IRS Warns Of COBRA Subsidy Abuse Penalty

The IRS website has a post on it that is a reminder that COBRA subsidy recipients who become eligible for other group health plan coverage or Medicare should notify their plan in writing that they are no longer eligible for the subsidy. Failure to do so could result in a penalty.

The webpage explains that if an individual continues to receive the subsidy after he or she is eligible for certain other coverage, such as group health coverage from a new job or Medicare, or was never eligible in the first place, the individual may be subject to a penalty of 110% of the subsidy provided after he or she became eligible for the other coverage. The website includes information on how individuals can self-report to the IRS that they are subject to the penalty – you have got to LOVE the optimism of the IRS.

By the same token, the IRS understands that not everyone may self-report the error of their ways. To that end, they have given people the opportunity to report SOMEONE ELSE they suspect may be receiving the subsidy after becoming eligible for other coverage. No reward is offered - yet.

Seasonal Flu and H1N1 Flu Information

Seasonal flu is not just a runny nose or upset stomach. On the contrary, it's a serious illness that can lead to pneumonia or even death. The good news is that most insurance companies are helping to reduce the cost of seasonal flu shots to their members. If you do not know if your carrier is helping with the cost, contact your agent or the customer service number on the back of your ID Card. Most carriers are letting you get your flu shot with a tier 1 co-pay on your Rx coverage.

Please note that the seasonal flu vaccine will not protect from the H1N1 flu virus. The government is covering the cost of the vaccine itself. Authorized providers may bill for administration charges. Again, check with your carrier for more details.

Groups recommended to receive the seasonal flu vaccine are:

• children aged 6 months up to their 19th birthday,
• pregnant women,
• people 50 years of age and older,
• people of any age with certain chronic medical conditions,
• people who live in nursing homes and other long-term care facilities,
• health care workers,
• household contacts of persons at high risk for complications from the flu,
• household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated).*

Groups recommended to receive the H1N1 flu vaccine are:

• pregnant women,
• household contacts/caregivers for children under 6 months old,
• health care and emergency personnel,
• people between 6 months old and 24 years old,
• people between 25 and 64 years old who have health conditions associated with higher risk of medical complications from influenza.

For more information, visit www.flu.gov.

Also, the CDC offers extensive information on the seasonal flu and H1N1. You can visit their web site, www.cdc.gov/flu for more information.

Finally, you can visit the Virginia Department of Health's Web site, http://www.vdh.state.va.us/ or call 877-ASK-VDH3 (877-275-8343) during business hours for local H1N1 information.

Example Of A Level Playing Field?

A recent Washington Times editorial highlights the hypocrisy of the recent "gag order" against Humana in light of arguments from those in favor of a public health care option who say it would be a level playing field. The "gag order" was placed on critics of Medicare reform, particularly Humana, Inc. The insurer sent a letter to its customers urging them to contact Congress about Sen. Max Baucus' reform proposal to cut funding for Medicare Advantage. The Times says the Centers for Medicare and Medicaid Services' "explicit threat of removing Humana from the Medicare system has barred the company from sending any more letters to its customers while the bureaucracy takes its time investigating the letter." The move is a "fair warning to anyone who thinks a government insurance plan will play fair with its private competitors."

Humana Gagged For Telling The Truth While AARP Encouraged To Endorse Plan

"The Centers for Medicare & Medicaid Services (CMS), which administer benefits under Medicare, issued what can only be called a gag order after Humana warned its Medicare Advantage customers in a letter that the president's plan might cause them to lose some benefits."

But "Tuesday, CBO director Douglas Elmendorf told Sen. Baucus' committee that its plan to cut $123 billion from Medicare Advantage would cost some 2.7 million people to lose this coverage altogether and result in lower benefits for the rest. The program will become so unattractive that people will quit buying the policies in the future.

So when Blum issued the gag order, it was because Humana was telling its customers the truth and exposing as a fraud the claim that "if you like your current coverage you can keep it."

WSJ

Meanwhile, the White House and Democrats "are laboring to attract skeptical seniors to their drive to reshape the nation's healthcare system, leading some to press the behemoth but reluctant AARP to be more aggressive about backing them." With polls showing that a majority of those over 65 are opposed to the reform plans in Congress, "some Democrats are prodding AARP...to explicitly endorse their plans."

AP

CBO Director Contradicts Boss

The Associated Press reports that CBO director Douglas Elmendorf is "contradicting" President Obama's "oft-stated claim that seniors wouldn't see their Medicare benefits cut under a health care overhaul." Elmendorf "told senators Tuesday that seniors in Medicare's managed care plans would see reduced benefits under a bill in the Finance Committee. The bill would cut payments to the Medicare Advantage plans by more than $100 billion over 10 years." In a separate story, Elmendorf is quoted as saying that the Baucus bill "would reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans."

Pandering In Real Time

With all of the talking pundits, round-the-clock news shows, all-news cable tv shows trying to best one another, is this scenario far behind?


New Live Poll Allows Pundits To Pander To Viewers In Real Time

Another Sign Tort Reform Is Needed?

Zurich University Hospital has stopped treating North American "medical tourists," fearing million-dollar claims from litigious patients if operations go wrong. Hospitals in canton Valais have also adopted measures to protect themselves against visitors from the United States, Canada and Britain.

"The directive applies only to patients from the US and Canada who come to Zurich for elective, non-essential health treatments," said Zurich University Hospital spokeswoman Petra Seeburger.

"It is not because treatment is not financed; it is because of different legal systems." In a statement the hospital said it was "not prepared to risk astronomical damages or a massive increase in premiums." Seeburger emphasised that the restrictions only affected people not domiciled in Switzerland.

Rising Cost Of Health Care

The Top 5 Medical Tourism Destinations

Medical Tourism is defined as "where people travel abroad to receive medical treatments like cosmetic surgery, which they could not afford in their own country." We have read quite a bit about it and posted about. A recent report came out and listed the Top 5 Medical Tourism Destinations. Coming in at #5 - The United States.

"Yes, that's right. America is a medical tourism destination. In fact it is one of the longest-standing medical tourism destinations in the world. That's right: Brits have been taking advantage of the dollar exchange rate and travelling to America to get their bits tucked in or pushed out since the 80s."

Huh. How can that be? We keep hearing how our health care system is so expensive and other countries have better health care than we do.

Maybe our system is not as bad as we are led to believe...

Ultimate Single Payer System

"There was a time, within living memory, when most Americans did not have health insurance-- and it was not the end of the world, as so many in politics and the media seem to be depicting it today.

As someone who lived through that era, and who spent decades without medical insurance, I find it hard to be panicked and stampeded into bigger and worse problems because some people do not have medical insurance, including many who could afford it if they chose to.

_________________________

the time finally came when
I could tell my wife that the
baby was now ours, free and clear.
_________________________

What did we do, back during the years when most Americans had no medical insurance? I did what most people did. I depended on a "single payer"-- myself. When I didn't have the money, I paid off my medical bills in installments.

The birth of my first child was not covered by medical insurance. I paid off the bill, month by month, until the time finally came when I could tell my wife that the baby was now ours, free and clear.

In a country where everything imaginable is bought and paid for on credit, why is it suddenly a national crisis if some people cannot pay cash up front for medical treatment?"

Thomas Sowell

Milton Friedman - My Hero

As a former economics major in college, I have always had a special place in my heart for Milton Friedman. His free market theory and arguments against government intervention always resonated with me. This is the first in what will probably be several (over time) posts with him talking about various items that are still relevant today.

Here he talks about Government's role in health care.

Will Your Doctor Continue To Practice Medicine?

"Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted.

The poll contradicts the claims of not only the White House, but also doctors' own lobby — the powerful American Medical Association — both of which suggest the medical profession is behind the proposed overhaul. The AMA, in fact, represents approximately 18% of physicians and has been hit with a number of defections by members opposed to the AMA's support of Democrats' proposed health care overhaul..

It also calls into question whether an overhaul is even doable; 72% of the doctors polled disagree with the administration's claim that the government can cover 47 million more people with better-quality care at lower cost."

(Click image to enlarge)

IBD

Free Market Innovation Continues To Lower Prices

BENTONVILLE, AK, Sept. 15, 2009 – While the debate over health care reform continues, Walmart remains committed to doing its part to reduce the cost of health care for everyone. Walmart announced today it is expanding its prescription mail delivery program nationwide, making it easier to receive prescriptions regardless of whether or not customers live close to a pharmacy. From Cromberg, California, to Rockleigh, New Jersey, Americans can order, with a valid prescription, a 90-day supply of eligible prescriptions for only $10 and receive them via free mail delivery, simply by visiting walmart.com/pharmacy or by by calling 1-800-2REFILL. Further, Walmart’s free mail delivery program has no gimmicks, no memberships and no enrollment fees.

_________________________
Walmart’s free mail delivery program
has no gimmicks, no memberships
and no enrollment fees
_________________________

“Walmart’s $4 generic drug program has helped so many patients afford their medication needs, but unfortunately we’ve found there are still too many patients unable to take advantage of our low prices because they are home-bound or live too far from a Walmart or Sam's Club pharmacy,” said Dr. John Agwunobi, president of Walmart’s health and wellness division.

“With this program, we’re able to provide consumers in every rural town or big city across America with more affordable prescription medicines through a convenient, free mail delivery system. Our $10 mail delivery prescription program is a true reflection of Walmart’s commitment to drive unnecessary costs out of the health care system so Americans can live healthier, better lives,” said Dr. Agwunobi.

PETA's Chicken Empathy Museum

You could not make this stuff up...

Roanoke, Va. -- This morning, PETA sent a letter to Virginia Gov. Timothy Kaine offering to rent the Botetourt Correctional Center building, which is slated to close because of budget concerns, and turn it into America's first chicken empathy museum.

The museum could feature exhibits that include video footage from research conducted at Bristol University in the U.K.--research that showed how chickens are intelligent animals with mental abilities comparable to cats, dogs, and even

_________________________

also feature a restaurant that would
serve heart-friendly and delicious
faux-chicken drumsticks and
chickenless pot pie.
_________________________

primates. It could also feature a restaurant that would serve heart-friendly and delicious faux-chicken drumsticks and chickenless pot pie and a gift shop that could provide free plush chickens for kids, with tags reading, "I Am Not a Nugget!" The museum would feature interactive displays, including one in which visitors have weighted backpacks strapped to their backs to simulate how large chickens' upper bodies can grow in proportion to their legs. The museum would also provide area residents with much-needed jobs.

"In addition to creating jobs, the museum would convert a building that was built for the purpose of incarceration into a tribute to liberation," says PETA Executive Vice President Tracy Reiman. "Chickens are sensitive, smart animals who have feelings just as we do--they deserve better than to be treated like mere meat machines."

Still think I made this up? Go here.

Salt In The Wound On Tax Day

On one of the four days of the year when millions of taxpayers have a deadline for their quarterly tax payment (many of the self-employed do not have the luxury of paychecks and tax withholding), this appeared the Richmond Times-Dispatch:

"This fiscal year Washington will spend $33,880 per household. Here is how the bill breaks down:

$9,418.....Social Security/Medicare
$6,328.....Financial bailouts
$5,850 ....Defense
$4,745.....Anti-poverty programs
$1,210......Interest on the federal debt
$982........Federal employee retirement benefits
$902........Unemployment benefits
$819........Veterans' benefits
$699........Health research/regulation
$529........Highways/mass transit

The remainder -- roughly $2,400 -- covers everything else, from the judicial system to education to farm subsidies to space exploration.

An itemized bill is always instructive. This one is particularly so."

Ah, Details, Details

“'There remain some significant details to iron out.' Thus spoke the President of the United States last night, in an address in which, with a straight face, he told an awaiting nation that he was finally delivering not lofty rhetoric, but his grand plan on health care.

On that score President Obama was right. It may have been, however, a bit of an understatement. Absent, of course, was how exactly all the savings he confidently predicted would materialize, how exactly the government would prevent employers from dumping all their employees into a government plan and how czars and boards would operate without bureaucrats coming between Americans and their doctors. Ah, details, details.

In fact, while he kept referring to “our plan” he never explained whose plan he meant. One of the two House plans? The one Senate plan that exists or the Finance one that’s under construction? What’s he actually for? What’s the President against?"

Mike Gonzalez

Never Forget

(Click on image to enlarge)

Games Sometimes Put Life Into Perspective

Sports fan or not, you have to read this article.

"Three years earlier he'd joined the staff as a 25-year-old volunteer. He loved being around the game, loved talking officiating (a particular passion of his), loved going out for beers with the equipment crew and, more often than not, getting into some kind of good-natured trouble. Only a couple months earlier, he'd been brought on full-time as the assistant equipment manager, benefits and all (and thank goodness for that). Which is how he came to be holding that key, sprinting toward that locker room, on that fateful night...

Gantt had landed on his neck and bruised between the sixth and seventh region of the vertebra. The team doctor rode with him to the ER, then huddled with him in his hospital room. Coaches and staff visited. The prognosis was grim: Gantt was paralyzed from the chest down. He'd need a wheelchair for the rest of his life.

It took three years of rehab for Gantt, but eventually he returned to William and Mary, this time as a fan. It would have been easy to be bitter, to blame football, but that wasn't his manner. "It was a fluke," he says. "It wasn't going to stop me. I've been loyal to this team the whole time." Staying away from the game, he says, would have only made things worse." Read more

Chris Ballard, Sports Illustrated

Burger Joint With A Medical Plan? Yep.

We ran across two articles that tie together nicely. One was an article about how having a job does not equate to job satisfaction. The first tip for employers to reduce feelings of dissatisfaction among their staff:

Make retention efforts more visible.

That led nicely into the second article. It is about regional restaurant chain that agreed to pay at least 90% of health-care premiums for hourly employees who work at least 20 hours a week. Talk about a retention tool!

Burgerville's experience is notable for the food-service industry, where turnover is high and fewer than half of chains offer health insurance for part-time hourly employees, according to People Report, a research firm. The chains that do offer benefits pay on average 49% of the cost for employees working at least 30 hours a week, People Report says.

Burgerville's initiative "not only improves quality of service but it saves money by not having to replace staff as frequently," said Darren Tristano, executive vice president at Technomic Inc., a Chicago consulting and research firm for the food industry.

In absorbing more of the costs, Burgerville's annual health-care bill nearly doubled, to $4.1 million from $2.1 million. But company leaders figured the move would boost recruiting and retention.

Executives say the plan paid for itself, and more. Turnover in 2006 plunged to 54%, from 128% in 2005. That's a big deal when it costs an average of $1,700 to replace and train a restaurant worker, according to People Report.

Mr. Harvey believes part-time hourly employees work harder to qualify for more hours, which are assigned on a priority system based on performance. Burgerville says that work ethic translates into higher revenue. Sales rose 11% in 2006 after the plan was implemented.

Today, 98% of Burgerville's 579 eligible hourly employees and 97% of its 161 eligible salaried employees are enrolled in its health plans.

All without the 'help' of the federal government. Simply amazing.

Thanks to Scott for the Burgerville article

Get Out Of The Way

All we want is for the government to get out of the way...

(Click on image to enlarge it)

Michael Ramirez

Market Innovation Without Government Intervention

Visit msnbc.com for Breaking News, World News, and News about the Economy

"Never underestimate the power of the profit motive and competitive market forces to bring about real health care reform. The 1,200 retail health clinics across the country are providing high quality care at lower costs than emergency rooms or physician offices, and they offer better, faster service, with longer and more convenient hours than a traditional medical office (watch MSNBC video above).

While politicians sit around and have endless debates about how to bring down health care costs and expand access to medical care through various grandiose government interventions and programs, the private marketplace is already doing it - lowering costs and expanding access at more than 1,000 retail clinics. And unlike government-based health care reform, the explosion of affordable, convenient retail health clinics across the country didn't require any tax increases, government spending or funding, or special legislation.

Retail clinics truly could be the "model for the future" for health care reform. When it comes to lowering costs and improving quality and service, government enterprises have a miserable track record, and competitive markets have a proven, excellent record. Retail clinics are just one example of thousands of cases of how market competition results in bringing down costs and improving customer service."

Mark Perry

Health Care Reform? Just Get The Government Out Of The Way

In the midst of all the talk about a top-down overhaul and reworking of the health-care industry, supposedly to fix the failures of the private sector, two new studies show that the private sector could do a better job of reform if government would just get out of the way. Time Magazine features two Rand Corporation reports on the rise of a new phenomenon, retail health clinics, and the impact that price awareness and competition have on the market.

_________________________
The top-down reform proposed by
Congress threatens to stop real
reform and amplify everything that's
currently wrong with the system.
_________________________

Instead of hiding behind insurance co-pays, the clinics offer pricing up front to consumers, so that they can decide for themselves what to “buy” and how much they want to pay for service. This is the same mechanism that works to keep prices down and supply consistent in other areas of health care that insurance plans do not traditionally cover. For instance, cosmetic surgery and Lasik rely entirely on consumer compensation. There are no third-party payers to get in the way of rationally allocating resources to demand. In those markets, producers and consumers find each other in the normal manner, advertising, discounts, and price competition, and the market attracts new providers when scarcity appears and prices rise.

If we want to reform care, bend the cost curve downward, and promote supply in the health-care industry, we need to learn the lesson from retail health clinics. The top-down reform proposed by Congress threatens to stop real reform and amplify everything that's currently wrong with the system.

Edward Morrissey

FINAL SCORE

William & Mary...26
UVA.....................14

Wellpoint CEO Speaks Out

WellPoint CEO Angela Braly said in speech that by focusing on the insurance industry, those backing health reform are missing "a much bigger target" to lower costs. "Three cents of every health insurance premium dollar collected go toward insurer profits, while 87 cents go toward medical care," Braly said. And even if insurer's profits are "completely eliminated," the savings will only "pay for two days of healthcare in America."

Braly pointed out that Medicare spending "totaled $468 billion last year" and cited a study, which found that Medicare patients receive "evidence-based medicine, only about half the time. ... This inefficiency, she said, drives up costs and forms the 'crux of the problem.'" Braly added that she objects to the public option because its low reimbursement rates "would shift costs to private insurers," and families covered by private insurance "already pay about $2,500 per year" to make up for such care "provided by Medicare and Medicaid."

Duh! Increase In Coverage Increases Premium

"The House health bill would raise insurance premiums for seniors but save money for those who spend more on drugs, a CBO study found." So starts an article we recently ran across.

The House health bill wants to reduce the amount seniors pay out-of-pocket for drugs (which is an INCREASE in coverage). That is a noble desire in and of itself. But to pay for the increased coverage, you need to raise premiums.

CBO director Douglas Elmendorf "said Medicare recipients would pay less out of pocket for prescriptions under the legislation. But for those who do not spend as much annually on drugs, the changes could result in higher insurance premiums without any added benefits." The House bill "would increase drug insurance coverage under the Medicare Part D drug program by closing the 'doughnut hole.' ... While the proposed changes would lead to lower drug costs for some Medicare beneficiaries, the push to increase coverage would increase costs for drug and insurance companies, resulting in higher drug benefit premiums for seniors. The average premium would increase by approximately 5 percent in 2011 and by 20 percent over the next decade."

It like the analogy of squeezing one of those long balloons clowns use. If you squeeze one end of it, the other side get bigger. Duh.

Cut Costs Without Rationing Care By Putting Patient Back In Charge

"Decades of data confirm a simple truth: If we want to lower health costs, we need to put consumers back in charge. The greater the percentage that patients instead pay directly to their doctor out-of-pocket, the more patients are in charge.

Whether it's televisions, computers or Lasik eye surgery, when consumers are in charge, prices stay in check. In 1970, consumers paid for 62% of all privately purchased health care out-of-pocket. Today that percentage is just 26%.

_________________________

The only proven pursuer of value in American
medical care is the American consumer
_________________________

Where consumers have had the least control, costs have risen the most. As a study by one of the authors (Anderson) for the Pacific Research Institute study has shown, since 1970 the per-patient costs of Medicare and Medicaid have each risen one-third more than the combined per-patient costs of all other health care in America — the vast majority of which is purchased privately. And that's even without the Medicare prescription drug benefit.

So, how do we put consumers back in charge?
1. End the unfair tax on the uninsured. We should give tax credits to individuals and families who are uninsured or self-insured, thereby putting them on the same ground as those with employer-sponsored insurance.
2. Make it easier for consumers to see prices.
3. Encourage consumer-driven insurance models to give consumers skin in the game.

Unfortunately, the federal government currently limits the use of such incentives."

Tevi D. Troy and Jeffrey H. Anderson