An Open Letter to North Dakota

[We've rarely (if ever) weighed in on WC issues, but this case appears uniquely egregious. Our friend Joe Paduda has helped spearhead an effort to better publicize this travesty, and we were happy to lend our support. HGS]

An open letter to the press, business community and people of North Dakota:

The authors of this letter are journalists, columnists, bloggers and content publishers for the workers' compensation industry across the United States. We are a politically and professionally diverse group. We do not agree on everything, yet find ourselves of one opinion on a highly critical matter. We are competitors who are now colleagues for a common cause; to bring light to a serious injustice being committed within your state.

The prosecution of Charles (Sandy) Blunt was, in our view, an outrageous and almost farcical event. It is, in the final analysis, a travesty that has damaged the national view of your state, hampered the operation of a State agency, and ruined the life of a good man wholly undeserving of such results.

Sandy Blunt was Director of North Dakota's Workforce Safety & Insurance from May of 2004 until December of 2007. He was, as you are likely aware, prosecuted by state authorities for "misspending government funds". Specifically, he was charged and convicted on two counts:

During his almost 4 year tenure his agency spent approximately $11,000 on employee incentive items, including flowers, trinkets, balloons, decorations and beverages for Workforce Safety and Insurance employee meetings, and on gift certificates and cards in small denominations for restaurants, stores and movie theaters. Blunt personally approved some of these expenditures. Others were made by managers as part of daily operations under his watch. Not a dime went into an employee's pocket, nor did Blunt personally benefit from any expenditure.

His agency paid $8,000 to an employee, David Spencer, for sick pay when he was not apparently sick, and it also failed to collect $7,000 from Spencer when he left prior to the end of his employment agreement. The $7000 was for moving expenses incurred that prosecutors felt Spencer owed the state. Blunt's position was that the agency was not entitled to collect these funds, since Spencer's departure was not voluntary.

All told, the state prosecuted Sandy Blunt, and he is now a convicted felon for "misspending" $26,000 of government money.

No one has ever alleged that Blunt personally benefited from any of these expenditures. Blunt was acting like other capable, ethical North Dakota executives ‐ in the best interest of customers and of the mission of his employer. In our industry it is considered a best practice to provide employees and supervisors with incentives. It is not frivolous, it's necessary, and what every employer should do.

The first of these two charges would be, to many people, laughable if it were not for the damaging consequences associated with them. The notion that buying inexpensive incentive items for your employees could result in a felony conviction is simply stunning. This would not be elevated to a criminal status in most states in the nation. The fact that it is in North Dakota should have a chilling effect on businesses looking to move there.

The second and more serious charge, involving the sick pay and moving expenses of employee Spencer, has been fatally undermined by the revelation that the prosecutor in the matter, Cynthia Feland, withheld critical evidence from the defense - evidence that largely clears Blunt in this area. A disciplinary panel for the North Dakota Supreme Court has found on November 7, 2011 that:

"Cynthia M. Feland did not disclose to Michael Hoffman, defense attorney for Charles Blunt, the Wahl memo, and other documents which were evidence or information known to the prosecutor that tended to negate the guilt of the accused or mitigate the offense."

Withholding of evidence by prosecutors is one of the most serious acts of prosecutorial misconduct in North Dakota and all other states. In recognition of this, the panel recommended Ms Feland's license to practice law be suspended. We urge that you read the entire report of the panel, including the penalties the board recommended be imposed on Ms. Feland. For the report, go here.

Had the prosecutor not withheld evidence, in all likelihood the case would never have come to trial, and the reputation of Blunt and the WSI would be free of taint. The evidence in question shows that WSI's auditor's own findings backed Blunt's position on payments related with Spencer. However, those findings were not made available to the defense, and the prosecutor was found to have allowed testimony to be given at the trial that directly conflicted with information she had. As we indicated, Feland, now a judge in your state, has been recommended for suspension and a fine over these findings.

Yet Sandy Blunt remains a convicted felon. His crime? Buying balloons, trinkets and $5 gift cards - for his employees, not for himself. For that, Blunt, who is married with two children, has had to spend half a decade, and untold thousands of dollars trying to clear his name.

Some of us have known Sandy for quite a while. Some have come to know him while learning of his situation. Others of us have never met Sandy, but recognize the tenuous nature of his treatment. Collectively we speak to thousands within our industry every day. Our opinions have been clear; this situation needs the light of truth shone brightly upon it. The time and resources expended prosecuting a man on such questionable grounds should be more closely examined, by the business community, workers compensation professionals and the media in North Dakota.

Sandy Blunt is a good and decent man. He deserves better. So, it would seem, do the people of North Dakota.

Peter Rousmaniere
Consultant & Writer
Working Immigrants

Robert Wilson
President & CEO
workerscompensation.com

Joseph Paduda
Principal, Health Strategy Assoc, LLC
Managed Care Matters

Rebecca Shafer
Lower Your WC Costs

Julie Ferguson
Consultant & Editor
Workers' Comp Insider

David DePaolo
President & CEO
Work Comp Central

Henry Stern, LUTCF, CBC
InsureBlog

Tom Lynch
Founder & President
Lynch, Ryan & Associates, Inc.

Jon Coppelman
Senior Vice President
Lynch, Ryan & Associates, Inc.

OmniCare in the News, Again!

Well, that was fast. Previously, it took over three years between OmniCare posts; this time it's less than three weeks:

"PharMerica Corp. said Monday it hopes ... Omnicare Inc. will drop its $457 million takeover bid in the face of the federal government's suit late Friday to block the deal ... The Federal Trade Commission said a combination of the nation's two biggest long-term care pharmacies would raise the cost of Medicare Part D prescription plans"

Hey, wait a minute.

Did I just hear the gummint say that competition is a good thing and that fewer choices is a bad one?

Has anyone clued in HHS Secretary Shecantbeserious?

Because that's exactly the opposite of what she's been advocating.

[Hat Tip: FoIB Holly R]

Potter strikes (out) again

Wendell Potter, erstwhile shill for Cigna turned professional insurance industry basher, is at it again. This time, he's using the tragic death of skier Sarah Burke to indict our health care system. There are many, many holes in his diatribe, but we'll highlight a trio:

"The irony is that had the accident occurred in Canada… her care would have been covered because, unlike the U.S., Canada has a system of universal coverage"

Really?

Please tell that to Kent Pankow, little Baby Joseph, and pregnant women. The truth is that the Canadian system may offer universal coverage but has a dim track record on actual delivery .

"but with medical care covered through donations, the aftermath will not bring them additional hardship"

And so?

There are a number of lessons here: first, why would Mr Potter expect the surgeons who worked on Ms Burke to do so for free? Second, we obviously have the infrastructure here to handle these kinds of incidents, paid for by Americans. So in Mr Potter's world, it would have been perfectly fair for American citizens to be stuck with the bill for her care, because she chose not to purchase readily available travel medical insurance?

Sheesh.

Finally, Potter pulls out the ol' "medical bankruptcy" canard, long debunked, by claiming that "An estimated 700,000 American families file for bankruptcy every year because of medical debt."

No they don't, Wendell, and you (should) know it.

I'd ask this question of Mr Potter: how do you think Ms Burke would have fared had ObamneyCare© and its death panels been in full force?

Yeah, I thought so.

We're THIS many (7)!

Hard to believe, but today marks our 7th blogiversary.

With over 4,750 posts, numerous awards, and a top-shelf selection of co-bloggers, we have a lot to celebrate.

Most important, of course, are our wonderful, loyal readers.

Thank You all!

ObamneyCare© vs The Constitution

While (almost) all eyes have been on the constitutionality of the (Evil) Individual mandate, another constitutional issue is hitting the radar, and it's pretty powerful:

"Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law."

Seems pretty benign and banal, no?

It is anything but:

"Dear Brothers and Sisters in Christ:

I write to you concerning an alarming and serious matter that negatively impacts the Church in the United States directly, and that strikes at the fundamental right to religious liberty for all citizens of any faith. The federal government, which claims to be “of, by, and for the people,” has just been dealt a heavy blow to almost a quarter of those people — the Catholic population — and to the millions more who are served by the Catholic faithful."

At issue is the requirement, about which we wrote this past fall, that health insurance plans pay for abortions and birth control, with no deductibles or co-pays.

There are several issues at play here. We've already debunked the idea that this coverage is "free." But that's not even the worst of it. Catholics are not the only constituency that forbids artificial birth control: approximately 845,000 Orthodox Jews would be affected by this trampling of the First Amendment, as well. As for abortion, well, that's against Catholic doctrine, and not a few Christian denominations, as well.

And according to at least one source, abortion is also forbidden by Islam.

Which begs the question: ACLU, where art thou?

Walgreens Makes a Funny

Last time we looked, Walgreens was in the process of slitting its own wrist. The good news is, we recently received snail-mail [copy available here] from them detailing how we can help them retain their customer base.

The bad news is, of course, that I don't work for Walgreens.

In a particularly tone-deaf plea for assistance, we're told that "[o]pportunity for selling Small Group plans with an integrated pharmacy benefit can ensure your clients access to Walgreen's in 2012" [underline in original]

First, no employer really cares which pharmacies are included in any particular plan. They are concerned primarily with the prohibitively high cost of small group plans, and are looking for ways to reduce them. They're further challenged by the fact that small group plans are "off the rack;" that is, there is precious little customization available, and no carrier (to our knowledge) offers multiple pharmacy provider options. You get what's packaged.

But never fear, "Walgreen's has put together a comprehensive education program to reach patients who may be expressing concerns to their employers." Which is nice, but employers have also rolled out a comprehensive education program to reach their employees with such concerns: "this is our group plan. Feel free to sign this waiver if you don't like it."

Walgreeen CCO (Chief Client Officer) Joe Terrion provides us with handy "Talking points for Health Insurance Brokers;" these include the statement that "pharmacy access is an important consideration for small group." Um, not so much, Joe.

But -- and here's where I literally laughed out loud -- (Slow) Joe continues, groups "can easily switch to competitively priced health plans that provide access to a broad network of pharmacies, including Walgreens."

Uh-hunh.

Here's a question, Mr T: what color is the sun in the sky above your planet? Because here, medical underwriting has tightened up, premiums have sharply increased while choices have sharply decreased, and employers are looking for ways to minimize the damage. I have yet to have any employer ask me about what pharmacies are included in any particular carrier's offerings.

No one but Walgreens cares, and as I pointed out at the beginning, I don't get paid to shill for them.

Open wide and say....ObamneyCare©

Writing in this month's issue of Health Insurance Underwriter magazine (not the swimsuit issue), Ameritas Sr VP Karen Gustin opines about how dental plans will fare under ObamneyCare©. We've addressed this issue before, when we took to task Companion Life's cave-in on "young adult" coverage. At the time, we pointed out that dental plans are specifically excluded from this requirement.

In fairness, what the law (purportedly) says and how it's implemented by HHS Secretary Shecantbeserious are often at odds, so it may not have been completely unreasonable for Companion to have acted pro-actively at the time.

Still, that was then, this is now, and Ms Gustin previews the year ahead as regards dental coverage under the current regime:

■ Dental care for children: as with the medical parts of ObamneyCare©, there will be a core "essential" benefits component, the make-up of which is still being considered.

■ Dependent tracking: this one's disturbing. New requirements will be rolled out detailing employers' responsibilities to track their employees' dependents and how (or even if) they're covered. This is part of new compliance requirements that, frankly, sound even worse than the Individual Mandate (who even thought that was possible?).

■ Fee integration: aka new taxes. 'Nuff said.

■ Employee education: aka Brainwashing. Ms Gustin's point is that the law (ostensibly) requires only juvenile coverage and there's concern that as they age off these plans, folks will forgo needed care. Or, as we call it, personal responsibility.

There's more, and the article is definitely worth the read. Maybe in the dentist's office?

[Hat Tip: SoIB Gail S]

SOTU: ObamneyCare© MIA

Careful listeners might be forgiven if they missed the 44 words covering his signature legislative "victory" in President Obama's most recent State of the Union address. That's correct, 44 words in a speech which, oddly enough, barely qualified as Smarter than an 8th Grader.

Now why would the President elide over his stellar accomplishment?

Well, the fact that 44% of the public disapproves of it (versus 37% who think it's just Jim Dandy). The most hated part? Well, that remains the (Evil) Individual Mandate, which 54% believe (correctly) is unconstitutional.

Which is not to say that the Republicans should rest easy, either. In his rebuttal, Hoosier Gov Mitch Daniels gave the subject short shrift, as well. As Bob pointed out yesterday, the Republicans' plan is not exactly a barn-burner, either.

Still, one is left to wonder why the President was so uncharacteristically modest about the bill we had to pass to learn what's in it.

$howing us the money

Take a gander at this:

Put together by the folks at research biggie RAND Corporation, it "provides a graphical look at how accelerating health care costs have gobbled up the income gains made by American families over the past decade."

There's no question that the cost of health care, both its delivery and the financing thereof, has become an ever-increasing burden on the consumer. Although it's not the primary cause of the problem, ObamneyCare© has certainly exacerbated it, by decreasing consumers' "skin in the game" and choices, and increasing the cost of both health care (scarcity) and health insurance.

Americans are not stupid: they can see the disconnect every time they look at their pay stub or pay their insurance bill, or write a check at the doctor's office. Would that Washington actually understood this.

And couple that with this little tidbit:

"Just 1% of Americans accounted for 22% of health care costs in 2009"

Make of that what you will...

[Hat Tip: Warren Robak]

RepubliCare

We have Obamacare. The law no one bothered to read before voting on it (and many still haven't read it).

In spite of the fact it was never really embraced by the public and their disdain for the law continues to grow with each passing day, apparently we are stuck with this fiasco . . . at least for a while.

Comes now the Republican party that wants to replace Obamneycare with a monster of their own. For some reason, I doubt it will be a new, improved version.

The folks at The Hill wanted to let us know about this little gem.

Republicans have made good on their promise to try to repeal Obama’s healthcare law, but the “replace” part of their “repeal and replace” strategy has proved more difficult. Pitts said Republicans will be ready for the opening a Supreme Court ruling will provide — no matter what the justices decide.

If the court strikes down the law’s individual mandate, or the entire law, the GOP can present its plan as an alternative. If the court upholds the mandate, renewed attention to the issue could still give Republicans an election-season opening to argue that they have a concrete agenda on healthcare

.

It seems the Keystone Cops in the Republican party want to have SOMETHING to fill the void if the law is repealed even if that something is still flawed.

One positive thing (in my opinion) is the current practice of medically underwriting would be preserved under the Republican plan. Their solution is to allow "state based" risk pools where the sickest would go for insurance and have their premiums subsidized by taxpayers.

I don't have a problem with that per se, but about 40 states already have that in place in the form of risk pools or "guaranteed issue".

In other words, the "you can no longer be discriminated against by insurance carriers" under Obamneycrap was always a bit of a red herring any way. Most folks with pre-existing conditions have multiple options for securing health insurance if they really wanted it.

Along these lines, PCIP was one provision of Obamneycrap that I actually thought was a good idea, but one that was poorly implemented.

Georgia does not have a risk pool meaning some folks were disenfranchised from the system when they needed it more. We now have PCIP, federal edition, thanks to Obamneycrap.

All in all it isn't a bad plan and is priced right considering the benefit levels and "no underwriting" approach. However, it has not been well received because it isn't free.

Of course Obamneycrap isn't free either.

the committee will also send a bill to the floor this spring to repeal the Independent Payment Advisory Board, an expert panel tasked with cutting Medicare payments to doctors. Energy and Commerce could also renew its push to roll back a piece of the new law that prohibits states from cutting their Medicaid eligibility until 2014, when Medicaid is set to expand.

A hit and a miss here.

The IPAB, AKA "death panels" is a bad idea all around and should be eliminated. Why should we allow folks in DC to decide how our doctor should treat us?

Medicaid is already a massive hole in state budgets. Obamneycrap is only going to make it worse. States are attempting to salvage Medicaid by tightening the qualification rules.

I have no problem with that.

While I applaud the Republicans for doing something, the bottom line for me is, tell DC to keep their mitts off my health care. Washington does not have to micromanage every aspect of my life.

If I want to use 5 gallons every time I flush and burn 100 watt incandescent bulbs I will. It is my money and I will spend it the way I see fit.

Small Biz: RIP

As we've previously noted, one of the major victims of ObamneyCare© is "small business." Aside from affordability issues, there's the very real problem of uncertainty. That is, if would-be employers can't make at least an educated guess about the future of their business, they're going to be very reluctant to even consider new hires.

But don't just take our word for it:

"A new poll from the U.S. Chamber of Commerce reveals an increasingly frustrated small business community worried about the impact [ObamneyCare©] may have on their bottom line.

Nearly three-quarters ... say the new law is causing an impediment to job creation."

But why is that?

It's pretty simple, really:

"[Owners of small businesses] look at this bill as more of a tax bill wrapped up and packaged as a health care reform bill ...It really puts most of the cost and burden on small business owners."

Indeed.

La plus ca change...

Thanks to FoIB Holly R, we learn that the bill we had to pass to learn what's in it has accomplished, well, see for yourself:

In point of fact, the overall rate of uninsured has been increasing despite [ed: more likely, because of] ObamneyCare©.

Feel better now?

Cavalcade of Risk #149: You'll need a #2 pencil...

Nothwithstanding offers a unique, indeed unprecedented, version of the Cavalcade of Risk: a test. For each entry, you'll be asked a question, and offered a set of possible answers. Go ahead, give it a go!

[High scores win a coveted one-year subscription to the CoR Newsletter. If and/or when we ever decide to do one]

GrandRounds Today

Grand Rounds makes its MSM debut today, as FoIB Dr Val Jones hosts the premier roundup of medblog posts at USAToday. It's an ambitious project: dozens of entries in 4 separate posts.

Whew!

Kudos to Dr Val for putting this together, and for the opportunity to reach a larger audience.

High and Dry with the MVNHS©

Hungry? Thirsty? Best not count on the Much Vaunted National Health System to bail you out:

"Four patients are dying hungry and thirsty on hospital wards every day ... 1,316 deaths were linked to or directly caused by dehydration and malnutrition in 2010."

This is of a piece with a post Bob wrote earlier this month:

"We need to get the basics right. Patients need to get the food and drink they need."

The scariest part of this is that the Brits' health system is one of the primary models on which our own ObamneyCare© is based. Why is this scary?

Well, let's let the chief executive of the Patients Association, Katherine Murphy, explain:

"These figures are a terrible indictment of our precious National Health Service."

Coming soon to a hospital near you...

Obamacare Techno Version

One of the little discussed aspects of Obamneycare is the loss of personal service. Insurance agents: Love them or hate them, agents perform a service in helping the consumer navigate their options, help them find a plan that suits their needs and budget and advise them of potential pitfalls of one plan vs. another.

Agents also save you from the morass of home office non-service and the dreaded "Press 1 for English".

Home office staff costs money. Salaries, overhead, benefits all have a cost. Home office staff is paid regardless of whether they are productive or not. Even worse, the answers they provide don't even have to be accurate or helpful.

By contrast, agents are not compensated until after you make a purchase and are satisfied.

But all that is about to change.

Come 2014 "Exchanges" will be where many American's buy insurance. You will be encouraged to go online or call an 800 number and pick a plan. You will discuss your needs with salaried navigators that are unlicensed and unregulated.

This is something like PCIP, only bigger.

PCIP, the health insurance program for those with pre-existing medical conditions, was supposed to capture 4 million uninsured citizens in the first two years.

So far fewer than 30,000 have signed up, many states have run out of money and states like California will put you on a waiting list if you call.

And the Exchange is supposed to serve over 200 million people.

Maybe it is just me, but I sense a problem brewing.

Meth Burns Sinking Hospitals

Uncompensated care is a major problem for hospitals. Burn units are closing due to an overwhelming number of burn injuries caused by "cooking" methamphetamine.

An Associated Press survey of key hospitals in the nation's most active meth states showed that up to a third of patients in some burn units were hurt while making meth, and most were uninsured. The average treatment costs $6,000 per day. And the average meth patient's hospital stay costs $130,000 — 60 percent more than other burn patients, according to a study by doctors at a burn center in Kalamazoo, Mich.

Uncompensated care leads to higher health care costs which creates higher health insurance premiums.

Slippery Slope?

Building on Bob's post from yesterday, reporting that health insurance policies will now have to offer first-dollar coverage for birth control, we learn that the MVNHS© (upon which Obamneycare© is based), has a glimpse of the next step:

"Six children in Britain will be given jabs to delay the puberty on the NHS because they are convinced they were born the wrong sex... It will also make any sex-change operation far easier should they decide to permanently swap gender."

This will come as no surprise to regular IB readers:

"The number of sex change operations carried out on the NHS has almost tripled in the last eight years."

As with IVF, neither birth control nor sex-change procedures are medically necessary, but (as we've pointed out again and again), all of these mandated "benefits" add to the cost of health insurance.

But hey, they're "free," right?

Higher Health Insurance Premiums

Santa Claus is coming to town. It is Christmas in August and all the good (and bad) girls are going to get free contraceptives.

Obama want's to be re-elected and he is handing out freebies like it is going out of style.

Of course it isn't his money, so why worry?

Most healthcare plans will be required to cover birth control without charging co-pays or deductibles starting Aug. 1, the Obama administration announced Friday.

The final regulation retains the approach federal health officials proposed last summer, despite the deluge of complaints from religious groups and congressional Republicans that has poured in since then. Churches, synagogues and other houses of worship are exempt from the requirement, but religious-affiliated hospitals and universities only get a one-year delay and must comply by Aug. 1, 2013.

“This decision was made after very careful consideration, including the important concerns some have raised about religious liberty,” Health and Human Services Secretary Kathleen Sebelius said in a statement. “I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services."

So what't the issue?

It isn't free.

The drug companies won't be giving away the prescriptions, some costing $150/month, so where does the money come from?

Health insurance premiums . . .

Isn't Obamneycrap wonderful?

Can you hear the risk?

Not being much of a music lover myself (although I was saddened by this news), I don't own a Sony Walkman MP3 music player, and my car's satellite radio is generally tuned to a comedy channel. But my better half and daughters are avid audiophiles, so I'm pretty familiar with the little (annoying) earbuds.

What I was not familiar with, however, is this:

"The number of serious and fatal injuries involving pedestrians wearing headphones has tripled since 2004"

Sounds pretty scary, right?

As so much with the media these days, the hype seems - what's the word? oh, yeah - hyped:

"According to Lichenstein’s study, 116 people have been injured while walking with their headphones on since 2004, with most of them being injured in the last few years. According to his study, 16 people were injured while walking and wearing headphones in 2004. By last year, that number increased to 81."

Okay, lessee now, 116 injuries over 7 years (it's only January, so I'll give them the benefit of the doubt) comes to, um, about 17 injuries per year.

But each year, 40 people are killed by lightning (what, they didn't hear the flash over their Gaga?), 823 folks drown in their tubs, and over 320 people die in bus crashes every year (although there's no word on whether or not the drivers were listening to tunes at the time).

So tell me, why is this even news?

A Very "D'unh!" Moment

Over at The Conversable Economist, Timothy Taylor (no, not that Tim Taylor) makes a very simple, but very powerful point:

"[W]hen you see comments about how pay hasn't gone up much in recent years, one big reason is that health care costs are swallowing the gains."

And he's got the chart to prove it:

You really should read the whole thing.

And if you'd like a more detailed explication of how employers don't actually pay for any of your health insurance, click here.

[Hat Tip: FoIB Holly R]

Cavalcade of Risk #149: Call for submissions

The NotWithStanding blog hosts next week's CavRisk. Entries are due by Monday (the 23rd).

Just click here to submit your post.

You'll need to provide:

* Your post's url and title
* Your blog's url and name
* Your name and email
* A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

Cannon Fodder/LinkFest

FoIB Michael Cannon, the Cato Institute's director of health policy studies, has a trio of interesting, provocative and insightful posts up:

■ Oops, Maybe ObamaCare’s Cost Controls Won’t Work after All wherein MC reports that the Congressional Budget Office just revealed they aren’t very successful, after all:

"In nearly every program, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program"

Ooops indeed.

■ *Will the Feds Be Ready With the Fallback Insurance Exchanges by October 2013? As we've repeatedly pointed out here at InsureBlog, the Exchanges aren't really the panacea they're being touted as. The reality is that less than half of the 58 states are actually on-track with having their Exchanges "ready to go" on schedule.

Quelle surprise.

■ Wisconsin Stiff-Arms ObamaCare Seems that Badger State Gov Scott Walker has told the Feds "thanks, but no thanks," and has ""announced Wisconsin will return the $37 million “Early Innovator Grant” it received from the Obama administration under the health care law."

Not just no, but Hell No.

MVNHS© Docs: Strike One!

The so-called Doc-Fix is (once again) on hiatus; Congress keeps kicking this particular can down the road, in a (no doubt futile) attempt to make it go away all by itself. But as we continue hurtling toward full implementation of ObamneyCare©, it's worth noting that the system upon which it's modeled seems to be hitting a breaking point.

To wit:

"The British Medical Association ... said two thirds of its members support industrial action which could cripple hospitals and GP surgeries throughout the country."

That amounts to about 87,000 docs and med students.

The "industrial action" to which the BMA is referring is a threatened strike by doctors over planned cuts to their pension plans. It seems that the Much Vaunted National Health System© isn't any better (and is, in fact, arguably worse) at reining in costs than their former colonists.

By the way, the Telegraph claims that the average value of a doc's pension is over $2.6 million.

Not too shabby.

But I'm sure that has no effect on the budget shortfalls.

Health Wonk Review: Future Shock/Beer Month edition

HWR co-founder Julie Ferguson hosts this week's collection of noteworthy (and wonkish) posts, featuring a peek into the future of health care polity and policy.

Amelia's Story

Over the years, we've posed several Ethical Conundrums, most recently here. This one's difficult: Amelia is retarded (aka developmentally delayed) and has poor kidney function.

She is, in all probability, dying.

And she is a toddler.

Here's the problem:

"Did you just say that Amelia shouldn’t have the transplant done because she is mentally retarded ... This phrase. This word. This is why she can’t have the transplant done?

Yes."

So, is this a Death Panel?

Read the whole thing, and then feel free to share your thoughts in the comments here.

[Hat Tip: Ace of Spades]

Southern Belle Tolls

True story: a few years back, my better half and I were watching Paula's Kitchen on the Food Network, when we heard a distinct - and unmistakeable - sound. We turned to each other and asked, "did they just bleep Paula Deen?!"

Indeed they had. First, last and only time we'd ever heard a bleep on Food Network.

I was reminded of that experience when this appeared on the radar:

"Drug giant Novo Nordisk has nabbed Paula Deen ... as a new spokeswoman to help raise awareness about type 2 diabetes – which she has."

Well, that last is no real surprise, but what is news here is that "Deen had profited from making herself and others diabetic, and that now she would make more money selling drugs to make those same people better."

Sort of a "Backdraft" moment, no?

So the question becomes: is this a conflict of interest? After all, one could argue that she encouraged eating behaviors that could easily lead to developing diabetes, a risk that could have been avoided by pushing healthier recipes.

I don't think it's that simple: for one thing, these kinds of shows are as much entertainment as educational. And let's face it, no one's forcing you to make deep-fried butter-balls topped with chocolate syrup and sprinkles.

(Although that sounds delicious!)

And certainly more than a few of her fellow diabetes patients see her "as a fellow traveler, different from the doctors and health nuts who are lecturing them about what they eat." In fact, she may actually have more credibility, given her own food proclivities and history.

Which brings us to this obesity-related item sent in by FoIB Holly R:

"As one of the many outgrowths of [ObamneyCare©], health insurers and employers must now pay the cost of screening children for obesity and providing them with appropriate counseling."

Of course, insurers and employers don't actually pay for any of this: their insureds and employees do, in the form of higher premiums.

On the one hand, it's in the bill we had to pass to learn what was in it. On the other hand, well, the Law of Unintended Consequences is a brutal mistress:

"Other than intensive hospital-based programs, few proven models exist for helping children and adolescents achieve and maintain a healthier weight, and researchers do not even fully understand the factors that contributed to the rapid rise in childhood obesity in recent years."

We don't know what causes this, but the answer is obvious: Quick, throw more money at it!

Why not just block Paula's Kitchen?

On Buggy Whips and Slide Rules

Ironman at Political Calculations (host of the most recent Cavalcade of Risk), has a thought-provoking - and inspiring - post on tech obsolescence:

"Think of things like buggy whips, or Commodore 64 computers, or newspapers, or DVDs."

These have all gone away (buggy whips) or evolved into something new (DVD's). But Ironman points to one example that "would be instantly recognizable to a time traveler from the past for what it is."

Can you guess what that is?

The answer may surprise you, as may the tech that just might supplant it.

Medicare vs. Doctors

Suppose you were self employed and the government decided not only which services they would pay you for, but how much you could accept and not a penny more as full payment for services rendered. How would you like that?

Believe it or not, that is exactly how Medicare treats doctors.

They provide them with a list of roughly 7500 different services that are reimbursable and then hand them a price list as well.

The doctor does not get to decide which services are best for the patient, nor are they allowed to set a price for their time. If a doctor CHOOSES to provide additional services not on the list because it would be of benefit to the patient they do so at their own expense.

Is there any chance that Medicare can get all those prices right? Not likely.

What happens when Medicare gets them wrong? One result: doctors will face perverse incentives to provide care that is costlier and less appropriate than the care they should be providing. Another result: the skill set of our nation’s doctors will become misallocated, as medical students and practicing doctors respond to the fact that Medicare is overpaying for some skills and underpaying for others.

The problem in medicine is not merely that all the prices are wrong. A lot of very important things doctors can do for patients are not even on the list of tasks that Medicare pays for. Some readers will remember our Health Alert on Dr. Jeffrey Brennan in Camden, New Jersey. He is saving millions of dollars for Medicare and Medicaid by essentially performing social work services to reduce spending on the most costly patients. Because “social work” is not on Medicare’s list of 7,500 tasks, Brennan gets nothing in return for all the money he is saving the taxpayers.

We have also seen that there are other omissions — including telephone and e-mail consultations and teaching patients how to manage their own care.

Welcome to Medicare. We trust you will enjoy the ride.

In addition, Medicare has strict rules about how tasks can be combined. For example, “special needs” patients typically have five or more comorbidities — a fancy way of saying that a lot of things are going wrong at once. These patients are costing Medicare about $60,000 a year and they consume a large share of Medicare’s entire budget. Ideally, when one of these patients sees a doctor, the doctor will deal with all five problems sequentially. That would economize on the patient’s time and ensure that the treatment regime for each malady is integrated and consistent with all the others.

Under Medicare’s payment system, however, a specialist can only bill Medicare the full fee for treating one of the five conditions during a single visit. If she treats the other four, she can only bill half price for those services. It’s even worse for primary care physicians. They cannot bill anything for treating the additional four conditions.

Who comes up with these rules?

Oh yeah, the government. That explains it.

Friends Don't Let Friends Use NHS

If you won't tell your friends, who would you tell?

The NHS provides great care to its patients. But recent reports by the Care Quality Commission and Health Service Ombudsmen, and the well documented problems at Mid Staffordshire, highlight how the NHS sometimes falls short.

We need to get the basics right. Patients need to get the food and drink they need. They need to be treated with respect. These are basic needs. But one in five hospitals are failing to deliver this. This is unacceptable and it needs to be put right.

Good customer service applies to health care as well . . . even if you do get it from the government.

Wonder if Brit's have the same expression we do?

"I'm from the government and I am here to help you."

Price Check, Please!

As we've discussed on numerous prior occasions, one of the positive consequences of consumer-centric health care has been increased price-awareness on the part of consumers. Of course, this had led to an increased demand for that most vital necessity: information. My favorite metaphor is McDonald's, where a quick glance at "the board" reveals the going rates for Big Macs and fries salads and Diet Cokes.

So why isn't this the case for health care?

Well, that's changing, as we noted long ago regarding Aetna's Navigator tool. And now, Assurant Health has entered the fray with its take, called "Price Check." This online portal enables Assurant insureds to determine ahead of time the price of a given office visit or procedure:

"With Assurant Price Check, ... clients can find guaranteed costs for common medical services and doctor visits ... Assurant Health Access customers will be reimbursed by Assurant Health for costs exceeding the quoted price range," subject to some fairly reasonable conditions.

Once at the site (currently available only to Assurant's clients and agents), you put in your zip code, select a category (office visit, lab, etc),and a provider (optional). I plugged in a simple flu shot, and got prices ranging from $15 to $18 (excluding the cost of the office visit). Nothing fancy, but pretty cool.

Just for kicks, I also asked about a CT scan of my head/brain [ed: bet the results showed nothing!], and learned that these run from $216 to $238. Such a bargain!

It's heartening to see these kinds of tools becoming more widely available; hopefully, they'll empower consumers to be more cost-conscious.

Oh, Those Invincible Yutes

In Colonial America, "full majority was reached at the age of 21." Folks who attained that age could "Buy or sell land without restriction ... Vote or hold public office ... [even] Act as a guardian."

Oh, how far we've come:

"Seventeen million young Americans would lose promised access to health insurance if the Supreme Court strikes down [ObamneyCare©]"

And how, pray tell, does "consumer advocacy group Young Invincibles" define a "young adult?"

Why, that would be folks "between the ages of 18 and 34."

Could we cast a wider net?

Didn't think so.

And of course, these Young "Invincibles" [ed: now there's an oxymoron!] continue the grand tradition of conflating health care with health insurance .

And then there's this little legerdemain:

"The law has already allowed 2.5 million young people to gain coverage thanks to a provision that requires health plans to allow them to remain on their parents' family plans through age 25"

So which is it? Age 26, or age 34? Or some other (arbitrary) number?

And in case you think that this doesn't affect you, because you're a 35-year old fogey, think again:

"When [ObamneyCare© kicks] in in 2014, about 8 million young adults will qualify for Medicaid and another 9 million will become eligible for federal subsidies to buy private insurance"

Translation: you'll be on the hook for health insurance for another 17 million "young people."

Finally, gotta love this howler:

"The group's amicus brief argues that the requirement that everyone have insurance ... "does not impose a significant burden on young adults."

Well first, no one seriously argues that this is a question of finances. It's about the government forcing us to buy something we may not want or need. And second, if it's not a "significant burden," then what's their beef in the first place?

Sheesh.

Grand Rounds is up

Intensive Care nurse Gina hosts this week's curated edition of interesting medblog posts.

OmniCare (Back) in the News

When last we visited OmniCare (in passing, some three-and-a-half years ago), they were accused of so-called "pill-flipping;" that is, surreptitiously dispensing more expensive forms of the drug to unsuspecting customers, at the expense of both them and us (as taxpayers).

Fast forward a bit, and we see "the more things change, the more they stay the same" in action:

"Omnicare Inc. faces a lawsuit from a former employee who claims the Covington-based company overcharged Illinois and the federal government for medications ... He alleges that as a result of the actions, the governments possibly incurred millions of dollars of damages."

Now, this could be a big deal, if what they were doing was, in fact, illegal (as it appears to be, inasmuch as the whistleblower claims that "he was compelled by Omnicare to enter false billing information").

Sounds like OmniCare wasn't exactly OmniScient.

[Hat Tip: FoIB Holly R]

The Big, Fat MVNHS© Gets Creative

In what can only be called a very big deal, the Much Vaunted National Health Service© has come up with a really clever way to handle morbidly obese Brits who need CT scans:

"NHS hospitals have resorted to asking zoos and vets to scan patients who are too obese to fit into hospital scanners."

To be fair, this actually makes sense: rather than deny these folks any diagnostic options, this at least gives them some hope.

And, of course, room.

And from the Learn Something New Every Day© Dept:

"The practice of referring patients to zoos is commonplace in America where obesity has reached epidemic levels."

"Commonplace." Uh-hunh.

'Cept for one small problem: No, it isn't.

Alphabet Soup Update: 2012 Edition, Part 1

As ObamneyCare© continues its inexorable march towards full implementation, consumers need to be thinking at least 2 or 3 steps ahead. Case in point: Flexible Spending Accounts (FSAs).

As of next year (yeah, I know, '12 just got underway) there's a new $2500 cap on FSA contributions. So what, you say, it's only 2012.

The problem is that time passes rather quickly, and plans that currently max out at greater than the $2500 limit need to be amended sooner, rather than later. This is as much a timing issue as a wording one, because some plans are calendar-centric and some aren't; that is, some plans track from January 1, while others may run from (for example) April or June.

If you're wise enough to have availed yourself of expert local talent, you may already know about these changes. If not, it may be worthwhile to check in with your FSA admin folks to see what they recommend.

[Hat Tip: United HealthCare]

HHS Sec'y Shecantbeserious Hits Bottom, Keeps Digging

Because pandering to the LBGTBLT Community apparently wasn't enough, Ms Shecantbeserious has decided to throw caution (not to mention common sense) to the wind with this howler:

"‘Of all the forms of inequality,’ Dr. King said, ‘injustice in health care is the most shocking and inhumane"

Um, Kathy? That "Dr" part is of Theology, not Medicine.

Back under your rock, please.

Pancreatic Cancer and the NHS

The BBC published a video interview with two pancreatic cancer patients and their doctor. One person is inoperable and is terminal; the other is alive four years post-diagnosis.

The underlying message was that NHS budgets are delaying diagnostic work and that private insurance allowed one person to get treated early enough to survive.

Welcome to our future. It's worth a look.

http://www.bbc.co.uk/news/health-15672653

What's the 419?

Section 419 of the Internal Revenue Code outlines the steps necessary for companies to deduct various insurance premiums from their taxes. The first (and, as it turns out, last) time we discussed these was about 4 years ago, when we noted FoIB Joe Kristan's interesting post on 419's apparent demise.

Fast forward 4+ years, and Joe's at it again:

"A defense industry consultant signed on the Millenium Plan, set up as a section 419A(f)(6) welfare benefit plan to provide death, medical and involuntary severance benefits to employee participants. The IRS decided that the plan looked too much like a tax-free piggybank for the consultant and assessed over $5.5 million in taxes to the contractor and his corporation."

Ouch!

Definitely check out the rest of the story.

TNR Swings....and misses

Reality is hard for progressives:

"[T]rue competition can't exist without regulation."

This is of a piece with Sen Reid's recent proclamation that "[m]illionaire job creators are like unicorns. They are impossible to find and don’t exist.”

Tell that to, say, the late Steve Jobs or the very much alive Noah Glass, or even Messrs Ben and Jerry. But the bigger picture is that it is the over-regulation of insurance that has led us to where we are.

Mr Cohn cites his colleague Aaron Carroll, who continues to believe, despite overwhelming evidence to the contrary, that MassCare works (and thus ObamneyCare© is destined to, as well). Mr Carroll's argument hinges on the fact that the individual medical insurance market uses actuarially sound underwriting, which results in folks who develop significant health problems being locked into existing coverage, with no hope of changing for the better.

[As an aside, he's absolutely correct that this is a problem, one exacerbated, rather than solved, by ObamneyCare©s stupid PCIP rules]

But Mr Carroll (and thus Mr Cohn) double down on the fail:

"[S]ince the law [then-Gov Romney] signed in Massachusetts did exactly that. It organized the individual market, so all that people buying on their own can choose from among a variety of plans that they know will provide basic coverage and will always be there for them when they need it."

It's always the half-truths with folks like this. Yes, MassCare "organized" the individual market, if by "organize" one means forcing insurers to flee the state (resulting in less - not more - competition); increasing premiums, elevating the Bay State to the top tier of state debt, and encouraging folks to game the system for (essentially) free health care.

All that, and they still end up reducing choices in health care.

That is the result of "regulating competition."

But of course there's a silver lining here, right?

Not so much:

"The Affordable Care Act does the same thing"

Boy, howdy.

The TNR Boys conveniently neglect to mention, of course, that regulation in the form of mandates continue to drive up health insurance costs. And, of course, ObamneyCare© essentially outlaws consumer-centric health plans (eg HSA's), further decreasing choice and increasing expense.

Good thing we passed it to learn what was in it.

[Hat Tip: FoIB Holly R]