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Monday, March 16, 2009

2.6 Million Served (And Satisfied)

Co-blogger Mike tipped me to this intriguing, and ultimately validating, story on an ambitious study undertaken by Aetna. Indeed, as Mike also pointed out, HR behemoth Mercer is "effectively blessing the Aetna study results." Mercer, by the way, bills itself as "the global leader for trusted HR and related financial advice, products and services."
The comprehensive, 6 year study sought to determine whether any of the charges leveled against Consumer-centric health care were valid. The most oft-cited of these canards include:
"Folks in high deductible plans skimp on preventive care."
"Folks in high deductible plans eschew important health screenings like diabetes and breast and cervical cancer."
"Folks in high deductible plans skip needed meds, especially for chronic conditions."
and
"Folks in high deductible plans don't really use the online resources available to them any more than those with co-pay plans do."
The results of the study shatter every single one of these. It's important to note that the carriers themselves are apt to be quite objective when undertaking these studies. After all, they're not trying to get folks to switch from another carrier, only to determine whether or not their own products are serving the needs of their insureds. This is important in assessing the validity and bias of such studies.
What Aetna found was fascinating, and extremely good news for those of us who advocate more Consumer Driven Health Care (CDHC):
Turns out that insureds in CDH Plans seek out "preventive care more often than the control matched PPO population. Furthermore, Aetna HealthFund members had 10 percent lower primary care physician utilization for non-routine services and 15 percent lower utilization of specialist care" than those in co-pay plans.
Also, these folks "(a)ccess the same or higher levels of screenings for diabetes and breast and cervical cancer, compared to members in traditional PPO products."
And they use "the prescription drugs necessary to treat chronic conditions such as diabetes, congestive heart failure, coronary artery disease and high cholesterol at similar or higher rates than PPO members."
Finally, folks with "skin in the game" utilize those "consumer tools and information ... at twice the rate compared to PPO members."
Game, set and match.
Now, this isn't to say that CDH plans are a panacea, as they clearly are not. But it should lay to rest the most often heard objections to their use. The one issue which the study didn't seem to address was cost-differential with regard to co-pay plans, and between various out-of-pocket levels of HDHP's. I still think that carreirs need to look at these results as indicative of High Deductible Plans' ability to keep costs down and insureds healthy, and thus put some downward pressure on pricing of these plans.

Nick's Story [BUMPED TO TOP]

[Welcome IHIAA members!]

(This is a bit long, but well worth the read).


My father never was the picture of health. He smoked, he drank, and he ate things that most people wouldn’t touch unless they had to break into the box marked “Survival Kit - Last Option.” Vienna sausage does not a meal make. He constantly had some manner of cold, cough, or other malady, and we never really thought much of it. Normally, he would shuffle around for a few days, then get back to life. So, at Thanksgiving 2006 we didn’t really think anything of it when Chock developed a nagging cough that just wouldn’t go away.

By Christmas 2006, it still hadn’t gone away. He was also beginning to have some balance issues, some troubles with his memory, and was tripping over words. He didn’t want to see a doctor - half because he didn’t want to believe something could be wrong, and half because he just wasn’t the type to go to see someone until limbs were actively falling off.

He got progressively worse over the next few months and eventually couldn’t deny the fact that he truly needed to go see a doctor. It was May 9th, 2007 - my parents’ 32nd wedding anniversary - when he was formally diagnosed with Stage IV cancer (brain, lung, bone, blood, and colon). He started aggressive chemotherapy on May 13th, his 71st birthday.

On July 19th, 2007, at 12:40 in the morning, my father died. Very shortly thereafter, we realized that we had some serious problems.

You see, before Chock passed away, he had had a brain tumor the size of a baseball. His mental faculties were somewhat impaired, to say the least, and so some of his last financial decisions were...less than rational. Just before he passed, in one of his last moments of lucidity, he told my mother “I’m sorry, Jo. But I sure am glad I’m not going to have to be the one who has to clean up the mess I made.”

And holy crap, was he right. When Chock died, the bills hit us hard. Chemo had cost $8,000 a round. The cost of his two-month hospital stay in a private room was astronomical. Numerous tests, multiple labs, home hospice care, none of it was cheap. The $1,000 a month my family was paying for his “insurance” had drained us as well - the only thing that “defined benefit” plan defined was exactly what position we were expected to take as we were screwed. Add to that his already extant debt, and we were in deep.

Did I mention that this was all piled on top of my mother’s medical bills? She’s been handicapped for fifteen years with Meinere’s disease. Twenty-three surgeries haven’t been cheap - especially when several of them were excluded from coverage as “experimental procedures.”

Now, let’s make matters worse. Before Chock passed away, he told us that he had a $250,000 life insurance policy through New York Life. Well, that was partly true - at one time, yes, he had life insurance through NYL. The tumor that was altering his speech was also mixing up the chronological order of his memories. Tracing the money flow would reveal that the policy had lapsed years and years ago when he had pulled all the cash value out.

I always wondered how he had been able to afford that boat.

The average American family declares bankruptcy at $11,000-ish of debt. We were in to the tune of $167,000 (before funeral costs) with no life insurance coming.

If you’ll recall, mid-2007 was around the time the real estate market had really settled into its free-fall. My mother’s only option was to sell the house that she and my father had lived in together for thirty-two years. There was no such thing as a quick sell in that market, and the process was torturous. We couldn’t afford storage, and we had to clean out a massive amount of my father’s things in a short period of time to prepare the house for sale. I drove twelve hours round-trip every weekend for months, coming home from college to help my mother throw out over thirty years of memories. It was easily as depressing as sitting next to my father’s bed while he died.

Though we watched the money as closely as possible, there was only so much of it - and it was running out. By the time the house sold, my mother would later tell me, she had about thirty days of cash left before she would have had to declare bankruptcy. And when it sold, it did so for $75,000 under its appraised value.

Now, sad though that story was, it has a happier ending than most. My mother lives in Alabama now, back where she grew up. Between her disability, teacher retirement, and social security, she has enough to get by each month and put some back in savings. And I have a new career path than the one I originally envisioned. I sell insurance now, and I know that there’s not a single person that I work with who will ever find themselves in the situation that my family was in. I’m saving the world, one policy at a time.

This story has several morals worth remembering:

Don’t count on the ability to sell your assets in the event of a death in the family to float you. It might not come through in time, it’s painful, and you’re not going to be in any sort of position to get yourself in a positive bargaining position.

Life insurance does more than provide a bit of money upon a death. It allows the survivors time to grieve in dignity instead of spending sleepless nights throwing out years of accumulated memories.

That $2000 prescription drug cap might not seem like such a big deal when you’re taking a z-pack once every two years for a sinus infection. It’s a huge deal when you’re staring down $8,000 a day of chemotherapy drugs.

Plan for the worst when things are good. You’re rational, you’re calm, and you can think clearly. If you wait until the crap has already hit the fan, you’re going to end up scrambling - like we did.

Don’t just buy insurance. Hire an agent, and make it someone you trust. Talk to them. There are a few insurance agents that give us all a bad name, but I promise, some of us truly do care about keeping your family safe.

Nick Perry


(Nick is a friend, and fellow agent in the Atlanta area. He is wise beyond his years. Perhaps that is because he has lived through things most of us never want to think of, and pray we never experience).

Healthy Eating Under Spotlight

One of the most well known pieces of health advice is the "Eat 5 portions of fruit and veg a day" recommendations from the World Health Organisation and UK Government. Although this is to be applauded as a laudable and well intentioned policy - the overall effectiveness of the campaign has to be questioned.

In comparison to some of our major counterparts in the developed world, the UK reccommendations lag behind - for example here is what the rest of the world targets.

  • Denmark - 6 portions
  • Canada - 5 to 10 portions
  • France - 10 portions
  • Japan - 13 vegetable and 4 fruit portions

Although the Japanese portions are lower (50g as opposed to 80g in the UK), there is no doubt that the Japanese culture has an ingrained acceptance of fruit and veg as part of a daily diet. Sadly, this does not seem to be the case in the UK - some reports have even indicated that less than one-in-eight of Brits actually adhere to 5-a-day at all - and those that do tend to be either over 45 or affluent. According to the Department of Health, eating five portions of fruit and veg a day can significantly reduce the risk of death from chronic diseases such as heart disease, stroke, and cancer.

Therefore, the question that has to be asked is - why is the UK diet so opposed to fresh fruit and veg? - its not as if it is too expensive, difficult to find or hard to incorporate into a simple meal - the answer must surely lie in a deeper malaise within our culture.

What theories do you have for this?

Sunday, March 15, 2009

ERISA-roni, that San Francisco treat!

[Welcome Industry Radar and Kaiser Network readers!]

This article from the WSJ Health Blog reports the progress of Golden Gate Restaurant Association v. City of San Francisco. The Supreme Court has now agreed to hear an appeal from the judgment of the Ninth Circuit Court of Appeals, which reversed the original trial court’s decision.

IMO, Golden Gate Restaurant Association wins in the Supreme Court, and the City loses. The Ninth Circuit is frequently reversed.

The WSJ article fails to clarify a frequent misrepresentation in the media about the fundamental legal issue in this case. Specifically, the fundamental issue is regulation of “insurance plans” vs the regulation of "ERISA plans”. This distinction is essential to understand.

An insurance plan operates under a contract of insurance issued by an insurance company. The States are authorized to regulate insurers and the business of insurance. In contrast, an ERISA benefit plan is provided under a contract of administrative services only. In an ERISA plan, there is is no contract of insurance, no insurance company, and no insurance premiums. These plans are called ERISA plans because they are regulated by the Federal law called ERISA.

Most of the largest employers/plan sponsors, nationally and in San Francisco, manage their employee benefits thru ERISA plans. I think the Restaurant Association does the same and therefore the fundamental premise of their objection is that their plan is not subject to regulation by the City or the State. (If otherwise, I doubt the Association would have chosen to incur the expense of a trial and, now, two appeals. I also believe the Supreme Court would not waste its time if this were about an insurance plan – which the States have clear authority to regulate.)

I believe the City attorneys understand the law - but the City went ahead anyway. Why? I think because, if ERISA plans are ruled exempt from the requirements and tax the City wants to impose, then the City’s ability to manage its scheme of insurance for the uninsured would be greatly diminished. I understand the City's motivation. I just think the City is wrong on the law.

Friday, March 13, 2009

Another Treat-Worthy Carrier Trick

[Welcome Industry Radar readers!]
Regular readers are aware of our (ever growing) Stupid Carrier Trick series. Lesser known (and less populated) is our Treat Worthy Carrier series. I'm tickled pink to present our latest addition, Assurity Life Insurance Company.
I use Assurity primarily for blue and gray collar disability income plans. These are typically folks whom the "Big Boys" eschew in favor of doctors, lawyers and politicians. The particular case which has earned Assurity its place in the pantheon of "Good Guys" is somewhat unique:
Mike [ed: not his real name] works for a company which has tasked him with two seemingly unrelated jobs: one is inside sales, with little chance of major injury; the other involves some pretty hefty manual labor "out in the field." One of the primary factors in disability insurance pricing is occupation: more "hands on" jobs generate higher premiums. Because I tend to be fairly conservative in quoting policies, I erred on the side of caution and assigned Mike's case a relatively low occupation class, which resulted in a sizeable (but still reasonable) premium. I submitted his completed application, and waited.
A week or so later, I received an email from Assurity informing me of two things: first, that I had used an outdated app (my fault for not checking the date), which necessitated Mike having to complete a new one (not a huge deal, but my bad).
The second item regarded his occupation class: in reviewing the application, the underwriter noticed the dual jobs, and asked me to confirm with Mike more precisely the division of his labors. The underwriter felt that Mike may well qualify for a lower rate. So while Mike was re-completing the application, I had him be more precise in describing his typical day. We sent that off, and awaited an answer.
When the policy arrived, I was, to put it mildly, pleasantly surprised to see that the premium was reduced by some 40 percent; Mike had indeed qualified for the higher job classification.
This is an example of a carrier not just doing the right thing, but actively engaged in doing so. It is obviously a big part of their corporate culture. I pay little (if any) attention to carriers' "mission statements;" rather, I look at how they do business. It's obvious that Assurity looks for ways to make it easier on their clients (and would-be clients), and for that, they earn an IB Treat.
Kudos, Assurity Life.
[And a Very Special Thank You to Shannon Smith at Assurity]

Vet's Draw Sniper Fire

Marie Antoinette declared, "Let them eat cake".

Apparently the new regime in Washington is taking their cue from the headless wonder. CNN reports that "the Obama administration is considering a controversial plan to make veterans pay for treatment of service-related injuries with private insurance."

Like a lot of other things in the news lately, my initial reaction is, "they are kidding, right?".

No official proposal to create such a program has been announced publicly, but veterans groups wrote a pre-emptive letter last week to President Obama voicing their opposition to the idea after hearing the plan was under consideration.

The groups also cited an increase in "third-party collections" estimated in the 2010 budget proposal -- something they said could be achieved only if the Veterans Administration started billing for service-related injuries.
Let me see if I understand.

We have an all volunteer army. Everyone who enlists does so willingly because of a desire to serve their country. They knowingly put themselves in harm's way. Their reward is . . . pay for your own damn health care.

Asked about the proposal, (VA Affairs Secretary) Shinseki said it was under "consideration."

"A final decision hasn't been made yet," he said.
Under consideration. So this is one way Obamaman wants to save money and pull us out of a nosediving economy?

Incredible!

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