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Entirely preventable:

This 55-year old dad died from a #stroke in the U.K. because the surgery he needed wasn't available on #weekends.

On the #brightside, if he'd had the #surgery, at least it would have been free, right?#SinglePayer kills#MedicareForAll is #MedicaidForAll https://t.co/YPdUs8pEbp pic.twitter.com/zvt8lNzVQt

— Scott A. Olson, CLTC (@LTCShop) April 30, 2019

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We've previously discussed how one is is prohibited from collecting life insurance proceeds on folks one has murdered:

"California dad charged with insurance fraud after he drove off cliff, killing autistic sons"

But what about a person who's a beneficiary of a life insurance policy, who then goes on to murder someone else? In other words, two completely different circumstances, connected only by the person in the middle?

The facts:

The mother of the monster responsible for last year's Parkland shootings passed away a few months prior to the tragedy. It then took about a year and a half for her life insurance claim to be processed [ed: it's unclear why the long delay]. After her death, but before the claim was paid, her son murdered his classmates and teachers.

And here's where it gets, well, murky (and we're only going to discuss the life insurance issues here):

The murderer is due approximately $430,000 from his mother's policy, and so he's about to lose access to his public defenders:

"Parkland school shooting suspect['] ...public defenders asked to withdraw from his case on Wednesday because the defendant stands to inherit more than $432,000 through an insurance policy."

Okay, that makes sense, PD's are (ostensibly) for those in poor financial straits. But this raises a few issues, as well:

If he hasn't actually received the money, then how can they withdraw?

And what if he doesn't actually receive it?

How would that work, you ask?

Well, according to the (poorly written and researched) news article:

"A judge could award the money to families of the shooting victims, some of whom have sued [the defendant] in civil court."

Really?

How would that work? These are two completely separate cases and courts: one civil, one criminal. The defendant's mother had no connection to the murders; indeed, he would have received the money before them had the claim been processed more quickly. Would he have then been forced to just hand over the cash in that circumstance? One doubts it, absent a plaintiff's win in civil court.

What would compel the insurance company to write the check to ... well, who knows? This just seems very unlikely.

Or am I missing something obvious?

(And by the way, if the judge did funnel the insurance money directly to ... whomever ... wouldn't that necessarily obviate the PD's recusal request?)

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Several weeks ago, I mentioned that from now on, I would be routinely breaking so-called "embargoes" foisted upon us by self-important PR flacks:

"We occasionally get "Embargoed" news releases from various sources, none of which are very interesting, but all of which apparently presume that we are obligated to honor the "embargo."

So here's the second in this presumably on-going series:

"I’m reaching out with the embargoed news that Limelight Health, the most efficient and compelling quoting, underwriting, and proposal platform for the employee benefits industry, is announcing a unique integration with global financial services provider, the Principal Financial Group®."

Well good for them!

In the unlikely event that readers might be interested, here's the link to Limelight Health.

[Caveat clicker]

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■ Despite the fact that there are currently no true catastrophic health insurance plans available, Health Savings Accounts remain popular:

HSAs march ever higher, expected to continue https://t.co/I8dYOS9UOa

— Employee Benefit Adviser (@EBAadvisernews) April 24, 2019

Very interesting.

■ The other day, we noted that "Canadians spend less on health care than Americans mostly because they are not allowed to use as much — not because they are getting a better deal."

Seems like things will have to get worse before (if?) they get better:

This makes me so sad and angry. Please demand more doctors for patients in 🇨🇦. Your life or the life of someone you love will depend on it. Vote for policies that help keep and attract doctors. #BeAHealthcareVoter #ONpoli #cdnpoli #cdnhealth https://t.co/COsOU7vgYV

— Mary Fernando (@MaryFernando_) April 24, 2019

#Medicaid4All

■ Some time ago, we posted on a unique service that helped facilitate end-of-life care decisions:

"Imagine you're at home. Maybe that's in Florida, Wisconsin, Rhode Island, wherever. You have cancer. You just had another round of chemo, and the phone rings ... This is no telemarketing call - it’s about the end of your life."

The Vital Decisions service still provides "counseling services to advanced illness patients near end-of-life." And now, at least one insurance carrier is getting on the bandwagon (of sorts):

A @mutualofomaha unit has developed an end-of-life planning package that combines whole life insurance with access to a funeral planning service. https://t.co/KpSdaQY7OK

— ThinkAdv Life/Health (@TA_LifeHealth) April 16, 2019

Nice.

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About eight years ago, we noted that one of RomneyCare's explicit promises was to reduce ER visits. RomneyCare being, of course, a precursor to ObamaCare, and the ER one of the most expensive pieces of the health care pie.

Of course, that's not what happened:

"... according to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in emergency room visits"

Why's that, you ask? Well, because "newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician."

Hunh.

But that was then, and this is now, and surely the ACA has tamped down on ER (over-)utilization, right?

Right??

Well, you may want to sit down for this:

Heard in the halls of Congress by me, February 2009:
"But Olympia, if we just give these people Medicaid cards then they'll stop going to the emergency room and the program will pay for itself!"
Whoops.https://t.co/BXp1LuJ1UI

— Michael Bertaut (@MikeBertaut) April 23, 2019

Surprise!

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Here we go again. Another year, another Trustee report, stating Medicare and Social Security will be insolvent in a few more years.

The solution?

Increase Medicare premiums and cut Social Security benefits.

Solving the Medicare Problem

Medicare Part B premiums are paid by Medicare beneficiaries. Most are retired. A few (like me) still work because we enjoy what we do.

But many of those age 65 and older work because they HAVE TO.

There are 160 million people in the U.S. labor force.

Currently 44 million are on Medicare.

Rather than raising premiums and cutting benefits on the 44 million on Medicare, why not RAISE TAXES on those still working?

Just saying . . .

read more - https://www.gamedicarenews.com/2019/04/23/medicare-social-security-unsustainable/

#GAMedicareExpert #GAMedicareNews

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■ The good news is that we're starting to see real progress in the world of 3-D printed medical items, from prosthetics to tissue to actual working organs. But that latter may pose some interesting (and, perhaps unexpected) concerns. As FoIB Holly R alerts us:

"Within a decade, manufactured hearts could obviate the need for organ donations; ethicists highlight potential pitfalls along the way ... But not everybody is gung-ho about the heart breakthrough, citing ethical implications — like whether it will widen the gap between rich and poor, and whether superhuman hearts or other mutations can also be manufactured."

So far, this is all hypothetical (the 3-D printed heart is not yet functional), but that day may be fast approaching.

After all, just because we can ...

■ As we've often pointed out, coverage ≠ care, and one of the most significant challenges facing the Medicaid4All folks is the question of just who will provide that care:

"The CMS saw a sharp decrease in the number of providers opting out of Medicare in 2017, after several years where thousands indicated that they did not want to participate in the program."

This is what is known in the nomenclature as a "trend."

See also: "Be careful what you wish for..."

■ A little over 5 years ago, co-blogger Patrick sounded the alarm about "tier creep" as it relates to Actuarial Value. His thesis was that rate and cost-sharing increases were essentially baked into the ObamaCare cake:

"However, there are a few big secrets they aren't telling you - ones that year after year will negatively impact everyone. They are called actuarial value, cost sharing limits, and indexing."

I highly recommend that folks read the whole thing.

And now, half a decade later, FoIB Greg Fann continues to bang the drum:

Check out my latest article: Risk Adjustment State Flexibility, Silver Loading and Automatic Re-enrollment https://t.co/4kZXreUnNq via @LinkedIn

— Greg Fann (@greg_fann) April 19, 2019

Good (if alarming) stuff.

BONUS: Remember when they said that suspending the tax/fine/penalty mandate would result in millions of people losing their insurance?

Funny thing and (you may want to sit down for this), but that didn't actually happen:

Imagine that.

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I doubt there is nary a soul anywhere that is not aware that "Our Lady" of Paris, Notre Dame Cathedral, suffered a terrible tragedy this week. One does not need to be Catholic to feel at least some sense of loss.

Even those who are not religious seem to at least share a sense of loss in this building that has stood for over 800 years.

The Cathedral averages over 30,000 visitors per day. More than even the Eiffel Tower.

While this is a great loss, some view it as a symbol of rebirth for the building, Catholics worldwide and many others with no affiliation with the church.

Donations to rebuild the structure exceed $1 billion in just a few days. Last week fund raising efforts for restoration hovered around $50 million.

Unexpected loss has an unusual impact on people.

"There is something about the brick and mortar stones, placed there by believing people, that can communicate to people. They know they are on holy ground, and it's not because the place is holy, but because it is made holy by the faith of the people there," he said. - The Church News

The fire occurred at the start of Holy Week.

"If there is a moment when Christians should be ready to mourn the death of something, but to believe in the resurrection of something, it's Holy Week," Father McCarthy said.

"It is my belief that something is going to rise from these ashes," he said, noting that even the pagan myth of the phoenix and the ashes can bring hope after the day's events.

When Jesus was on Earth he said "Tear down this Temple and I will rebuild it in three days".

Those who heard him, including his followers, did not understand the true meaning of his words. Some even scoffed and said "It took 46 years to build this Temple. How can you build it in 3 days?".

He was of course referring to his body as the Temple. And he was prophesying about his death, followed by the resurrection three days later.

Notre Dame will not be rebuilt in 3 days or even 3 years. But I have no doubt the Cathedral will one day return and welcome all who come.

Blessings

#NotreDameCathedral

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This evening marks the beginning of our annual observance of the Exodus, beginning with the lighting of candles. We will recount the story itself, and, as always, I've found some interesting readings to supplement that.

Of course, beyond the ritual and the special foods lies the central theme of liberation and freedom. May we never take either of these for granted.

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About that CanuckCare being such a great deal:

Canadians spend less on health care than Americans mostly because they are not allowed to use as much — not because they are getting a better deal. Canadians face average waiting times of 38 weeks for joint surgery and 47 weeks for neurosurgery. https://t.co/XZcporpgpG

— Manhattan Institute (@ManhattanInst) April 16, 2019

Heh.

[Hat Tip: FoIB Michael B]

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We often post about these things in England and Canada, maybe Sweden, but this marks the first time we've blogged on the (troubled) Hungarian health care system:

"Waitlisted: It Can Take Half a Year for Patients to Be Operated On"

By way of background:

"Hungary provides universal healthcare for its citizens, which is funded by a combined effort of citizen taxes and the National Health Insurance Fund ... All employed persons pay local and federal income taxes, which are automatically deducted from their salary, and in addition pay an extra fee to the Health Insurance Fund."

Talk about double-billing.

And for all that, they still can't provide timely care to their citizens, many of whom actually have to wait years for necessary surgery and other services. The truth is that, as with ObamaCare, coverage ≠ care.

#Medicaid4All

[Hat Tip: Holly R]

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Long-time readers may recall our series of interviews with attorney Kent Brown about his lawsuit against the Fed's "because Social Security officials claim that folks must forfeit their Social Security benefits if they withdraw from (or choose not to enroll in) Medicare."

[ed: Original and follow-up posts are here and here]

One would think that since neither of these are in any way legislatively connected, this would be a non-issue.

One would think that, but one would be incorrect:

"Is there something in the original Medicare legislation that dictated this? Surprisingly, the answer is no ... Nothing in the Social Security or Medicare statutes state that one must take Medicare in order to receive Social Security payments (or vice versa)"

So how did this come about?

Two words: Washington, DC.

Now, fast forward a decade, and there seems to be some light at the end of the tunnel:

If “Medicare for All” is enacted, causing your health care to go to sh*t, did you think you could opt out & pay cash for your health care? Think again. Under existing law, your social security benefits vanish. One brave plaintiff is challenging this travesty. Read more here —> https://t.co/JLwsXMHdWd

— Tinker, Tailor, Brennan Spied (@instavire) April 16, 2019

Nice! So I once again reached out to Mr Brown for his thoughts, and to confirm that this was in fact related to his case, and he graciously replied:

"Good evening to you!

Yes. It has EVERYTHING to do with my case. The whole purpose of the Retirement Freedom Act is to address what the U.S. Court of Appeals refused to do, but should have done. I hope this matter can be addressed legislatively.  The Washington Examiner article is very good. Thanks for sending it along."

So we'll be watching this closely as it wends its way through The Hallowed Halls.

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It's been almost 8 years since we wrote about Oz's version of the MVNHS©:

"Australia's national health care system (which is called, interestingly enough, Medicare) seems to have a problem. Although "(p)rimary health care remains the responsibility of the federal government," said government isn't actually keen on providing it."

But that was then, and this is now:

Hunh:

Australian Single Payer encourages private buy-ups and wrap-arounds and those who can afford insurance get care 4x sooner than the folks that stay on the regular bog-standard government insurance.https://t.co/a4onUl9OUD

— Michael Bertaut (@MikeBertaut) April 15, 2019

By contrast, current Medicaid For All proposlas all outlaw private plans.

One wonders why...

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We blog pretty regularly about Long Term Care (LTC), and more specifically about Long Term Care insurance (LTCi). But we haven't really spent much time discussing the impact of caring for a loved one on one's own finances. The last time we addressed the issue was almost a decade ago:

"About 73% of the primary caregivers – and 40% of the secondary caregivers – said they had reduced contributions to savings accounts as a result of caregiving responsibilities, and 80% of the primary caregivers and 55% of the secondary caregivers said they had reduced retirement contributions."

So we see that immediate and long term consequence in terms of savings. But what about earnings?

Recently, colleague Ian Kremer alerted us to this article that addresses the question of re-entering the workforce after an extended absence to care for a loved one:

"For the individuals that had to take a long break from their career to become a full-time caregiver the prospect of re-entering the workforce can be intimidating. Most likely you will find unique challenges that may make it difficult to land the job that you want. There are some ways that you can prepare for success."

As I replied on Twitter:

"This is an important issue, and one that very few people (especially those caregivers) have thought out beforehand."

Really recommended.

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How long does it take to add a person to a small group plan?

Apparently a lot longer than the 48 hours we were promised on Monday.

Backstory:

Anthem small group client, looking for April 1 effective date for new hire (when he became eligible). Sent in the paperwork mid-March.

Which paperwork was apparently not entirely legible on Anthem's end (it happens), so they requested another, cleaner copy, which we then provided.

April 1 comes and goes, no sign of his ID card, nor any indication that he's been added to the group. I keep calling our contact person, who keeps checking, and on Monday was told would be done in 48 hours.

That was something like 100 hours ago, and still no sign of him on the group roster, and no ID card , temporary or otherwise.

And he's still not on the group billing roster.

Now, because I'm basically a nice guy, yesterday afternoon I gave their media folks a heads' up, and invited them to address the issue.

Which they did and, to their credit, responded very quickly. Meanwhile, my Cornerstone rep was also working her magic. I was hopeful that between the two of us, we could help this client out.

This morning, she came through, and I learned just what the holdup was: Anthem was conflating the employee's hire date and eligibility date. Once she was able to help them resolve this, we were able to obtain usable ID information.

I'd like to say that this was resolved to my satisfaction, but it really wasn't: for one thing, the time it took to get it resolved was ridiculous, and the fact that Anthem didn't reach out to me to confirm these dates was just dumb. I'm clearly listed as the agent, and they have both my phone number and email address.

I do appreciate the help offered by Anthem's media folks, Jill B and Leslie P. And, of course, the immeasurable aid rendered by my Cornerstone rep, Beth D.

They say that all's well that ends well, but I don't think that applies here. I realize that no one's perfect, and that companies have processes, but when you have sick or injured folks who've done their part in getting you the information required of them, it seems to me that you have an obligation to also act expeditiously on their behalf.

We'll see if that happens going forward.

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Our friends at Issue Insurance send along this news from life insurer Symetra (A M Best Rating A):

"SYMETRA’S PREFERRED CANCER PROGRAM
With over 14 million people receiving a diagnosis each year, cancer is one of the world’s most pressing health challenges.2 However, thanks to progress in research, cancer patients today are living longer than ever before—many in full remission. That’s why at Symetra, we believe your clients deserve a second look when it comes to qualifying for life insurance coverage.

Designed for clients with low-grade cancer histories, our Symetra Preferred Cancer Program is an underwriting program that can help provide your clients with the opportunity to receive up to a Preferred underwriting rate, allowing them to get more affordable life insurance coverage.

Check out our Symetra Preferred Cancer Program flyer to learn more about this underwriting innovation."

Great news!

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■ Contra the MVNHS©:

NHS poised to drop 4-hour A&E treatment target via @FT https://t.co/YhFzC7ZZmE pic.twitter.com/qN1lRrJRQH

— Sally Pipes (@sallypipes) April 8, 2019

We last blogged on the Much Vaunted National Health Service©'s problems achieving its (apparently unattainable) goal back in '17:

"Nearly a quarter of patients waited longer than four hours at A&E last week with just one hospital hitting its target."

Now they've just thrown in the towel.

■ Contra the MSM:

Here in the States, meanwhile, we have a much prettier picture:

"leading medical journals report the U.S. has superior medical results; U.S. wait times are far shorter than for seriously ill patients in peer countries like Canada and the U.K."@TPPF @RightOnHC https://t.co/Hnba7FWYa9

— David Balat (@DavidBalatHC) April 8, 2019

And that's including the impact of ObamaCare.

■ Contra the Spinmeisters:

You may have read that a Canadian couple, faced with "outrageous" US medical care costs, elected to drive their beloved father back to Canada. Problem with that story is:

The guy had a massive heart attack and died.

Rather than notify authorities for proper transport of the deceased, the family decides to drive home.

Media spins it to blame health care costs. https://t.co/QcB1TBW4We

— Amy Curtis (@RantyAmyCurtis) April 10, 2019

■ Bonus Round:

Maybe the Brits' wait time problem stems from this inconvenient factoid:

UK short 100,000 physicians ; 50,000 surgeries cancelled ; Americans are you ok with this ? @somedocs @LeahHoustonMD @mass_marion @Empoweringpts9 https://t.co/5knnd2hTI1

— Basia Jenkins,MD (@Docbasia) April 6, 2019

#Medicare4All FTW.

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"Patients who go to the hospital [in Venezuela] need to bring not only their own food but also medical supplies like syringes and scalpels as well as their own soap and water." https://t.co/QfgDLzkmah

— AssocAmerPhys&Surg (@AAPSonline) April 10, 2019

 #Medicare4All

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One of the subtexts of the healthcare transparency movement is something called Pharmacy Benefit Managers (PBM's):

"PBM's are (allegedly) a cost-efficient way for carriers to offload the administrative functions of filling prescriptions ... The stated reason for this business model is that it helps carriers to rein in the cost of medications, which make up a disproportionate percentage of claims."

Of course, intentions ≠ results.

While the concept seems innocuous enough, it's apparently become a major source of tension in the health care community, and is frequently cited as a major driver of increasing health care costs.

So when I got this link from FoIB Holly R, I just had to pass it along:

Big Pharma Motto: A Healed Patient is a Lost Customer.

— 🖕🏻Aunt Crabby calls Bullshit 🖕🏻 (@DearAuntCrabby) April 9, 2019

Perhaps coincidentally, I also recently received an email from local insurer CareSource about their new efforts to bring about more transparency, and to rein in the power of PBM's:

"CareSource, a leading nonprofit multi-state health plan serving government sponsored programs, announced its intent to implement a new, integrated approach to administering pharmacy benefits and services."

The new push will focus on:

* Full price transparency validated by an independent third-party

* Custom pharmacy network to provide the same access members have today while protecting independent pharmacies

And several other worthy endeavors.

Although I'm generally skeptical about "feel good" insurance company campaigns, this one at least seems to focused on something real, not just lofty.

#TimeWillTell.

Case in point: A client who takes synthroid recently refilled her 90 day scrip. Through her insurance (and thus, PBM), the cost would have been about $100. Uncharacteristically, GoodRx was almost $120. As usual, though, BlueSky clocked in at about $30. Heh.

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Oh:

In The U.K., Blindness Is Free https://t.co/WdmI3bDUm3 from The Political Hat Blog

— Political Hat Blog (@PoliticHatBlog) April 9, 2019

It's what inevitably happens when health care becomes a "right."

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So here's the scenario:

I sell a life insurance policy from Carrier A. The insured dies, and her beneficiary files the claim directly with the carrier (likely out-of-area relative who doesn't know I'm even involved). The carrier not only doesn't send the check to me for delivery, but doesn't even notify me that the claim has been made.

So I call them on this, and they say that they have no way to make the connection (even though they eventually notify me when he claim is settled, after the check's cleared, so they obviously can connect those dots).

I think that:

1) The carrier is obligated to inform me that a claim has been made, and

2) Is also obligated to send me the check unless I tell them otherwise.

I am livid.

But am I wrong?

In consulting with colleagues around the country, it seems that I am a bit behind the times on insisting on delivering the claim check personally (where possible). And I'm okay, albeit disappointed, with that.

But there's also agreement that the carrier needed to alert me the instant the claim was filed.

So, I'd be interested in our readers' take:

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1 - Last week, I asked about the value of a proposed new Ohio law mandating that "[b]usiness owners with less than 100 workers would be allowed to see data on employees' health claims." I was wondering specifically why we even needed this, and what good it might be expected to do.

My co-blogger Patrick has provided me with a great answer, and I thought it'd be helpful to share it:

"This is only for 50+. Right now in the ESI market segment from 50-99 there is no data shared. This is a good step in the right direction for transparency but will also have to be accompanied by projected data if it’s going to be efficient."

Thank you, Patrick!

2 - Our friend Holly R has tipped us to this item, which becomes even more relevant as we head into the Spring and Summer:

"To produce a malaria vaccine for mass deployment, biotech firm Sanaria has to decapitate and dissect out the salivary glands, which hold the malaria-causing parasite, for each individual mosquito—by hand. Enter the mosquito guillotine."

Cutting edge.

3 - Finally, FoIB and actuary Greg Fann offers an inside look at the truth behind one of the most controversial aspects of health insurance:

https://t.co/GZvKBMdCDh

— Greg Fann (@greg_fann) March 29, 2019

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I know next to nothing about college basketball, and even less about March Madness, but I do know little something about insurance. So when FoIB tsrblke tipped us to this story, my interest was piqued:

"Citing sources, Rovell tweeted that Duke paid for an $8 million policy for its star freshman, with the premium for such a policy typically costing around $50,000. Schools are allowed to pay for such a policy under NCAA rules."

Now, it's true that one trenchant Twitter commenter opined that "Health insurance is a totally different universe than Disability insurance," but neither of those is in play here. Rather, this falls under the category of 'special risk' cover, about which we've posted before. Here, for instance:

"World Furniture Mall "promised that if the Bears shut out the Packers in the season opener at Lambeau Field in Green Bay, Labor Day weekend shoppers would get their furniture free."

Which, as it happened ... happened, and the store owner's special risk policy paid out over $300,000. Smart buy, that.

The key here is that, unlike health or disability income insurance,. special risk plans fall under the category of Property/Casualty (not Life/Health). They're designed to cover a specific and identifiable circumstance or event, shifting the risk of that event or circumstance happening (or not happening) onto the insurer.

In fact, this "loss of value" plan is closer to diminished value coverage for your wrecked car than it is either DI or health.  And at a very reasonable cost, as well.

Now, as to the propriety of such an arrangement? Well, as noted above, these plans are allowed under NCAA rules. But more specifically:

"According to the NCAA, loss of value insurance is insurance that "protects a student-athlete's future contract value from decreasing below a predetermined amount due to a significant injury or illness suffered during the policy's designated coverage period. It is typically purchased for the year leading up to the athlete's draft eligibility. It requires medical underwriting, and may include exclusions for specific pre-existing injuries or illnesses."

So there you have it: $50,000 against potential loss of $8,000,000. Quite the bargain.

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We occasionally get "Embargoed" news releases from various sources, none of which are very interesting, but all of which apparently presume that we are obligated to honor the "embargo."

Today was no exception, and I'm taking this opportunity to flout it.

And by no exception, I mean that I've been told that this is "embargoed" and I can see that it's not terribly interesting. So I'll spare the details and just break the "embargo" thusly:

"Given your interest in climate change, I want to offer you the following statement from JupiterIntelligence in support of tomorrow's release of a new report by the Independent Advisory Committee on Applied Climate Assessment: EvaluatingKnowledge to Support Climate Change."

Now, I have no idea how these folks determined that we have any interest in "climate change," since it's not an insurable risk (AFAIK). But if you're really interested in the report, it's available here.

That is all.

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Courtesy FoIB Holly R:

"Quebec nurses to strike against mandatory overtime Monday"

When the system is run by the government under the principle that access to health care is a right, it means that providers of that care must sacrifice their own autonomy and are then forced to provide it.

Thank goodness no one's suggesting it here.

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Follow Sol Shipotow's journey into and out of the Medicare Avantage jungle.

Full NPR story at this link.

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