [ed: National Center for Policy Analysis] has released an evenhanded consumer’s guide to health care reform, focusing on both new benefits and costs, in a helpful Q&A format.

■ At the Health Affairs Blog, Michael O’Grady and Jennifer Baxendell Young propose an automatic adjustment mechanism in which federal Medicaid financing would increase for states suffering economic hardship, without the need for special Congressional legislation. Left unanswered: why only Michael's picture is on the post.

■ The Health Business Blog's David Williams interviews one of my favorite med-bloggers: Dr Evan Falchuk. What makes him a fave? Here's a sample: "We connect with people because we’re talking about real stuff." Trust me, this guy is important.

■ And finally, our own Bob Vineyard puts the smackdown on all the "wonderful" changes promised by ObamaCare©, including the fact that we now have fewer choices at higher costs.

That wraps up this week's episode of Health Wonkery. Please be sure to tune in again on the 16th when Jay's better half, Louise Norris, hosts the next edition.

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Mid-Week ObamaCare© Implementation Update

First up (and as previously noted but now confirmed), Aetna will no longer write so-called "child-only" plans. These have been useful in, for example, divorce situations and some group-based scenarios, and are now off the table insofar as Aetna's individual medical plans are concerned. While this may not seem to be a big deal, it's a further erosion in the choices available in the (previously) open market.

This change is effective October 1st for Kentucky and Indiana, and November 1st for Ohio.

If you're tuning in late, these changes are a direct result of ObamaCare©'s careless and destructive assaults on basic risk management principles. For example, the new regs prohibit underwriting on "children" 19 years and under, which, according to the folks at Aetna, "have the potential to significantly increase the cost of premiums and make coverage unaffordable." Quite so.

On the other hand, Medical Mutual is poised to pick up at least a few of Aetna's minors:

"Medical Mutual will continue to accept applications and provide quotes for plans with effective dates of September 23, 2010, through October 31, 2010, for children under the age of 19 (either as a stand-alone product or as part of a family)."

Of course, no one really knows what's going to happen going forward from October. As the folks at MMO told us in email, "the Company reserves the right to withhold final approval based on clarification of state and federal regulations on individual plans or not issue a policy at all."

How's that for Hope and Change?

UPDATE: And this just in from United Healthcare's Golden Rule:

"In previous communications, we had informed you of an impending change to the coverage effective date that would take place on September 1, 2010. Due to broker feedback, this date has been moved to September 6, 2010."

Interesting that they received, and acceded to, what must have been fairly intense pressure from agents.

So beginning with new applications received on or after next Monday:

"Coverage effective dates for Golden Rule renewable health plans will be the later of 30 days after an application is received or the date requested by the customer (but no greater than 60 days)."

Glad they cleared that up.

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Health Insurance Bridge to Nowhere

The folks in Washington that gave us the "bridge to nowhere" have done it again, this time with health insurance. ERRP (Early Retirement Reinsurance Program) as announced by HHS is supposed to make it easier for employers to provide health insurance to early retirees. Congress authorized $5 billion of money they did not have to fund this program until 2014.

Most expect that will not be enough to support the program, but then, what else is new? According to Sunshine News:

Sixty-nine Florida businesses and government entities have been accepted into a new federal program designed to help employers and unions maintain health coverage for early retirees not yet eligible for Medicare.

The Early Retiree Reinsurance Program is designed to be a $5 billion bridge to the new federally mandated health insurance exchanges that begin in 2014.

But U.S. Rep. Bill Posey said the program looks more like a shell game, and it could come up short financially.

Rep. Posey is not the only one with this concern.

"The timing of this announcement by the administration is interesting because earlier this month Medicare trustees issued a report noting on page 183 that the new health-care law will result in nearly 6 million retirees losing their prescription drug coverage from their former employers -- a fact that went largely unreported," said Posey, R-Cocoa.

Posey added, "Nowhere in today’s HHS release is there a reference to HHS’ own warning to retirees that this program is largely unfunded -- by perhaps tens of billions of dollars.

Probably just an oversight . . .

The White House said immediate action was needed to bridge the health-care gap for early retirees, noting that the percentage of large firms providing retiree coverage dropped from 66 percent in 1988 to 29 percent in 2009.

Does the White House actually believe they can magically reverse a trend of the last 20 years when they can't reverse the unemployment and foreclosure trend of the last 2 years? Or do they only care if the voters believe this garbage?

The folks at EBRI, who have a pretty good handle on health insurance costs, have estimated the money for ERRP will run out in 2 years.

Just another stupid government trick from the folks who brought you Obamacrap.

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