Doc Visit

I went to the doctor this morning. Never did figure out why it is called a doctor visit, or office visit. It's not like I dropped in for a cup of coffee or to talk over old times.

I was there because I was sick.

Nothing serious. Well not REAL serious, but it could be.

I have had a cold for about a week. More of a nuisance than anything. Vitamin C and chicken soup put a dent in it but didn't knock it out.

Last night I woke up at 2AM with an earache. Sharp, stabbing pain. After a few minutes it appeared it was not going away so I took 2 Tylenol.

About an hour later I went back to sleep without incident.

When I woke up, only a dull pain and fluid in both ears but more prevalent in the "sick" ear. So I went for a doctor visit.

When I arrived Helga wanted to know if I had been there before and how long since my last visit.

I don't know. Maybe 4 or 5 months ago.

"Here, fill this out and wait on us to call your name".

I can understand why they want to know if I am taking any new medications, or if I had any other medical issues since my last . . . visit. But I did wonder why the form needed my gender and race. Do those things change?

For a moment I considered indicating I was a black female but Helga didn't seem like she was in a jovial mood, so I marked white male.

About 20 minutes later I was called in for my visit. After checking my height and weight we agreed that I probably had too much turkey last week but I was not going to get any taller. 

Although the form didn't ask and we didn't talk about it, I probably won't get any more hair and if I did it won't be the factory issue color.

A few minutes in to my visit, the doc took a few notes, looked in my ear and said "You aren't kidding. This is a classic ear infection. Red, bulging ear drum. I wish I had a medical student here to show them. You did the right thing to come in today. If you had waited much longer you would have had a bigger problem".

Well, I was glad he didn't have a student around. I just wanted something to make me well so I could go back home and crawl in bed.

He wrote out a prescription and sent me on my way. I walked out of the office without paying anything. Same at the pharmacy.

"No charge today Mr. Vineyard".

We have a high deductible plan coupled with an HRA to pay a significant portion of our bills.

Still, the trip to the doc and pharmacy was painless, at least from a cash perspective.

Kind of like free health care. 

For a moment I felt like a Democrat.

Health Wonk Review Comin' Up - Another Nudge

We'll be hosting this week's Health Wonk Review, and (as usual) the emphasis will be on "health policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends."

You can submit your wonky post here, and be sure to include:

■ Your name
■ Your blog's name
■ Your post's link
■ A brief summary of the post

Submissions are due by this Wednesday (the 5th),  but early birds get better seats at the table (hmmm, bit of a mixed metaphor, that). And speaking of seats at the table, make sure to bring some apple sauce and sour cream (and maybe some peanut M&M's).

And matches. Definitely matches. Or a lighter.

Avik's Apothecary

FoIB Avik Roy's Weekly Digest is a must read for serious health care policy wonks. His insights and analysis are at once easily understood and remarkably thorough. Here's this week's edition - and we recommend signing up for his email distro list so you don't miss out.

Tiers in my eyes

No, that's not a typo, but the latest strategy by Big Insurance to find creative ways to rein in costs, of both health care and health insurance It's actually a pretty cool idea.

FoIB Jeff M recently attended a Lunch-And-Learn put on by Blue Cross/Shield of North Carolina (pizza, natch). The purpose was to roll-out the next generation of group insurance products, and some of the new strategies being built into them in anticipation of the full implementation of the ObamaTax in a little over a year.

BX introduced two new plans for 2013: "Blue Value" for groups of 1-50 1-48 (what rational employer wants to butt up against the mandate?) and "Blue Select" for groups of 51 and up.

They share a common goal: to reduce rates by anywhere from 2-12 percent over existing plans.

And how, exactly, do they intend to accomplish this?

Common sense. That is, under the ObamaTax, there's a practical limit of how much you can tweak the internal plan design. Ratings structures will be closely monitored by Mmme Secretary Shecantbeserious, and the Medical Loss Ratios will continue to exert downward (or is that upward?) pressure. Carriers have already "adjusted" how prescription drugs are covered, what with separate deductibles, tiered co-pays and cost-sharing, formulary changes, and the like. There's not a lot of wiggle room left on those.

But the concept of "tiers" doesn't have to apply only to meds. What if you could unbundle your provider network, and steer your insureds to cheaper/more efficient docs and hospitals? Might not that improve the bottom line? Of course it would, but how to get that to happen?

Well, you bake it into the cake policy.

Take a look at the different plan designs (generously provided by Jeff M and available here). The change is clearest with the Blue Select plans, where there's a 20% out-of-pocket differential between Tier 1 and Tier 2 providers. That's a heck of an incentive to go online to confirm that your doc (or hospital) is in the "right" Tier.

It has an additional effect, as well: when you reward something, you get more of it. By incenting insureds to patronize Tier 1 providers, BX is rewarding both the consumer (who pays less) and the provider (who, presumably, enjoys a bump in patient count). And Tier 2 providers will get this message, one way or the other.

Very interesting - Thanks, Jeff!

From the P&C Files: Marathon Insurance

No, not that Marathon, this one:

"The New York Roadrunners Club and its insurers have been waging a pitched battle the past four weeks over how much money race organizers will be able to reclaim in the wake of last month's canceled New York City Marathon."

When Mayor Bloomberg cancelled the annual event (in the wake of Hurricane Sandy), it seemed like the right thing to do. After all, tens (if not hundreds) of thousands of area residents were still without power, and relief efforts were (at best) haphazard. Add in the fact that area hotels were at capacity with displaced storm survivors, and there seemed no reasonable way to actually hold the run.

Now, in addition to all the other financial headaches, there's the matter of the non-refundable entry fees prospective participants had to pony up for a chance at glory, and the millions more would-be spectators had plunked down for tickets.

Hard to believe but we first covered the concept of "Special Event" insurance over 6 years ago:

"Special Event insurance is just that: coverage to protect one from a sudden loss during some unusual activity or promotion. Think "$1 million Hole In One Contest."

Well, the New York City marathon is indeed a "special event," and had (propitiously) obtained coverage through a Lloyd's of London syndicate. Of course, these things are never as simple as they might at first appear:

"A person familiar with the Lloyd's deliberations said the company already has authorized a "large payment," a sign that it has acknowledged liability, even though the running club actually decided on its own to cancel the race. The person said Lloyd's is still working with NYRR officials regarding the size of the payment, and a significant disagreement remains."

Of course, of course.

The "disagreement" stems from the fact that the event organizers don't "have enough money to refund all the investments made in the race by runners, sponsors, broadcasters and the travel partners who arranged trips for foreign participants."

On the other hand, "the marathon has a clear no-refund policy, even if severe weather forces organizers to cancel the race." So it's unclear (at least to me) why there's a problem: doesn't "no" mean "no?"

Beats me.

Nurse: 50cc's Johny Walker, Stat!

Gotta love the Kiwi's:

"The 65-year-old Taranaki man suddenly went blind when vodka he had been drinking reacted with his diabetes medication. He regained his sight only after hospital staff administered expensive whisky."

Seems that the gentleman, a catering tutor, was celebrating his parents' 50th wedding anniversary (yeah, I didn't get the math there, either) with hooch his students had gifted him. When he found himself unable to see, he made haste to the nearest hospital. As surgeons cut him open, they got a string whiff of "nail polish remover" and believed they'd found formaldehyde poisoning. The standard treatment is to administer ethanol, which tends to counteract the methanol (a component of formaldehyde):

"Auckland City Hospital intensive care medicine specialist Tony Smith said administering ethanol was a well-established treatment for methanol poisoning.

It worked because the ethanol competed with the methanol and prevented it from being metabolised into harmful formaldehyde, which can cause blindness."

So what was this magic potion?

"Johnnie Walker Black Label. It was good whisky, yeah."

L'chaim!

Don't Ask, Don't Tell: MVNHS©-style

So, what do (sickly) grandparents and their (sickly) grandchildren have in common?

They both get to travel the Liverpool Pathway, and at least half of them aren't even asked about it:

"Almost half of dying patients placed on the controversial Liverpool Care Pathway are never told that life-saving treatment has been withdrawn ... around 57,000 patients a year are dying in [MVNHS©] hospitals without being told that efforts to keep them alive have been stopped."

Well, why should they be?

After all, it's not their money being spent on care. And, of course, there's the remote chance that they (or their parents) might raise nasty, totally unnecessary objections. Of course, this is entirely logical: what sense would there be in disclosing the distasteful fact that while health "care" is free, there's a finite supply of it, and that supply is much more efficiently spent on folks who have some hope of survival, right?

Now, if this sounds familiar, it should: the ObamaTax's IPAB's Death Panels are right around the corner to enforce this course of (non-)treatment on us.

Pleasant dreams!