InsureBlog

Perspective...

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Sat, 07 Nov 2009 14:00:00 +0000

Quick - Let's put these rocket surgeons in charge of our health care!

On the Record with Joe Wilson

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Fri, 06 Nov 2009 19:28:00 +0000

This morning, I was privileged to participate in a blogger teleconference with Rep Joe "You Lie!" Wilson (R-SC) about health care and the War on Terror. We'll focus primarily on the former, but I learned something very interesting about the latter which I'll share at the end of this post.

Rep Wilson began by acknowledging the terrible events at Ft Hood yesterday, and expressing his concern about the victims and their families. He then spoke about yesterday's demonstration in Obamington, and segued into his support of HR 3400 (a Republican version of health care "reform"). He spoke about "limited government and expanded freedom," which he believes is in direct contravention to PelosiCare.

Tuesday's elections, he observed, marked a watershed moment for those opposed to government take-over of our health care system. Given the results in Virginia and (especially) New Jersey, he thinks that Blue Dog Democrats have to be concerned about backing that kind of effort at their own re-election expense.

He spoke a bit about Afghanistan and Iraq, and then took questions from the half dozen or so of us on the call.

I had the privilege of asking the first one. Truth be told, I had at hand a number of questions, some my own, some from Mike, and chose to ask about his amendment that would require CongressCritters to go on the Public Option if it's passed. I pointed out that, two years ago, then-Senator John Edwards had proposed an essentially similar idea, which was deemed to be unenforceable. I asked Rep Wilson what he thought the chances were of its passing (slim-to-none) and whether it would be practical if it did.

He answered that the way his was worded was enforceable; that a specific class of "employee" could be carved out and put on that plan.

I followed up by asking why Speaker Pelosi was in such a rush, since Sen Reid was on record that no Senate bill exists and that they wouldn't even be considering the matter until after the first of the year. He replied that he believed that Nancy and her allies are obsessed with the government takeover of health care, in a continuing bid to "grow government." She knows that this may well be their last real chance at passing something, based on what they saw Tuesday.

Jim Hoft of Gateway Pundit then asked about Rep Wilson's take on Sen Alan Grayson's recent outbursts regarding Republican efforts. He replied that "Sen Grayson speaks for himself...truly outrageous and insulting." For those who liken Sen Grayson's comments to Rep Wilson's outburst at SOTU, he pointed out that his own was a "townhall moment;" that is, spontaneous and unscripted. By contrast, Sen Grayson spoke with the aid of storyboards, and were obviously not spur-of-the-moment.

Publius Forum's Warner Todd Huston asked if the Republican caucus had pushed any further on the constitutionality of many of the ObamaCare provisions (e.g. mandates, jail time, etc). Rep Wilson said that, should it pass, it would take litigation to determine that. He also took to task those who would equate auto insurance to health insurance; these folks point out that auto insurance is mandatory, but neglect to finish the sentence: "if you want to drive." But no one is required to own a car, whereas we are all "required to breathe." Thus, it becomes a tax simply for living.

I then asked about his thoughts on tomorrow's (potential) vote. Rep Wilson believes that the Democrats are counting on winning with a "one vote margin," but that there's not much assurance they'll have even that [ed: see link re: "(potential")]. He said that so-called "Blue Dogs risk becoming Lap Dogs" if they toe the party line.

He also pointed out that it wasn't until July that folks began to understand the "squeeze on Medicare and the elderly" that ObamaCare represents. The other major problem, he said, was how it would adversely affect small business, "the backbone of our economy." He then praised groups like the National Federation of Independent Businesses (NFIB) for their efforts to educate the public, pointing out that the additional taxes which would accrue would likely result in at least "another 1.6 million jobs lost."

Next up was Jeff Poor from NewsBusters, who stayed on the unemployment theme, quoting (Sheriff) Joe Biden's claim about the mess this administration had inherited. Rep Wilson took that as an opportunity to point out that, in hard economic times, history has shown that tax cuts are the way to go, citing both Presidents Kennedy and Reagan. He also had little use for the "Porkulus" which, he said has cost more jobs than it's saved [ed: a claim borne out by this chart].

Richard Zuendt, from Conservatives with Attitude, spent some time reviewing the profound impact of the election results in New Jersey. He was quite concerned about how the draconian cuts in Medicare will fall to the states to make up. He and Rep Wilson agreed that governors from both parties are justifiably concerned about this increase in states' costs, especially in a troubled economy.

Rep Wilson then pointed to Tenncare as a failed example of government-run health care, one which nearly bankrupted the Volunteer State.

Finally, The Hill's Tony Romm asked about the "one vote margin" which Rep Wilson had mentioned early on. He wanted to know if the vote was really going to happen tomorrow [ed: doubtful], and Rep Wilson was skeptical. He believes that Tuesday's vote put a real damper on that effort. He also pointed out that the political class was surprised at the intensity of the Republican base, as well as the cooling off of the corresponding Democrat's.

In a followup from Mr Romm, Rep Wilson was asked about AARP's endorsement of Pelosicare. The Congressman replied that folks should cut up their AARP cards, and send them back with a letter as to why [ed: sound familiar?]. He then named some other seniors' organizations that more accurately reflect their members' needs.

I mentioned at the top of this post that I learned something interesting about Afghanistan, and that country's economic woes. Rep Wilson told us that there is obviously concern about continued poppy (and thus heroin) production, but that Afghani's actually have an attractive alternative: apparently, Afghani pomegranates and grapes are highly prized in the Arab world, and are actually more profitable than poppies. There's now an effort to move Afghanistan's poppy farmers to these more profitable (and safer) crops.

And that's that. Our very Special Thanks to Lyndsi Thomas for making this happen. And again, I'll be updating this post with names and links as they become available.

UPDATE 1: Conservatives With Attitude reports on the call here.

UPDATE 2: Names and links are now in place.

A Tale of Two Bills: Show Me the Money

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Fri, 06 Nov 2009 14:00:00 +0000

Let's put aside for a moment whether ObamaCare (that is, the Senate version -such as it is - and PelosiCare) includes coverage for abortions (it does) or Death Panels (it does), and focus instead on actual costs. According to the Congressional Budget Office, "in their true first 10 years, the House bill would cost $1.8 trillion, and the Senate bill would cost $1.7 trillion." [emphasis in original]

And just to drive home the point that Granny's been thrown unceremoniously under the bus, PelosiCare includes some $800 billion in Medicare cuts, which is trumped only by the Senate version's $900 billion reduction. No more cookies for you guys.

For those keeping score, those $2 trillion price tags are almost double what the Majority Leader and the Speaker have previously claimed. I'm reminded of something an old sage once observed.

Contrast those ginormous numbers with this one: "a gross cost of $61 billion that is partly offset by about $52 billion in additional revenues associated with the coverage provisions." Those provisions include such outrageous schemes as tort reform and interstate sale of insurance (Full Disclosure: Bob maintains, and I agree, that this particular change will result in premium reductions for, at best, a very short time).

Lets compare those numbers: almost $2 trillion vs about $61 billion.

To be fair, Obamacare proponents will claim, justifiably, that the so-called Boehner Amendment cited above results in about 85% of the population being insured, while their efforts would result in some 95% covered. What they won't tell you is that their 95% includes illegal aliens (it does), which account for about 20% of the 15% of the uninsured; this means that ObamaCare and BoehnerCare are within about 5% of each other with regard to covering the uninsured.

As to how much they'll cost, well, do the math.

Not Dead Yet

noreply@blogger.com (Bob Vineyard, CLU) — Fri, 06 Nov 2009 00:39:00 +0000

Late for your own funeral? Almost . . .

MSNBC reports a bricklayer showed up at his own funeral . . . but was very much alive.

A Brazilian bricklayer reportedly killed in a car crash shocked his mourning family by showing up alive at his funeral.

What family members didn't know was that Goncalves had spent the night at a truck stop talking with friends over drinks of a sugarcane liquor known as cachaca, his niece Rosa Sampaio told the O Globo newspaper. He did not get word about his own funeral until it was already happening Monday morning.

If he doesn't have life insurance, maybe now is a good time to buy it.

AARP Throws Seniors Under The Bus: Turnabout Fair Play?

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Thu, 05 Nov 2009 19:45:00 +0000

After several false starts, AARP has pulled the trigger on its endorsement of PelosiCare, and the draconian Medicare cuts which will result. Any organization that seeks to put its own members at risk is, of course, free to do so, but it seems reasonable that there should be consequences for such a betrayal.

Since I've never been a member, I can't tear up my AARP membership card, enclose it with a letter expressing my disgust and disdain, and then mail that to AARP's headquarters.

But if you are, then I would encourage you to do so as soon as possible, and then head over to the American Seniors Association, which is on record as being against ObamaCare (and its various incarnations).

And if you join today (as I just did), there's a special two-fer deal going on. Making an important statement and saving money: priceless.

Showdown at the It's-Not-OK Corral

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Thu, 05 Nov 2009 17:00:00 +0000

It's high noon (really!), the sun is beating down on the dry, dusty town below as the gunslingers saunter out into the middle of the street. Eyeing each other carefully, squinting from the relentless heat and light, they face off, knowing that only one will walk away.

A scene from a classic oater at InsureBlog?

Hardly.

FoIB Lyndsi Thomas tells us that "High Noon for Health Care is a joint project of an unprecedented coalition opposed to the government takeover of our heath care system."

Once there, you can email, call or even twitter your congresscritter about PelosiCare. The idea is that funneling thousands of voices further empowers each one. So click over, and use the power of the 'net to raise your voice.

Long Term Care Insurance: When's the best time to buy?

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Thu, 05 Nov 2009 14:00:00 +0000

As previously noted, we don't recommend specific policies here at IB; everyone has their own needs, goals and budgets. But we do often suggest that many (perhaps most) folks might benefit from specific kinds of policies. One of these is Long Term Care insurance (LTCi), about which we've written before. But a colleague recently posted an informative and highy-readable piece on when to buy LTCi, and we're reprinting it here (with his permission).

Herman Bruns is a veteran agent in the Metro Atlanta area (does this make him a MetroGeorgian?) who specializes in the often complex field of LTCi. In response to a recent question posed at a public bulletin board which Bob and I frequent, he explains some of the factors that should be considered in deciding when to purchase this coverage:

As with most types of insurance, the ideal time to purchase LTC insurance (LTCi) is about one month before you need it. That way, you can potentially collect from the LTC carrier for a lifetime and have only paid one month’s premium. Of course, without a crystal ball, very few of us can predict when we will have a car accident or a stroke, or be diagnosed with cancer or Alzheimer’s. Many of us may be one doctor’s visit away from a diagnosis that will either cause us to pay more for LTC premiums, or possibly not even qualify for the insurance.

Christopher Reeves (Superman) never planned to fall off his horse.

As more and more baby boomers become aware of the devastating financial and emotional effects that a long term care need can have on their family, the average age at which people purchase LTC insurance has been steadily dropping every year. Government awareness programs advising people to look into this type of insurance is also causing people to get educated on how these plans work and to start early. LTC insurance is surprising affordable when you buy it at a younger age, so more and more people are simply taking advantage of it sooner. My own personal experiences with my elderly parents and in-laws in nursing homes and assisted living (all paid out of their own pocket) caused my wife and I to purchase our plan when I was 52 and she was 50. I happily pay the premium every year, even though in the back of my mind, I hope I never have to use the insurance at all. Statistically, my wife has a much better chance of using the plan than I do.

The cost of purchasing LTC insurance goes up every year you delay. Carriers raise their rates for new purchases periodically, too. The older you get, the faster it rises. As one starts to move into their early to mid 60’s, you begin to enter into what the mathematicians call the “exponential curve” of rapid price increases. The good news is that when you buy a LTC plan from a quality carrier, you are essentially “locking in” your rate for the rest of your life. Now it is true that the rates on existing policies can and do in fact increase, but many of the top carriers in the industry have a long history of little or no rate hikes. No matter when you purchase a plan, it is always going to offer you tremendous protection for a fraction of the cost of an extended nursing home stay.

Sadly, as we grow older, many of us also get less healthy. Blood pressure, arthritis, diabetes, and other ailments show up frequently as we get into our late 50’s. Many of us simply don’t take good care of ourselves, and others of us are a product of our heredity. LTC carriers give preferred health discounts to those who qualify of between 10% and 20%, so it pays to be healthy. There are a lot more healthy 55 year olds than 65 year olds out there.

Back to the original question: when should you buy LTC insurance? Although you can buy it at any age up to 84 with some carriers as long as you can medically qualify, I would urge everyone to start considering it by age 50, and try to get it in your early to mid 50’s if at all possible. If you can handle the premiums at that time, it can be a great value……and with the power of a 5% compound benefit increase, the benefit you purchase at age 50 will immediately start growing. This will provide you with a huge plan of protection by the time you statistically will most likely need the coverage, which is in your 80’s. In the long run, even though you start paying the premium sooner, the overall amount of premium paid out can be less by starting early.

Everyone’s financial situation is different, and no one plan fits all. Not everyone can start at age 52. You may have to wait until the kids get through college to afford LTCi. You may first need to move to a more cost effective high deductible or HSA eligible health insurance plan, or wait until you are on Medicare, so you can free up the funds to pay for LTC insurance. If you are already 65 and reading this blog, then the time to buy LTCi is before you turn 66….assuming LTCi makes sense for your situation. The key is to first learn more about how LTC insurance works by speaking with an experienced LTC agent representing a variety of carriers and who can advise you as to all your options.

Thanks, Herman, for your insights and for permission to share them. Readers with additional questions or thoughts are encouraged to share them in the comments.

Got cancer? You can wait. Trust me.

noreply@blogger.com (Bob Vineyard, CLU) — Thu, 05 Nov 2009 13:58:00 +0000

The government response to health care reform is . . . wait 6 months before coverage begins.

Or 2+ years if you want to go on Medicare under SSDI.

According to Fox, the Senate version of health care reform contains this wording.

The six-month wait is in the health care bill the Senate Finance Committee approved last month. To qualify for the pool, patients must be turned down for coverage because of a pre-existing condition and uninsured for at least six months.

Seems like the government is a bit tentative about taking on risk. It can't be a profit motive, so what is it?

Obama proposed the pool in his September health care speech to Congress. Intended to serve the most vulnerable as a temporary fail-safe, it would stay in place until 2013. That's when insurance companies would be banned from denying coverage because of medical problems.

Government subsidies to make coverage more affordable for millions of uninsured would also start that year.

Has anyone bothered to question the reason for delaying major provisions of health insurance reform until 2013? You don't suppose it has anything to do with 2012 being an election year do you? Those running for re-election in 2012 can tell you to hold on, change is coming next year.

Both the House and the Senate Finance bills set aside $5 billion for the pools.

"It doesn't seem like it's near enough money," said Douglas Holtz-Eakin, who was a top domestic policy adviser for McCain. The McCain campaign ultimately concluded it could take as much as $20 billion a year to properly run risk pools, he said.

Of course this is all just a wag.

And when has the government EVER come in under projections? Even Cars for Clunkers exceeded the budgeted amount by a factor of 3. Why is there any reason to believe they are right here?

This reminds me of the new Windows 7 commercials with Mac and PC. You know the one.

So why is Obamacare better than private health insurance?

Trust me.

Where Your Swine Flu Vaccine Went

noreply@blogger.com (Bob Vineyard, CLU) — Thu, 05 Nov 2009 12:31:00 +0000

Can't find the swine flu vaccine? Maybe you aren't important enough.

The Today Show just reported that some Wall Street firms got more doses than hospitals in New York city.

What's up with that?

Yesterday I had lunch with a client who couldn't get her 4 year old daughter vaccinated at the pediatrician because they didn't have the vaccine. Calling around, she found the vaccine was being administered for free in her county at a local park. Her husband stood in line 5 hours to get their daughter vaccinated.

All you had to do was show up.

They didn't even ask for proof of citizenship.

Just more stupid government tricks.

This man is a national treasure

noreply@blogger.com (Mike Feehan) — Thu, 05 Nov 2009 02:42:00 +0000

Ample proof here and here.

Enjoy.

From the Hot Stove League . . .

noreply@blogger.com (Mike Feehan) — Thu, 05 Nov 2009 01:52:00 +0000

Late last week, God summoned Casey Stengel to his office. Casey (God said) I'd like to see a baseball game in Heaven. Don't we have enough old players to field a team? So let it be written, so let it be done!

Casey went back to his cubicle, his head spinning. Mantle! DiMaggio! Grove! Mathewson! Gehrig! Ruth! Hornsby! Sisler! . . . wow! (Casey said). What a team I'll have in Heaven!!

Casey decided on his lineup in no time. Then he called Satan to set up a game. But Satan seemed unsure. I dunno, Case (Satan said), do you really want to play us?

Why sure (Stengel said). Satan, I think you're afraid of us because we've got all the ball players.

Well (Satan said) maybe so, Case, maybe you do have all the players - but remember, I've got all the umpires.

. . . .

And so friends, that's why private enterprise such as insurance companies cannot compete against a "public plan". Because the government has all the umpires.

A Pair of Mysteries: Data and Laws Edition

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Wed, 04 Nov 2009 20:00:00 +0000

First, the Mystery of the Missing Context: The Blogger Known as McQ takes Ezra Klein to task for missing some obvious problems with this chart:

[Chart courtesy RWN]

McQ notes, correctly, that the graph's missing some key information, including the definition of "doctor's visit" (i.e. diagnostic, treatment, routine, etc), the fact that it says nothing about the quality of the care, and that it fails to point out that a primary reason that the Medicare visit costs so much less is because that agency shifts its costs to the private sector.

But wait, there's more!

While I absolutely agree with McQ's analysis, I don't think he takes it quite far enough. For one thing, the Medicare price point in the chart is what it is because Medicare decides how much it's going to pay.

A bigger issue regarding how much the "USA fee range" (i.e. non-Medicare charges) is that, for the most part, this number is invisioble to the consumer. That is, 85% (or more) have insurance, the majority of which requires only a nominal co-pay for the typical office visit. When one is responsible for only a small portion of the bill, one is less concerned with the actual cost. It's this disconnect which helps drive the cost of the care; as the unofficial InsureBlog motto goes, "health care costs drive health insurance costs."

[Hat Tip: McQ at RWN]

Which brings us to:

The Mystery of the Missing Bill: While we find it replete with new and unnecessary bureaucracies, tax increases and health care rationing, we must at least credit Speaker Pelosi with actually having a bill to discuss (if not debate).

Which is more than we can say for Sen Reid:

"…there is no bill to release publicly — it does not exist."

Well, glad we cleared that up! Turns out, the much-discussed Baucus Bill is not, in fact, a done deal, nor (apparently) is it the de facto reform effort turned out by the Upper House. That's because, so far, there is no such bill available, it hasn't been reduced to writing. So all this talk about a vote "any day now" is just that, talk. There's nothing to vote on, much less to examine. Such is what passes for legislative action in today's Senate.

"Shut up," they explained.

Cavalcade of Risk #91 is up

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Wed, 04 Nov 2009 17:59:00 +0000

Debbie Dragon hosts this week's roundup of risky posts, with a heavy emphasis on insurance. Sometimes, that's just the way it rolls.

We're scheduling for early 2010, so please drop us a line if you'd like to host a Cav.

Alien Health Care for All

noreply@blogger.com (Bob Vineyard, CLU) — Wed, 04 Nov 2009 15:36:00 +0000

Free health care for all, but not from Washington. Instead, it will be provided by aliens.

Not so far-fetched . . .

The "Trib", a media source and homie of our Prez, had this observation about the new sci-fi about aliens ("visitors") that premiered on ABC last night.

Imagine this. At a time of political turmoil, a charismatic, telegenic new leader arrives virtually out of nowhere. He offers a message of hope and reconciliation based on compromise and promises to marshal technology for a better future that will include universal health care.

The news media swoons in admiration -- one simpering anchorman even shouts at a reporter who asks a tough question: "Why don't you show some respect?!" The public is likewise smitten, except for a few nut cases who circulate batty rumors on the Internet about the leader's origins and intentions. The leader, undismayed, offers assurances that are soothing, if also just a tiny bit condescending: "Embracing change is never easy."

Methinks this reporter nails it, even if their tongue is firmly in their cheek.

Welcome to ABC's "V," the most fascinating and bound to be the most controversial new show of the fall television season. Nominally a rousing sci-fi space opera about alien invaders bent on the conquest (and digestion) of all humanity, it's also a barbed commentary on Obamamania that will infuriate the president's supporters and delight his detractors.

Indeed . . .

Obamamania has spread beyond the 57 states to infinity and beyond.

111 and Counting... [UPDATED & BUMPED]

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Tue, 03 Nov 2009 19:50:00 +0000

That's the number of new federal bureaucracies contained in the PelosiCare boondoggle. From the Health Choices Administration (#6) to Comparative Effectiveness Research Trust Fund (#39) to a Clinical Prevention Stakeholders Board (#52) to the Centers for Disease Control Office of Women’s Health (#88) to, well, you get the point.

In fact, there are 6 new such agencies just for women, and (but of course), 1 for men.

There are also 2 just for "yutes," and 11 -- count 'em, 11! -- just for Indians/Native Americans.

This one's a gem: Program for treatment of child sexual abuse victims and perpetrators (#108). The perps get their piece the taxpayer pie, too. Isn't that special.

As Bob says, "Smaller cars, bigger health insurance, Poppa Washington."

[Hat Tip: Red State]

UPDATE: Thanks to Bob, here's the actual list of all 111 new bureacracies.

Medicare Demos: Then and Now

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Tue, 03 Nov 2009 19:00:00 +0000

Back in 1983, the Medicare system introduced its prospective payment system for hospitals. The program, considered successful, apparently represents the last time such a plan was deemed a success.

Now, Kaiser Health News confirms something we've been saying for a long time: that Medicare's alleged cost-savings mechanisms are illusory. In a ground-breaking story, KHN vets Chris Weaver and Kate Steadman examine how provisions in PelosiCare, et al may well be based on some false conclusions.

Recommended.

[Hat Tip: FoIB Kate Steadman]

A Foxx Looks at Obamacare

noreply@blogger.com (Bob Vineyard, CLU) — Tue, 03 Nov 2009 18:49:00 +0000

Virginia Foxx is a feisty lady with the ability to cut right to the heart of the problem with Obamacare. I like her style.

November Wikio Rankings: InsureBlog Exclusive

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Tue, 03 Nov 2009 18:40:00 +0000

Thanks to Wikio's Clara Chappaz, we're proud to present - exclusively here at IB! - this month's new Wikio (Health) rankings. And we're mighty proud to have moved up 3 notches to the #5 spot. Thanks, Clara!

1	Highlight HEALTH
2	Kevin, M.D. - Medical Weblog
3	The Covert Rationing Blog
4	In the Pipeline
5	InsureBlog
6	The Carlat Psychiatry Blog
7	Health Care Renewal
8	Diabetes Mine
9	Six Until Me.
10	Healthcare Economist
11	DB's Medical Rants

12	Fight Aging!
13	John Goodman's Health Policy Blog
14	Doctor Anonymous
15	Pharmalot
16	The Last Psychiatrist
17	The Doctor Is In
18	Disease Management Care Blog
19	Musings of a Dinosaur
20	Schwitzer health news blog

Wikio Blogs

Grand Rounds is up...

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Tue, 03 Nov 2009 13:30:00 +0000

Dr Joseph Kim presents this week's round-up of great med-related posts. Do check it out.

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Tue, 03 Nov 2009 01:16:00 +0000

If you haven't already done so, please take a moment to read this compelling and life-affirming guest-post.

Then, think about the implications of this:

"Cancer patients will receive funding for private treatment if they have not seen an NHS specialist within two weeks of GP referral."

This is not the current "law of the land," merely a piece of pending legislation.

Much like PelosiCare.

Sandi - Breast Cancer Survivor

noreply@blogger.com (Bob Vineyard, CLU) — Mon, 02 Nov 2009 19:31:00 +0000

Cyberspace is a wonderful thing. You can "meet" people from all over yet still never REALLY meet.

Over the last few years I have met some really great people from all walks of life. Some of their stories will lift your spirits while others will bring a tear to your eye.

This story of "Sandi" will do a little of both. She is a very brave woman who has faced a lot in the last few months. She posts regularly on a public forum and always has such a wonderful outlook on life. She recently took someone to task who was complaining about having to pay insurance premiums and "getting nothing in return".

Here (with her permission) is Sandi's story.

For years and years I paid into insurance, never had a claim, beyond just the usual that they cover, checkups, etc.

THEN, one day, I went for a routine test and lo and behold, they discovered lung cancer! 2 rounds of chemo and 35 radiation treatments later, at a conservative and just a running guess in my head, around $300,000 was expended on me. Came back to edit to let you know that ONE chemo treatment for me was around $12,000 and some change.

A few months later, I went in, AGAIN, just routine test and walked out with a recent bilateral mastectomy, two weeks later, lymph node surgery, I'm currently on the "chemo pill" and looking at that for the rest of my life, working towards having myself rebuilt (my ins. company is picking up the tab for my "boob job" with a plastic surgeon that costs in my area, around $7,000, and I'm grateful for my insurance company picking up that tab, because stuffing my bra was an option as a teenager, but now, not so much. So about now, I'm probably up to around $600K, and if my CT on 11/10 confirms that there is some "movement" in my lung cancer, then I will be back in for more chemo and if so, we will hit a million!

So, should I have been "paid back" as you claim for those years of good health, only to then have them spend close to a million or more on me to keep me alive?

You keep the change, folks, I will be happy to have my insurance!! there is NO WAY that I have paid a fraction of what they have expended on my behalf.

And keep in mind, you just may walk in one day and find that you are not so healthy and you won't be squawking about those few dollars they kept every month when you need them to expend hundreds of thousands to keep you alive and somewhat comfortable.

Disclaimer: I have no issues with paying for insurance, I have seen what it has done for me so you won't find this old girl bashing any insurance company over a few bucks I didn't use in the past. And it is PAST, not passed. Just thought you might like to know.

There was some back and forth where the original complainer tried to justify their position that there should be a refund for premiums paid that did not result in a claim. This person also indicated she had canceled her insurance in protest.

Here is Sandi's retort.

I would strongly ENCOURAGE you to go back to carrying your health insurance.

You said in your post that you have lost family members due to Cancer and that in and of itself makes you more susceptible.

If you think it was tough for your family WITH insurance, can you imagine what it will be like for you WITHOUT insurance?

I am always looking for ways to cut back and cut out out of fear of what my illness may do to me.

I am continuing to talk to you about this because those years of good health can turn on you in a heartbeat. My life turned completely upside down at 10:54 a.m. on 8/18/09 when I learned about the lung cancer, and then it started, those $12,000 chemo treatments, 10 of those, I set it out for you, but not all of the other tests, mediaendoscopy (sp), CTs, PETs, MRIs, Bone Densities and blood work and after chemo shots and on and on it goes. A new chemo pill that I will be on for the rest of my life, $50 a month, doesn't sound so bad, but that's forever, and even a frugal person like me had to do some juggling to work it in with everything else. I had a PowerPort implanted in my chest to make my life easier...

Believe me for all of your chagrin, if you walked a day in my shoes, you would be glad to trade that money over the past 5 years for NOT living like I do.

I'm fortunate than most. I don't have some big paying job, I'm a peon in a big DC lawfirm, but I learned to be careful with the little money I have, so when this hit, I was not then and am not, so far, yet, living hand to mouth. I was debt free then, am now, but for my mortgage and I have money in the bank, and while I'm no millionaire, I made it my business to become a good strong hundredaire and I can make it.

But this is not only about the physical, being "well", Cancer does other things, I thought after I finished all the lung cancer treatments they could do, well, I fairly skipped to that mammyslammer in June, figured I'd be wowing the boys at the pool no later than 2:30...not to be, they needed another one to compare, then they wanted a sonigram, then they wanted to do three biopsies...my breasts looked like they had been in a bar fight. No pool for me.

It was/is Cancer. On Sept. 8th, my copay to enter the hospital to let them cut off both my breasts was $200 and the ins. picked up the tab...I won't be wowing anyone, but thank goodness, I only had to pay that $200, the insurance is picking up the other thousands and I still have more down the road.

Not only does Cancer do a number physically that ins. pays for, there is a lot of mental things going on...I was so distraught that a vain woman like me losing her breasts I went on drugs to keep me from crying every day. Insurance pays, but I thought, it's done now, I should be OK, I let the scripts run out...bad idea, this morning I have been sitting her with tears in my eyes because I'm having a meltdown, I'm tired, MENTALLY and Physically. But thank goodness, tonight when I get off work I will take a few bucks and pick up my scripts again and no more crying jags.

I just fear that you and folks like you have no idea what an illness can do to you, and be ever so grateful that you went those years without any claims. Walk a day in my shoes and you would say "keep the change" and thank God in His Heaven it is not you, but someone else.

In response to this: Ask yourself -if i wanted "my money" back -don't you think i would have found a way to get it back by now?

No, I don't think you could! Not in a billion years will you get that money back.

In response to this: Once again I did not mean to offend anybody and hope nobody takes it personal

I am not offended, I would have to give you the Power to do that and I don't grant you that permission, and I'm not, the word is "offended", I am just worried about you and everyone who doesn't understand that 5 years/10 years/20 years means nothing when an illness hits.

I am talking to you because you are being very foolish and I don't want anyone to go through what I'm going through, and despite your 5 years of good health, you are NOT immune.

I hope you will think about what I have said and be happy to pay your premium and stay in good health, and if you don't, then have them to help you along the way...

As I said, she is a brave woman. Throughout her ordeal, she has retained her wit and positive outlook on life. I am truly blessed for having met her, and now, so are you.

One More Flu Vaccine Post

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Mon, 02 Nov 2009 14:30:00 +0000

60 Minutes did another piece on the swine flu vaccine last evening. Two items stood out for me:

First, HHS Secretary Sibelius came across as especially clueless: when pressed on citizens' skepticism regarding this adminstration's clumsy attempts at frustrating transparency, she blamed talk radio and TV's Glenn Beck, rather than address the very real concerns of a substantial number of Americans who just want to make an informed decision. And the fact that the House has put forth a 2000-page behemoth which we're not supposed to question does nothing to allay these concerns. No wonder people have doubts.

Second, a University of Michigan (?) professor made an especially specious comparison, likening taking the vaccine with wearing a seat belt. This is stupid on two levels: first, seat belt use is mandatory when traveling in a car - it's the law. So far at least, taking the vaccine isn't (which is probably a good thing, since it's in short supply; unless, of course, you're a terrorist. Second, and more important, no one has ever been injured by simply buckling a seat belt, but there are any number of cases of folks who've had life-altering complications from taking vaccines.

If the goal of the piece was to reassure us that this is safe, effective and available, it failed on all counts.

The Blair Witch meets Nancy & Harry

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Sun, 01 Nov 2009 22:36:00 +0000

Even though Halloween's over, be afraid.

Be very, very afraid:

[Hat Tip: Reader Fred W]

"He chose...poorly."

noreply@blogger.com (Henry Stern, LUTCF, CBC) — Sun, 01 Nov 2009 16:00:00 +0000

I'm still ambivalent about the wisdom of taking the swine flu vaccine, but I don't begrudge my fellow Americans their choice to do so. It looks, though, as if they'll have to wait, because there's another group who gets first dibs:

"(T)he Pentagon has offered to give swine flu shots to detainees [at] Guantanamo Bay, Cuba ... Detainees at JTF Guantanamo are considered to be at higher risk and therefore they will be offered the H1N1 vaccination."

Oh really? People whose mission in life is to kill Americans get to cut in line ahead of those Americans?

Words fail.

Medicare 2010

noreply@blogger.com (Mike Feehan) — Sat, 31 Oct 2009 03:02:00 +0000

On October 16, The Centers for Medicare and Medicaid Services (CMS) announced the Medicare premiums and deductibles for 2010.

This announcement contains the usual annual increases in premiums and deductibles. For 2010, the Part A hospital deductible reaches $1,100 per admission. The Part B ambulatory deductible is $155 per year. The Part B monthly premium increases 15% to $110 monthly per participant. (The Part B premium has increased by 41% in just the past 5 years – from $78 to $110. Wow.)

It’s important to recognize that in setting the 2010 Part B premiums, CMS has followed current law. The law includes certain limitations on growth of physician reimbursements. The $110 rate for 2010 reflects these limitations. For 2010 the limitations would reduce present physician reimbursements by 21% (!) Congress has waived these limitations in each of the past 5 years and is expected to waive them again for 2010. Why is this relevant? Because waiving the limitations will require a recalculation of the physician cost, meaning that both the Part B deductible and the Part B premiums will be higher than shown here. Wonderful.

The remainder of this post contains a brief summary of Medicare benefits for 2010. If, or as, you scan this summary (I know, it’s boring) please ask yourself: "would I want to be covered by THIS plan, at THESE rates?"

1. Medicare has many deductibles, all of them are increasing. Values for 2010 are:
a. Part A inpatient deductible = $1,100 per confinement.
•Inpatient benefits are limited to 150 days per confinement.
•Medicare pays inpatient benefits at 100% up to 60 days per confinement after the $1,100 deductible
•Medicare requires a $275 per day deductible from 61-90 days
•Medicare requires a $550 per day deductible from 90-150 days.
•After 150 days – no coverage
b. Part B Medicare deductible for all other types of expenses = $155 per year
2. For these other types, Medicare pays 80% of allowed expenses after the deductible
3. Medicare does not limit the residual expenses (the 20% that you must pay)
4. Medicare will continue to reimburse 80% regardless how large your expenses may grow - and you will continue to pay your 20% - no matter how large that may grow.
5. Medicare does not have a health reimbursement or health savings account.
6. Medicare contains no limit to the share of your own medical costs that you must pay in any year
7. Preventive care is subject to the same deductible and 80% reimbursement
8. Medicare does not cover retail Rx – no prescriptions – unless you buy Part D for an extra premium
9. Medicare does not reimburse any expenses incurred outside the U.S.
12. The Medicare gross premiums (before subsidy) are $461 per month for Part A and $442 per month for Part B, a total of $903 monthly or $10,836 per person, per year. This friends, is what Medicare COSTS.

The Medicare benefits may seem, well, skimpy compared with the relatively high premiums. On the other hand, an older population is expensive to insure, given the numerous chronic conditions and other health issues that people accumulate over a lifetime. This cost is not decreasing, it is increasing. And the government’s response year after year is to reduce benefits (e.g., increase deductibles) and increase premiums - but not to attempt to manage the overall cost. What else could it do? Well, it could aggressively seek out rampant fraud; or implement specific disease-management programs; or help physicians and hospitals identify and eliminate wasteful cost in the system. That’s only three of many possibilities. Oh, but hey, I forgot – Medicare has such a wonderfully low expense ratio in part because it doesn't do these things.

Note: By law, for citizens and legal residents who have at least 40 quarters of Social Security earnings, Medicare subsidizes the cost of the premiums. For the typical Medicare participant, Medicare (i.e., taxpayers) subsidizes 100% of the Part A premiums, and 75% of the Part B premiums. As the result, the typical Medicare participant will pay about $110 monthly in 2010 for Part B. That's equivalent to 12% of the overall Medicare cost. Still, it's an increase of about 15% above the $96 monthly per participant cost of Part B for 2009.