NAHU, (National Association of Health Underwriters) sent a note out today regarding a Washington Post article detailing polls which show that companies are trying to reduce health care costs by a) raising deductibles, and b) increasing the employee’s share of the premium:

On the front page of its Business section, the Washington Post (1/25, F1, Haynes) reported, “A growing number of workers in 2009 will pay more for health benefits — and in some cases receive less coverage — as their employers grapple with the financial fallout of rising medical expenses and diminished revenue and profits, recent surveys of human resource officials show.” According to the Corporate Executive Board, “30 percent of the employers” surveyed “said they expected to raise deductibles an average of 14 percent in 2009,” while “Mercer, a global benefits consulting firm,” discovered that of the “nearly 2,000 large corporations” surveyed, “44 percent planned to increase employee-paid portion of premiums in 2009.” Additionally, in order to “cut costs, employers increasingly are introducing high-deductible health savings accounts (HSA) and focusing on wellness programs,” the Post noted. The article went on to discuss specific examples of employers that are increasing employee premiums or adding the option of HSAs in 2009.

As your friendly neighborhood Health Insurance Professional, I’ll offer my sage advice on this: Raise the deductible first. It makes a lot more sense to shift RISK to the employee (within reason) than it does to shift PREMIUM to the employee, and if the employees are properly educated on their options, then they will prefer to MAYBE spend an extra few hundred or couple of thousand dollars a year, then to DEFINITELY have that much or more additionally taken out of their paycheck.

The Post article, as is common with press regarding the Private Health Care System in the U.S., displays an utterly unrealistic view of that system (I know…really shocking). This, for instance:

Carter, a technical editor for a District consulting firm and mother of twin boys and a girl, is facing steep increases in out-of-pocket expenses for health coverage this year. What she shells out for premiums and co-pays more than offsets any fuel savings. Her employer picks up 50 percent of the coverage for her family, up from 33 percent a few years ago. But because insurance costs have soared, she says she’s actually paying $200 a month more in premiums.

Her co-pays also have risen to $30 from $20. That extra $10 adds up, Carter of Bowie says, with “accident prone” teenagers in and out of the emergency room: Her 19-year-old track star son suffered a lacerated liver, broken rib and concussion when he slipped and fell on wet pavement. Her 16-year-old cheerleader daughter who is asthmatic is in physical therapy three days a week for a dislocated knee. Carter and her other son contribute to the costs with visits to the doctor for serious flare-ups of asthma.

So the companies are paying a higher percentage of the premiums than they were (very rare) but its a “sucker-punch” to expect policy-holders to pay an extra $10/doctor visit.  The truth is, the company is likely not raising copays ENOUGH, which is one of the reasons why costs keep going up.  If Ms. Carter actually had an in-network DEDUCTIBLE (which from this it doesn’t look like she does) the company AND her would fork out a LOT less money monthly for her coverage.

Here Locally in Loudoun County, the School Board has the option (and it looks like it’ll happen) to increase copays on prescriptions from a 5/20/40 to a 5/25/45 tiered system.  How much is that going to save Loudoun Taxpayers (to say nothing about how much it’ll save out of School employees’ checks every month)?  Over $1,000,000.

An extra $5 per prescription MAYBE saves roughly $10/employee/month DEFINITELY.

If your employees (or your employer) are NOT educated on these phenomena, then feel free to shoot me a note at wdporter@gcfin.com, and I’ll be happy to help.

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Butch Porter
Goose Creek Financial
Loudoun Health Insurance Professional

First of all, a disclaimer:  I’m not a medical professional.  I don’t even play one on TV.

And since I’m not qualified to make recommendations on health or mental health, please take this post as an informational piece and not a position piece.  That being said, I’m hoping my medical professional colleagues have some opinions on the issue, so here goes.

This article comes via a friend of mine who is a post-doc in NeuroScience at Baylor University.  The abstract of the article is as follows:

What is attention-deficit hyperactivity disorder (ADHD)? Why are so many children being diagnosed with ADHD and prescribed medication? Are stimulant drugs an effective and safe treatment strategy? This article explores the current state of scientific research into ADHD and the key social and ethical concerns that are emerging from the sharp rise in the number of diagnoses and the use of stimulant drug treatments in children. collaborations among scientists, social scientists and ethicists are likely to be the most promising route to understanding what ADHD is and what stimulant drugs do.

The article goes on to explore such issues as: the validity of diagnoses, alternative treatments, ethics of medicating children, etc.  A couple of excerpts I found interesting:

Diagnoses of psychiatric disorders are controversialbecause they are based on clinical assessment of behavioural symptoms: there are no laboratory tests to determine no unequivocally whether a subject has the disorder. In the case of ADHD, this problem is exacerbated by the fact that ADHD symptoms are difficult to distinguish from normal childhood behaviours. As long as there is no clear and indisputable scientific rationale for the growing rates of ADHD diagnosis and treatment in children4, the validity of ADHD diagnosis will continue to come under social and ethical scrutiny.

and:

In the future, better diagnoses and more comprehensive understanding of ADHD aetiology are likely to have a positive impact on treatments for ADHD. At this time, however, the state of scientific understanding is not sufficient to overcome the problem of over-diagnosis of ADHD and overuse of stimulant drug treatments. In this context, it is necessary to evaluate the ethics of medicating children for ADHD.

Safety is a paramount ethical issue in psychotropic drug treatments for children with ADHD. children are not small adults; nevertheless, most of the psychotropic drugs that are prescribed to children have only been tested on adults. Although stimulants have been used to treat childhood behavioural problems since the 1930s, there have been few systematic longitudinal scientific studies of the long-term effects of stimulant drug use in children. Moreover, an increasing number of children are taking not just a single psychotropic drug, but a combination of these drugs. The fact that there are no safety data available for drug cocktails does not dissuade parents and clinicians from using these drugs off-label in children, in increasing quantities and in ever younger populations of children. The FDA has attempted to resolve this problem by providing 6-month patent extensions to drug companies that conduct follow-up studies in children. However, the pharmaceutical industry selectively reveals psychotropic drug trial results and has concealed unfavourable safety data. These are compelling reasons why careful, systematic follow-up of children taking psychotropic drugs is essential.

The main reason I post this is, of course, that a fairly sizable number of my clients and/or their children are taking or have taken medications for ADHD and it’s important that we all have as much information as conceivable.  Plus, since I have a kid of my own, I’m always thinking of what it’s going to be like a few years down the road when I get that note from the principal:  “Your kid is fricking crazy, put him in an institution for Pete’s sake!”

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Butch Porter
Goose Creek Financial
Loudoun County’s best source for Health Insurance Expertise
703-651-3705

The latest newsletter from the National Association of Health Underwriters referenced an article in the New York Times about the disparity of health insurance premiums between men and women:

Data indicate cost disparities among women, men for individual insurance policies.

The New York Times (10/30, A23, Pear) reports, “Striking new evidence has emerged of a widespread gap in the cost of health insurance, as women pay much more than men of the same age for individual insurance policies providing identical coverage, according to new data from insurance companies and online brokers.” Price quotes and rate tables indicate that “the disparities are evident in premiums charged by major insurers like Humana, UnitedHealth, Aetna, and Anthem.” And, although “in job-based coverage, civil rights laws prohibit sex discrimination,” the “individual insurance market is notoriously unstable.” While “some insurance executives expressed surprise at the size and prevalence of the disparities,” others, such as women’s advocacy groups, “have raised concerns about the differences, and members of Congress have begun to question the justification for them.” Still, citing more use of healthcare services among women, “especially in the childbearing years,” insurance companies “say they have a sound reason for charging different premiums.”

This, like a myriad of things that comes out of the New York Times, is INSANE.  What’s missing is three simple facts:

1) Women use the doctor more…period.  To not take that into account from an actuarial standpoint would be completely and utterly insane.  It’s not a civil rights issue that women use the doctor more.

2) Maternity is typically automatic with Group Health Insurance, it’s rarely an option.  The last I checked, men are not getting pregnant…at least as far as I know.

3)  Women pay less for Life, Long Term Disability, Long-Term Care insurance, Car Insurance…and Men special interest groups, the last time I checked, weren’t lobbying Congress to equalize that playing field.

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Butch Porter
Goose Creek Financial
Loudoun County’s best source for Health Insurance Expertise
703-651-3705

A brief article on the history of why the healthcare system got to where it is, and why the McCain plan is actually the only one of the two (between his and Obama’s) that can truly accomplish anything:  by putting more control back in the hands of the consumer instead of simply shifting control from EVIL Insurance companies to the ALL-LOVING Federal Government.

Mr. Jacoby is very explicit in explaining the history of the problem:

During World War II, federal wage controls barred employers from raising their workers’ salaries, but said nothing about fringe benefits. So firms competing for employees at government-restricted wages began offering medical insurance to sweeten employment offers. Even sweeter was that employers could deduct those benefits as business expenses, yet employees didn’t have to report them as taxable income. For a while the IRS resisted that interpretation, but Congress eventually enshrined the tax-exempt status of employer-based medical insurance in law.

Result: a radical shift in the way Americans paid for medical care. With health benefits tax-free if they were employer-supplied, tens of millions of Americans were soon signing up for medical insurance through work. As tax rates rose, so did the incentive to keep expanding health benefits. No longer was medical insurance reserved for major expenditures like surgery or hospitalization. Americans who would never think of using auto insurance to cover tune-ups and oil changes grew accustomed to having their medical insurer pay for yearly physicals, prescriptions, and other routine expenses.

Now, I actually don’t agree with the part of McCain’s proposal that taxes employer-based coverage.  I’m more interested in parity (making sure that individuals get the same tax cut), than I am a punitive approach.  But it at least cuts at the core of the problem: the individual has been left out of the process for far too long.  It’s actually just a little too harsh.

I preferred the plan that President Bush proposed in a State of the Union address a few years ago (seems like so long ago), and that was a tax-credit (and a pretty sizable one, if I recall) for those participating in Consumer-Driven (High-Deductible) Health Plans.  That would have accomplished a lot as far as getting more control of costs back in the hands of the consumer without giving a Democratic contender ammunition to call the Republican contender a tax-hiker.

(Mirrored on logipundit.com)

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Butch Porter
Goose Creek Financial
Loudoun County’s best source for Health Insurance Expertise
703-651-3705

None of you really want to hear my opinions on the general bailout package passed by the Senate last night, but I felt it my duty to inform you of the implications of the added section regarding mental health (since some of you are obviously crazy).

NAHU (National Association of Health Underwriters) sent me a good summary this morning, so I’ll give you some excerpts:

Modern Healthcare (10/2, DoBias) explains that the Senate measure “includes the already agreed upon mental-health parity language that passed the Senate as part of a tax-extenders package and the House as a stand-alone bill.” According to MedPage Today (10/2, Walker), an earlier mental health parity bill, passed by the House in March, “was dead on arrival in the Senate because of language that would have required insurance companies to give equal coverage to all mental illnesses outlined in the DSM [Diagnostic and Statistical Manual of Mental Disorders]. This was a far-reaching stipulation that made some conservatives squeamish,” according to Peter Newbould of the American Psychological Association’s Practice Organization. The new mental health parity language, included in the rescue plan, “removes any mention of the DSM.”

[...]

Meanwhile, the New York Times (10/1, A28) editorializes, “The bill is endorsed by President Bush, business groups, insurance companies, the medical community and mental health advocates. … But it requires a final shove because the measure is snarled in a broader legislative struggle over how to pay for tax revenues that would be reduced by this measure and others. Is there a statesman who can push this worthy parity legislation through to final passage before adjournment?

I’m not a mental health expert and I don’t even play one on TV, but “Mental Health Parity” is not something that I have always been an ardent supporter of.  It would be good for me, insurance companies, medical professionals, medical health advocates, etc.  I’m just not 100% sure that it’s good for patients.  This is most likely because I don’t believe that “medicine” is always the best approach to mental health problems, but if I talk any further I will begin to effectively display my ignorance on the matter.  I’m hoping to get some input from our “Behavioral Medicine” specialist.  If and when I do, I’ll post again or have him do so.

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Butch Porter
Goose Creek Financial
Loudoun County’s best source for Health Insurance Expertise
703-651-3705

A little news I thought might be worth mentioning:

The Loudoun SBDC is putting on an event this coming Tuesday, April 29th, from 6:00 to 8:30pm, titled “Health-Care Options for Small Businesses” (Full info here). There will be various representatives from the health field (yours truly included) talking about how Small Businesses can best contain risks and Health-Care costs for their companies and employees.

SO please:

a) attend (IT’S FREE!), but register ahead of time.
b) forward this along to your respective networking groups, organizations, committees, etc, so that all those seeking an education on this topic will have the opportunity.

Any questions about the event, please direct to the Loudoun SBDC.

Here’s a grand example of how Congress can talk out of both sides of its mouth. On one side they are concerned about making Health Insurance more affordable; and on the other, they want to make it just a little more difficult for us to manage our own healthcare. First of all, this story does not mean that HSAs really lose any of their benefits, but it is simply the Congress trying to “save” tax dollars by making it more bureaucratic to save money in an HSA. It’s complete nonsense and is further evidence that those in Congress that talk about Health Care “affordability” only want that affordability to exist within the framework of Socialized medicine:

This week, the House passed legislation that included a provision to require every HSA transaction be reviewed and verified as a legitimate medical expense. Democrats say this is to ensure that consumers are using their tax-free withdrawals for a knee replacement, rather than a new iPod. In reality it adds a layer of bureaucracy that could sharply reduce the appeal and cost savings of HSAs.

A key player here is Ways and Means Health Subcommittee Chairman Pete Stark, whose main purpose in politics is to give the U.S. a government-run health-care system. He is a known opponent of HSAs – once comparing them to “weapons of mass destruction” – because they introduce more individual choice into the health-care marketplace.

Pushing for the provision was a company called Evolution Benefits, which has patented a system for the substantiation of health-care expenses. Evolution’s lobbyist, John McManus, was the former staff director of the Health Subcommittee under Republican Bill Thomas. The company first lobbied for the HSA provision, then withdrew its support when Republicans began to focus on its role. But Ways and Means Chairman Charlie Rangel helped make sure the provision was in the bill, which passed largely on partisan lines.[emphasis mine]

But hey…we want to keep “Special Interests” out of Washington, right? If we as health-care consumers want to continue to have control over our health-care without the Government making it difficult for us, we need to make sure this provision does not pass. Call YOUR Senator, and while you’re at it, call the three that are running for President, and make sure this bill is stopped.

This is an interesting site about Free-Market medicine.

I particularly like this article where David Gratzer (author of The Cure) explains what the real problem is, and why socialization is not the answer. It begs the question: if we ARE in a market-driven system, why is it that costs don’t go down like other high-tech fields? The answer is: we’re NOT in a market-driven system. And it’s tough to argue that a truly market-driven system definitely wouldn’t work. So shouldn’t we try it first?

A lot of the rest of the site has videos that dispel some myths about the current system…like the number of people that are uninsured by choice, and the extent of the safety net for those who don’t have a choice.

A sister site, On the Fence Films, has a video about a brain surgery patient from Ontario which illustrates the flaws in a single-payer system.  Many of the arguments for “rationed care” simply comes to this:  only poor people are important, and those with jobs and money should have to wait just like everyone else.  Tell that to this gentleman.  The dirty truth is…even a poor person in the U.S. with no “coverage” would have better “access” than this middle class family in Ontario.  And our private system would eat the bill.

In addition, missing from the conversation of Government Health Care is the fact that local governments and non-profits have been an effective solution so far for those without private coverage.  Like the Loudoun Free Clinic, where anyone in the county who makes less than 200% of poverty can get FREE health care.

Here is an article that falls a little short on health care. It briefly states the obvious and then opens up to comments (hmm…kind of like this site). The most entertaining part is reading some of the comments after the article. They range from the ridiculous to the pitiful, but neither the article NOR the comments specifically address the real problems:

1) Most health insurance (companies and plans) is not chosen or negotiated by the end user.
2) The average deductible in the U.S. is $500.

That’s it. End of story. You solve that, you solve about half the problem. And until you solve that it’s IMPOSSIBLE to solve the other half of the problem. Is this an easy problem to solve? It is for the consumer if you live in the right state (about 45 out of the 50). It’s not if you don’t.

My personal advise until the “Gubment” decides to solve all of our problems:

Take control of your health, and take control of your health insurance. Get underwritten while you’re healthy, and stay healthy.

This is a great illustration, and I would even argue the BEST illustration–brought to my attention by my good friend, JohnnyB–of what’s wrong with the current Health Care System, how it got there, and who’s actually (shockingly enough) coming up with the most radical (and arguably the most logical) approaches to solving said system. My favorite excerpt:

…[E]verything people dislike about our system results from the tax break for employer coverage. It makes costs rise, since people are less careful when they’re not paying out of pocket. It means people often lose their insurance when they switch jobs. And it keeps a lot of people–those who don’t have employers who provide coverage–from having much access to health insurance.

It’s always amazing to me how so many want us to learn from our past and figure out the “how did we get here” when discussing public policy…except for Health Care for some reason. In the case of a flawed public (tax) policy towards Health Care, many instead want to look outward and say: “Hey everyone else is doing it this other way.”

It’s really very simple: We do not have a true market-driven system if the end-user, the consumer, is not involved in the decision-making process. As soon as we give that a try, we’ll see if an ACTUAL market-driven system works.

The lesson to take from this? Everyone needs to figure out a way to write off their individual Health Insurance. Start a business, somehow, sell Amway if you have to, start a non-profit, whatever it takes, but don’t depend on your employer for your Health Insurance, and don’t let 60-year-old tragically flawed tax policies keep you from managing your own health costs and risks.

AND DO THIS WHILE YOU’RE HEALTHY, so that you NEVER have to make a job decision based on benefits.

If you have questions about taxes, call Earl, if it’s the Health Insurance you’re looking for, well you know by now who to call.