Cavalcade of Risk #135: Call for submissions

NotWithStanding blog hosts next week's CavRisk. Entries are due by Monday (the 11th).

NB: We're now using this submission tool: The BC WorkAround

Once there, you'll be asked to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")

At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.

And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

Risk Management and Cell Phones

I have a long-running dispute discussion with a colleague regarding the argument that driving while talking on the cell is the same as drunk driving.

[ed: We have no disagreement vis: texting and driving - we both agree that this warrants the immediate application of the death penalty]

My take is that talking on the phone using a hands-free device is no more risky than listening (and talking back) to the radio, or to one's spouse in the passenger seat. Bill thinks that pretty much any use of the cell while driving is inherently more dangerous than either of those two activities.

So, who's right?

Well, score one for the good guys me:

"A comprehensive study on distracted driving has found there is no conclusive evidence that hands-free cell phone use while driving is any less risky than hand-held cell phone use ... there is no evidence that cell phone or texting bans have reduced crashes."

Is this dispositive? No, not really: the study itself contained enough contradictory findings that the case is still open. But it does recommend that states without such bans hold off a while before enacting them, which also tells you something.

CORRECTION: Bill M begs to disagree: He thinks that the study actually proves his point that there's really no difference between hand-held and hands-free in terms of risk, and that the study actually supports his position.

What say you, dear readers?

Food Pyramid Update: Pass the Salt!

(Yeah, we're old school like that)

Just two months ago, we noted a study of 4,000 Continentals and their intake of salt. The surprising results?

"People who ate lots of salt were not more likely to get high blood pressure, and were less likely to die of heart disease than those with a low salt intake ... The findings "certainly do not support the current recommendation to lower salt intake in the general population."

Now, one might be tempted to discount those results as a "one-off," but one would be wrong to do so. Researchers at Exeter University took a peek at "seven published studies involving 6,489 people. Some had high blood pressure, others had normal blood pressure and they had all been put on salt-reduction diets." Their results mirrored those of the one we cited in May:

"[T]he authors found that there was no evidence that cutting down reduced deaths or heart disease in either group."

In fact (and as noted in that previous study), folks who did cut back on their salt intake were actually more likely to die prematurely than those who didn't alter their diet.

Bon appetit!

Is this drug worth it? Is it rationing if the answer is "no"?

On July 1, the Wall Street Journal reported that Medicare had decided to cover Provenge, a new drug for treatment of advanced prostate cancer.

According to the article, men with advanced prostate cancer and treated with Provenge in clinical research lived a median of about 26 months, or about four months longer than patients who received a placebo.

Translated into English, this says half the Provenge patients lived at least 4 months longer than patients treated with sugar water. The other half lived fewer than 4 months longer.

The punch line is the cost--about $93,000 per course of treatment. (Not a typo.)

I have a question. Why shouldn't Medicare allow patients a choice between Provenge - and a cash payment of $50,000?

Why ask? Well, for starters because this drug delivers minimal benefit, patients might not want it especially if another option were available; the cash option might be a much more welcome way for the federales to help families cope with the loss of a loved one; having no choice means taxpayers will shoulder much higher costs; there's no telling WHAT Medicare was really thinking anyway; and the only party that clearly benefits seems to be Dendreon, the drug manufacturer.

So - is this drug worth it? Is it rationing if the answer is "no" ?

Are Hospital CEO's Overpaid?

Are Atlanta hospital CEO"s overpaid? Apparently an "investigative reporter" at the Atlanta Journal Constitution thinks so.

The AJC thinks is it important to know how much Atlanta hospital CEO"s are paid. My response is, who cares? If you believe paying execs less will solve problems in the health care system you must be on crack.

The reporter hopes to get you on his side by telling how hospitals are laying off workers and Georgia citizens are filing bankruptcy because they can't pay their medical bills. He wants you to believe jobs would be saved and people would be able to pay their hospital bill if the CEO's weren't so greedy.

I mean really.

Let's use the recently departed (for another job, not left this earth) Michael Young, CEO of Grady, as an example. The AJC reports his pay was $834,000 for the 623 bed hospital which translates into $900 per bed as his comp.

The author would have you believe this is excessive.

For some odd reason the reporter fails to consider the $22 MILLION in uncompensated care rendered by Grady.

If Young worked for free Grady would still have over $21,000,000 in uncompensated care and that number would probably go higher considering the excellent job Young did of turning Grady around from near bankruptcy to a profitable status.

And what about that $900 per bed figure? Spread over 365 days that is less than $3 per bed per day.

Give me a break!

Twelve of the 15 acute care hospital systems in metro Atlanta are exempt from taxes on more than $2.6 billion worth of property and equipment. They also escape millions in sales taxes and income taxes.

No one has calculated lost revenue from exempting some hospitals from paying taxes. The number is thought to be substantial, however. For example, Tenet Healthcare Corp., a for-profit system of five hospitals in Georgia, paid $10.1 million last year in local, state and federal taxes.

So for-profit is better than not-for-profit?

Common public belief is just the opposite. The lame stream media would have you believe the cost of health care and health insurance would drop precipitously if health care providers would escape the profit directive.

Many tax exempt hospitals also receive millions in government grants.

And where does the government get their money?

From taxpayers.

Taxpayers such as Tenet Healthcare. So it is a cycle. For profit hospitals pay taxes that are cycled back to not-for-profit hospitals . . . less the "vigor" collected by the government for reallocating the wealth.

In exchange (for non-profit statue), these hospitals are supposed to pursue a social mission — defined loosely as providing uncompensated care, medical training, research and community outreach.

But when their CEOs have salaries rivaling corporate executives, the charitable work is obscured by an apparent pursuit of profit,

But wait.

Most of the Atlanta hospital CEO's skewered in this report work for not-for-profit hospitals. So are the pursuing profits or not?

Does the reporter even know what a profit is? Does the reporter understand that not-for-profit does not mean they cannot pay a competitive wage?

I don't think this guy has a clue.

In fiscal 2009, John Fox of Emory Healthcare made $1,671,999 to manage Emory University Hospital and five associated institutions.

Tim Stack of Piedmont Healthcare, who manages Piedmont Hospital and three others, made $1,340,974 the same year. Piedmont announced last month it will cut 464 jobs, although the hospital system made $46 million above operating expenses in fiscal 2010 and $12.5 million in the first nine months of this fiscal year.

So what?

Emory generates $1 billion in revenues and has 8400 employees. At $1.6 million Mr. Fox's pay is less than 2 tenths of a percent of gross revenues and works out to $190 per employee under his management.

If Mr. Fox worked for $0 each employee could get a $190 annual raise.

The concept of criticizing CEO pay is totally illogical. And if you didn't have someone of that caliber overseeing the daily operations how soon before it failed? What is fair pay for a billion dollar organization with 8400 employees?

If you want to solve the health care problems it is not to be found in the pay scale of the CEO, nor in a discussion of for-profit vs. not-for-profit.

Roughly 80% of health care dollars are spent on chronic conditions and 70% of those conditions can be prevented or reversed with lifestyle changes. We are an obese nation that rarely exercises other than getting up from our chair to find new batteries for the remote.

The other problem is the way health insurance is designed. Health insurance pays over 85% of the cost of health care. Too many people believe they cannot afford to visit the doctor unless they have a copay, even though most copay's are roughly 70% of the cost of the actual visit.

We don't need health insurance for the little things, we need it for the big medical expenses.

We don't buy car insurance with copay's for tires, brakes and oil changes. Why do we think we need health insurance with a doctor copay when the average person see's a doctor less than 3 times per year?

Instead of focusing on CEO pay, someone needs to take a hard look at personal responsibility and leave the folks who keep the hospital doors open alone.

I dare say most who are critical of the pay afforded to CEO's would not be able to run a successful 1 person business much less one with hundreds of employees.

Those who can, do. Those who can't are simply jealous.

Colorado Burnin'...

Through the ObamaBux©, that is:

"The federally sanctioned high-risk insurance pool for Colorado is signing up fewer patients and burning through its limited cash faster than expected, as the plan attracts the sickest of the sick."

So let's get this straight: you set up a program specifically designed to attract uninsured folks, and are then surprised to learn that the overwhelming majority of them are uninsured because of chromic and/or severe medical problems? And are then further surprised when said programs racks up major costs because you've not only underpriced the plan, but then put it "on sale?"

As Bob says, "Poppa Washington: buncha rocket surgeons."

Friday LinkFest

■ First up, FoIB Jeff M tips us to some cancer-related good news/bad news:

"A group of new drugs is promising to prolong the lives and relieve the symptoms of men with advanced prostate cancer, but could also add billions of dollars to the nation’s medical bills."

In a sense, this is sauce for goose/gander, since we've already seen how politicized the battle over breast-cancer treatment Avastin became. These are, of course, valid and important debates to have, but we mustn't lose sight of the very real bottom line: peoples' lives are at stake.

■ Next, we consider the case of Dr. Susan Rutten Wasson. Is she a "renegade" or just ahead of the curve:

"[She's] a throwback to a time before HMOs, electronic health records and hospitals with fountains in their lobbies. She sees patients the same day they call if ... and usually charges only $50 for a consultation. She takes cash or check, but no insurance — and sometimes accepts gratuities of a dozen fresh eggs or a pie."

■ Finally, RandCorp's Lisa Sodders alerts us to a new Rand study on Medicare's new reporting thresholds:

"Effective January 1, 2012, Medicare will require insurers and self-insured companies to report settlements, awards, and judgments to a Medicare beneficiary to the Centers for Medicare and Medicaid Services."

Big Brother, or Concerned Agency?

You be the judge.