Grand Rounds founder Nick Genes hosts this year's first roundup of great medblog posts, and it's a doozy.
Tuesday, January 5, 2010
Monday, January 4, 2010
Doc's vs "Reform"
Dr Melissa Clouthier, blogging at RWN, has an outstanding video of real life physicians, not AMA hacks.
It's all good, but two "highlights:" Pay close attention at about 1:30, when one doc explains in simple but dramatic terms how "the private sector" has "allowed...physicians to actually take care of more patients."
Immediately after, another doc schools the Congresscritter on how many are truly uninsured. But the best part begins at about 4:05, when that physician - educated and trained in Canada! - is invited up to outline his take on what reforms are needed:
In fairness, kudos to Congressman Conyers for engaging in the first substantive and civil debate we've seen thus far.
It's all good, but two "highlights:" Pay close attention at about 1:30, when one doc explains in simple but dramatic terms how "the private sector" has "allowed...physicians to actually take care of more patients."
Immediately after, another doc schools the Congresscritter on how many are truly uninsured. But the best part begins at about 4:05, when that physician - educated and trained in Canada! - is invited up to outline his take on what reforms are needed:
In fairness, kudos to Congressman Conyers for engaging in the first substantive and civil debate we've seen thus far.
Product Update: Variable Annuities
We don't write a lot about variable products, but they can be a valuable part of one's insurance portfolio. Briefly, variable products, such as annuities or life insurance, are cash-value insurance policies with "sub-accounts" that mimic mutual funds. In addition to regular state insurance licenses, agents who sell these plans must also be registered with the Fed's, and require additional training and accreditation.
"Fixed" products, which don't have these kinds of requirements, depend on the insurer to determine rates of return. On the other hand, they do include a (modest) interest rate guarantee - a kind of "floor" below which rates cannot, by contract, fall. Variable products typically don't have these, because the carrier has no way of knowing what kinds of "investments" you'll be making. In other words, almost all the risk is on the insured; on the other hand, they hold the potential for greater returns than fixed policies.
Variable annuities are, simply, cash vehicles that offer the purchaser some tax advantages over CD's or mutual funds. As with all investment-type vehicles, they come with a lot of extra paperwork (e.g. prospectuses, disclosure agreements, etc). Until recently, these plans were considered pretty consumer-friendly, meaning that they offered some pretty decent returns without a lot of risk. That, of course, cost the insurers money, so a new generation of these vehicles is hitting the market:
"...for an additional fee, consumers can buy downside protection. In simplest terms, the safety net often works like this: If the funds perform poorly, the consumer can swap the shrunken sums in them for lifetime payments of a guaranteed-minimum amount.
Those guarantees of lifetime payments were a major strain on insurers after the market slide of 2008 and 2009. Insurers quickly pulled the juiciest deals off the market—subbing in less-generous versions at higher prices."
In a way, that stands to reason: if one's downside is essentially put back on the, um, backs of insurers, one is going to come out ahead, regardless of market performance. While that's a laudable goal from the consumer's side, it's not a good deal for the carriers (or their stakeholders). The new products come with some new rules which make it more challenging for consumers to put off that risk. While these plans remain a valid, and valuable, tool for retirement planning, they also require more consumer discipline and knowledge. If this is the kind of thing you might be interested in buying (or even just considering), seek out a professional, independent agent with at least 7 to 10 years of relevant experience (and, of course, proper credentialing).
Best of luck with your 2010 retirement planning!
"Fixed" products, which don't have these kinds of requirements, depend on the insurer to determine rates of return. On the other hand, they do include a (modest) interest rate guarantee - a kind of "floor" below which rates cannot, by contract, fall. Variable products typically don't have these, because the carrier has no way of knowing what kinds of "investments" you'll be making. In other words, almost all the risk is on the insured; on the other hand, they hold the potential for greater returns than fixed policies.
Variable annuities are, simply, cash vehicles that offer the purchaser some tax advantages over CD's or mutual funds. As with all investment-type vehicles, they come with a lot of extra paperwork (e.g. prospectuses, disclosure agreements, etc). Until recently, these plans were considered pretty consumer-friendly, meaning that they offered some pretty decent returns without a lot of risk. That, of course, cost the insurers money, so a new generation of these vehicles is hitting the market:
"...for an additional fee, consumers can buy downside protection. In simplest terms, the safety net often works like this: If the funds perform poorly, the consumer can swap the shrunken sums in them for lifetime payments of a guaranteed-minimum amount.
Those guarantees of lifetime payments were a major strain on insurers after the market slide of 2008 and 2009. Insurers quickly pulled the juiciest deals off the market—subbing in less-generous versions at higher prices."
In a way, that stands to reason: if one's downside is essentially put back on the, um, backs of insurers, one is going to come out ahead, regardless of market performance. While that's a laudable goal from the consumer's side, it's not a good deal for the carriers (or their stakeholders). The new products come with some new rules which make it more challenging for consumers to put off that risk. While these plans remain a valid, and valuable, tool for retirement planning, they also require more consumer discipline and knowledge. If this is the kind of thing you might be interested in buying (or even just considering), seek out a professional, independent agent with at least 7 to 10 years of relevant experience (and, of course, proper credentialing).
Best of luck with your 2010 retirement planning!
Carrier Update: Southwest Ohio Edition
Back in November, we alerted readers to a potential network-related issue here in the Dayton area. Medical Mutual's contract with Premier Health (one of the area's larger provider networks) had expired, and talks had broken down (as they will). Had this problem not been resolved, a lot of insureds would have seen some significant health care cost increases beginning last Friday.
We've been informed (via email) that the parties have reached an amicable agreement, and there was nary a burp in services. Thanks to our friends at the Industry Radar, here's the official news.
On a sadder (maybe) note, it appears that the American Community Mutual Insurance Company has hit the skids. According to email from a reliable source, the carrier has entered into a consent agreement with the Ohio Department of Insurance. Under the terms of the agreement, no new business has been accepted from Ohio beginning December 23rd. This affects both group and individual new business; existing policyholders aren't necessarily affected. Of course, the ability to generate income from new business affects renewal rates for current policyholders; look for some major increases in the near term.
[Hat Tip: Cornerstone]
We've been informed (via email) that the parties have reached an amicable agreement, and there was nary a burp in services. Thanks to our friends at the Industry Radar, here's the official news.
On a sadder (maybe) note, it appears that the American Community Mutual Insurance Company has hit the skids. According to email from a reliable source, the carrier has entered into a consent agreement with the Ohio Department of Insurance. Under the terms of the agreement, no new business has been accepted from Ohio beginning December 23rd. This affects both group and individual new business; existing policyholders aren't necessarily affected. Of course, the ability to generate income from new business affects renewal rates for current policyholders; look for some major increases in the near term.
[Hat Tip: Cornerstone]
New Year's Carnival of Personal Finance
The Financial Blogger presents the first CoPF of 2010. It's chock full of helpful tips for making this year a financial success.
Friday, January 1, 2010
No More Mayo
Mayo Clinics are one of the premier treatment centers in the U.S. and have been praised by Obama as a "national model for efficient health care", but there is a problem. As of today, January 1, 2010, the Glendale Arizona Mayo clinic will no longer treat Medicare patients.
Why?
Because the government pays too little . . .
This doesn't bode well for those who are, and hope to be, part of any government run health care plan.
At the present time, the Glendale clinic is the only one withdrawing from Medicare but this decision could have a ripple effect to other clinics. And it doesn't stop there.
Family physicians and other primary care docs are on the low end of the pay scale and are squeezed more than any other medical providers. Typical reimbursement for an insured primary care visit in the Atlanta area can run as low as $42 with most running no higher than $60. In other words, a trip to the doc is about the same price as a lube & premium oil change with tire rotation.
And Medicare pays even less than traditional health insurance carriers.
The folks in Washington love to get health care on the cheap and the proposals considered in Congress will cut funding for Medicare below current levels.
It doesn't take a rocket surgeon to figure out this is not going to work.
Why?
Because the government pays too little . . .
The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.
This doesn't bode well for those who are, and hope to be, part of any government run health care plan.
At the present time, the Glendale clinic is the only one withdrawing from Medicare but this decision could have a ripple effect to other clinics. And it doesn't stop there.
Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.
“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”
Family physicians and other primary care docs are on the low end of the pay scale and are squeezed more than any other medical providers. Typical reimbursement for an insured primary care visit in the Atlanta area can run as low as $42 with most running no higher than $60. In other words, a trip to the doc is about the same price as a lube & premium oil change with tire rotation.
And Medicare pays even less than traditional health insurance carriers.
Mayo’s hospital and four clinics in Arizona, including the Glendale facility, lost $120 million on Medicare patients last year, Yardley said. The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic, he said.
The folks in Washington love to get health care on the cheap and the proposals considered in Congress will cut funding for Medicare below current levels.
It doesn't take a rocket surgeon to figure out this is not going to work.
