Cavalcade of Risk: Come to the Carnival

We’re hosting the latest Cavalcade of Risk, the blog “carnival” for insurance wonks like ourselves. As always, it’s an embarrassment of riches:

Joe Paduda hits us with the latest in his seven-part (so far) series entitled “Why universal coverage is bad.” (Spoiler: He doesn’t really think it’s bad.)

Ezra Klein points to a recent study that says electronic health records - which both he and I have been touting - may not be all they’re cracked up to be. (Although, as I point out here, that may well be the result of unimaginative design that fails to use digital tech to linked to the right knowledge bases.)

Leon Gettler has an interesting post on Climate change litigation risk at Sox First, saying, “Lawyers are cashing in on climate change and that’s creating a new field of litigation risk … Attorneys expect a bonanza of climate-related work tied to government regulation, lawsuits against energy companies and new markets that will trade the rights to emit carbon. Carbon trading will be a big market so that means plenty of litigation.”

David E. Williams presents Health Business Blog » Blog Archive » Veggie booty recall: Update posted at Health Business Blog, saying, “Can the makers of Veggie Booty pass the buck?” He also asks where the import problems with China fit into all of this.

Bob Laszewski has an excellent post on a new Rand study that suggests lower insurance premiums would not significantly reduce the ranks of the uninsured. I wrote about that study, too, with a slightly different angle - but Bob cuts right to the chase.

And as long as we’re talking about me … I also wrote about some interesting news on the Health IT front, and looked at the political fight in Florida over personal injury protection in auto insurance and its relationship to the health mandate issue.

Henry Stern, LUTCF, CBC presents USFL has left the Building posted at InsureBlog, saying, “SUMMARY: The market for “high risk” folks looking for life insurance just got a bit smaller.”

Jon Coppelman of Workers’ Comp Insider illustrates the risks that small businesses face if they don’t buy workers’ comp coverage. He calls the post “The Great Pizza Bust.”

Dmitriy Kruglyak offers two posts from the Institute For the Future conference (wish I had been there): one on People Powered Health Care and one announcing a new health summit.

At Health Affairs Blog, Rob Cunningham discusses the topic of unfair health care treatment as reported in the U.K. Whitehall studies, and asks: “Can anyone imagine the U.S. health policy community taking on the issue of fairness?”

egon presents Interesting Facts You May Not Know About Group Health Insurance Coverage posted at InsuranceHelpHub.com.

Louise at Colorado health Insurance Insider writes about Angelina Ortiz, who has asthma and requires meds costing $1200/month.

Penelope Trunk presents New research reveals some new ways to buy happiness, sort of posted at Brazen Careerist by Penelope Trunk, saying, “The tenuous relationship between money and happiness is examined.”

Jason Shafrin presents ESD: Louis Eeckhoudt at Healthcare Economist, saying, “Prudence is discussed in an economic micro theory context with an application to health.”

Leon Gettler presents Corporate risk gaps posted at Sox First, saying, “Companies might be skilled at handling credit, market and financial risk, but they are hopeless when dealing with emerging risk issues of climate change, holding on to talent, and terrorism, according to a new report.”

There’s another set of entries that focus more on personal finance, which isn’t my thing do I can’t comment much. They include:

Tomorrow Calling: News From the IT Front

There’s a flood of interesting news in the Health IT world.  Each item deserves its own extended entry.  Hopefully someday …

EHRs

A recent study suggests that electronic health records don’t improve ambulatory health care - at least not unless they’re designed to take advantage of the things IT can do better than paper records can. As one of the study’s leaders, Dr. Jeffrey Linder, observed:

“There’s nothing magical about electronic health records. You need to have tools in place that take advantage of technology to show improvements in quality. You need to do additional work instead of just turning on the computer.”

EHRs must be joined to other knowledge-driven technology in order to enhance medical care. First, however, we need to catch up with Europe. Primary care doctors there have better access to IT than do their counterparts in North America.

Web-Based Messaging

A pilot project at Kaiser Permanente indicates that linking doctors and patients with web-based messaging reduces the number of office visits. While project leaders expected younger, more tech-savvy enrollees to be the primary users, they were surprised to discover that older patients were enthusiastic users of the system. Their health needs, especially regarding chronic care, led them to make the most use of messaging. That’s good news for a country with an aging population.

Now the nation’s economic model has to catch up with the technology. Reducing office visits is fine for Kaiser, where doctors are on salary. Fee-for-service medicine will be a hostile environment for messaging as long as doctors are giving up their time to message and losing income in return. As I’ve said for a long time, insurers will need to come up with a fee schedule for online consultation - a nominal fee of, say $5 with no patient copay - in order for programs like this to succeed.

Technology With a Human Touch

Dr. Thomas Lee has written an interesting piece about the human/technology interface and its relevance to health IT. We’re of like mind. IT won’t change or enhance human behavior in the health care system (using “system” in the global, socio-economic sense) until its easier to use.

Speaking of which, I thought I had weathered the iPhone craze without sparking my own techno-lust. But I saw one at a friend’s house this weekend. I’m trying to fight the phenomenon of craving that it triggered.

Rapid Learning

And speaking of health as a system - a dynamic organization with inputs, outputs, and behaviors that are observable, predictable, and changeable - there’s an exciting (to me, anyway) special edition of Health Affairs on“Rapid Learning”: using information from current and future electronic sources to monitor the changing epidemiological and behavior picture in order to respond rapidly to changing patterns of disease and treatment.

I hope to write more about this in the future. In a related effort, the DHS recently joined with bloggers from across the political spectrum in a very smart attempt to mobilize blogs and other web-based resources to help in case a pandemic strikes. Their first effort was Pandemic Flu Awareness Week. Hopefully there will be more such enlightened efforts in the future.

And it’s nice to be able to praise the Feds for a change.

Tallahassee Sunset: Doctors vs. Insurers (and Mandates Again)

Health providers and auto insurers are headed for a head-on collision in Tallahassee over the scheduled “sunsetting” of a law that requires that every auto policy in the state include “PIP” - personal injury protection.

The PIP law is, in effect, a form of health mandate for auto insurance policies. It insures some level of coverage for medical treatment that results from an auto accident. The trade-off is that auto insurance is more expensive than it otherwise would be.

Although I’m not comfortable with mandated health coverage, I’m not opposed to mandatory PIP coverage. Here’s my reasoning:

1. The added cost of PIP is nothing like the cost of health insurance. Most families can afford it (State farm says it adds $360 per year on average) - and it’s worth it if there’s an accident.
2. Owning a car is a matter of choice. Owning a body is not. There’s not escaping mandated health coverage, but people can choose not to own a car if they don’t want to pay for auto insurance that includes PIP.

Hospitals and doctors oppose letting the PIP provision die. They would lose revenue, gain more collection problems, and struggle even more with uninsured medical treatment. Auto insurers want the sun to set on PIP, since that would make it easier to sell insurance while simplifying claims administration.

Purchasing Health Insurance: A New Angle on Supply and Demand

Here’s an interesting and thought-provoking study. A RAND project finds that cutting insurance premiums by as much as 50% wouldn’t significantly increase the number of Americans with health insurance. This USA Today article doesn’t go into details about methodology, so a lot of questions remain unanswered.

Presumably, even half of today’s high insurance rates represents a daunting number for many of today’s uninsured. If this study is correct, only 2% of those currently without coverage would purchase insurance after a 50% premium cut.

This study will provide fuel to both sides of the health policy debate. Those who support mandates to purchase private health insurance will use it to argue that many of the uninsured are simply irresponsible. Others (like me) will say that universal access to coverage should be either very affordable or free, and that requiring lower-income Americans to give private health insurers a large chunk of their income isn’t a fair solution.

Single-payer advocates can also use this report to reinforce their position, since it suggests that pricing private health insurance to fit middle-class budgets may be impossible.

Len Nichols, an economist USA Today describes as a “centrist,” said this:  ” “The humane thing to do is have subsidies for the low-income, and they’ll buy, and then mandate coverage for the immortals.”  By “immortals,” he’s referring to people who don’t believe they’ll get sick.  That sounds reasonable, except that policymakers in Massachusetts and elsewhere have shown a certain disregard for the real-life financial pressures of the middle class.  The people Dr. Nichols pejoratively calls “immortals” may, in fact, simply be worried about making ends meet.

Until more research is conducted, this study may have something to please - or discomfit - people on all sides of the health reform question.