Thursday Morning LinkFest

■ First up, FoIB Jeff M tips us to this rather sorry Tar Heel State of affairs:

"[North Carolina] one of the least competitive health insurance markets"

Apparently there are just two viable "competitors" left in the state, The Blues and UHC. And that's before ObamneyCare© goes into full effect.

■ Next, one of my favorite health policy wonks, Cato's Mike Cannon, pens a fascinating take-down of what we call ObamneyCare©. Here's a sample:

"During the initial debate over ObamaCare, House Speaker Nancy Pelosi (D-CA) famously said, “We have to pass [it] so you can find out what’s in it.” One irreverent heir to Hippocrates quipped, “That’s what I tell my patients when I ask them for a stool sample.” The similarities scarcely end there…"

■ And finally, we've posted quite a few times on the inherent tension between insurable interest, stranger owned life insurance, and life settlements. Now Sheriff Joe's adoptive home state is getting in on the act:

"The life settlement industry is welcoming a pair of recent Delaware Supreme Court decisions ... the court has affirmed the common law ability of a legally insured person or insurable trust to sell a policy on that person's life for market value."

There are the usual caveats, but at last we're seeing a bit of common sense being brought to the subject.

Another LTCi rate hike on the way?

The next shoe is apparently about to drop in the Long Term Care insurance market. According to a source, MassMutual is set to announce a rate hike on new business for 2012.

It's not anticipated that this will affect in-force policies, but folks "on the fence" may want to pull that trigger sooner than later.

Can't say this is unanticipated, according to email:

"[MassMutual] LTC business exploded in 2011 due to the changing marketplace. While MassM wants to be competitive, we do not want to be a low price leader. That tends to attract excess business that may not be as desirable as slower, steady growth."

In other words, if you're looking to buy business, you're going to get burned.

I don't think that this is a particularly bad move on MassMutual's part: we're going to see rate increases more and more often now, as Boomers hit their mid-60's and look for ways to protect their assets. Being out front of the wave is a good way to avoid drowning.

Cavalcade of Risk #143: It's a Beautiful Day in the Neighborhood Edition

Julie Ferguson channels her inner toddler to bring us this week's fun and insightful Cavalcade of Risk. Button up your cardigans and enjoy!

BTW: We're now scheduling for late 2011/early 2012. Hosting is fun and easy, just drop us a line to grab yours.

The Facts Can Set Us Free

[From time to time, we offer posts from guest bloggers with particular expertise. Today, we're pleased to offer this contribution from certified Project Management Professional (PMP) Gail Stern. In it, she proposes a solution to one of the more vexing problems of the current PCIP (Pre-existing Condition Insurance Plan) model: the fact that there is no (current) way to verify the insurance status of any given individual.

As a side note, this solution could also provide factual confirmation of one other data point of contention. Can you guess what that is?]

I’m an IT Infrastructure Project Manager, so a good portion of my professional time is spent documenting and communicating facts on which my Customers and Teams agree. These include tasks my projects will accomplish (as well as those already completed), the issues a Project Team encounters and how they will be resolved. Working within IT Infrastructure means that the projects I manage to successful completion are in support of software that enables a corporation’s mission and is used by a corporation’s customers and associates.

Almost 30 years of marriage to The Professor means that I hear about the challenges of finding affordable health insurance (NOT health care) for the citizens of our Great Country.

My greatest and most valuable skill as a leader of, and guide to, my Project Teams is my ability to ask probing questions. So here it is –

WHEN will Insurance Carriers begin feeding some very simple information into a current information storehouse that will contain the FACTS about whether an American has private insurance coverage?

Proposed Project Charter – creation of a Warehouse of Insurance Coverage Data (WICD) that would validate the health insurance coverage status of every American.

Justification –

1.Valid and current information would make available the FACTS about who is privately insured and who is not. Availability of WICD is no guarantee that this information would be used by the right people (AKA State Employees, State and Federal Legislators and The Press, all of whom are so fond of using un-validated information as facts), but it’s a start. I know, it’s a blue sky thought. But if we could speak consistently about using available facts, it’s support for the right direction.

2.To make WICD available would be a mighty task of cooperation amongst Carriers, and a huge technical challenge to make correct information flow on a regular basis.

A gut level sizing of such a venture would start with documenting requirements; determining and communicating design; communicating with stakeholders at all levels; selling the value of such a cooperative effort to Carriers and the benefits to Legislators and The Press; acquiring funding; and hiring Project Staff (at a minimum: IT Architects; Software and Human Factors Engineers; Hardware, OS, Database, Network, and Storage Engineers; data center Support Staff; Project Managers; Testing Coordinators; Technical and Business Testers; Training Coordinators; Trainers; Procurement Professionals; Communication Staff). With executable plans in place, the first release of WICD might be ready by November 2016 if we started today.

Carrier scope must be nationwide, and given the current ease of running IT Projects with geographically distributed project resources, project staff could reside in any state, which implies NATIONWIDE EMPLOYMENT. And that’s just to get WICD built. To keep it operating acceptably will require a staff of Skilled Software, Hardware, and Support Engineers and Communicators, because to keep people and systems talking is an ongoing support challenge. Who knows what the follow-on enhancements would include.

3. Data scope would be simple – include only information that uniquely identifies each citizen and their health insurance coverage status. Personal and private health information is arguably irrelevant.

4. The begging questions that WICD would satisfy: WHY isn’t this information available for validation today? Without it, My State is mandated to offer tax-subsidized health insurance coverage to anyone who says they’ve not had health insurance coverage for the past six months. Does My State trust and verify? No, because there is no vehicle today that enables this.

My proposal is to make simple FACTS widely available in a current, straightforward way. Without this, My Tax Dollars are being wasted.

Why is this not available today? I think I know why – no one is selling the importance of making this a priority. The issue of available dollars, people, and time are secondary to selling how relevant and valuable this system could be, and to whom.

I’ve never run a project that wasn’t fraught constantly with politics that had to be managed to enable successful project completion. Stakeholder approval of a project charter, and support and cooperation to manage and deliver that charter are the keys to overcoming the politics. Easy is not the operative word; relevance, cooperation and support are.

Thanks, Gail, for sharing your insights and expertise on a crucial subject, and Congratulations on your debut Guest Post.

That Giant Sucking Sound

That giant sucking sound you hear is Social Security circling the drain. With more than 60 million on Social Security and another 10,000 baby boomers each day reaching retirement age, the drain on Social Security is taking its' toll.Years of borrowing against the "trust fund" by members of Congress have nearly depleted the reserve. Last year Social Security went negative for the first time in 30 years.

Social Security is sucking money out of the Treasury. This year, it will add a projected $46 billion to the nation’s budget problems, according to projections by system trustees. Replacing cash lost to a one-year payroll tax holiday will require an additional $105 billion. If the payroll tax break is expanded next year, as President Obama has proposed, Social Security will need an extra $267 billion to pay promised benefits.

Running on fumes.

Wonder what happened to the bi-partisan debt reduction report compiled by Erskine Bowles and Alan Simpson?

Obama ignored the Social Security blueprint put forth by his own bipartisan panel on debt reduction. During this summer’s debt-limit showdown, he endorsed the panel’s proposal to tie future benefits to a less-generous inflation index. But Obama took that idea off the table in September when he submitted recommendations to a special debt-reduction “supercommittee” now at work on Capitol Hill. Until recently, members of the supercommittee said, Social Security had rarely come up in their closed deliberations.

Makes you wonder if anyone up there has a clue what they are doing.

The $2.6 trillion Social Security trust fund will provide little relief. The government has borrowed every cent and now must raise taxes, cut spending or borrow more heavily from outside investors to keep benefit checks flowing.

Robbing Peter to pay Paul.

Senate Majority Leader Harry M. Reid (D-Nev.), who is fighting to maintain control of the Senate, has been particularly outspoken. In March, as a bipartisan group of six senators was gaining attention for a push to draft a debt-reduction plan that included a Social Security fix, Reid summoned hundreds of activists to a rally on Capitol Hill. Fresh off a tough reelection campaign that turned in his favor after he accused his tea party opponent of wanting to “wipe out” Social Security, Reid exhorted policymakers to “leave Social Security alone.”

“Let’s worry about Social Security when it’s a problem. Today, it is not a problem,” Reid said to applause.

Heads up Harry. It's a problem now.

The average age for claiming Social Security benefits dropped from 68 in 1940 to 63 in 1980, where it remains. Meanwhile, average life expectancy has risen by five years. The average worker spends 20 years drawing benefits. A quarter will see their 90th birthday.

As a result, the average retirees have gotten back far more in federal benefits than they paid into the system during their working life, according to research by Eugene Steuerle, a senior fellow at the Urban Institute. That return is diminishing, in part because people today have paid more into the system than previous generations. But a two-earner, middle-income couple retiring this year can expect to get $913,000 in Social Security and Medicare benefits over their lifetimes, in return for $717,000 in payroll taxes.

The younger generation will never see that kind of return on their "deposit".

Certner, of the AARP, said it is unfair to cut Social Security benefits to solve that problem.

“The federal government is saying, ‘We’re in the red right now and we’re having trouble paying back Social Security, so we’d like to cut Social Security benefits,’ ” Certner said. “But that’s not the deal.”

Others argue that the deal has long since been abandoned and that the trust fund has become a fiction of accounting. “We can debate until the cows come home whether there’s really a trust fund or not,” said Olivia Mitchell, a professor at the University of Pennsylvania’s Wharton School who served on a 2001 presidential commission to study Social Security. “But the fact is, there’s no money available to pay for those benefits. And the system is short on cash now.”

To the folks at AARP, here is a clue.

You were lied to, now deal with it.

Of course it is time for AARP to stop lying to their members and other seniors. The proposed changes to Social Security would not impact those currently receiving benefits. Most of the plans only impact those currently under age 55.

So stop with the scare tactics.

Shoe Tags

Paul Simon sang about diamonds on the soles of her shoes. Has a much different ring than GPS on the soles of your shoes.

Sixty percent of Alzheimer’s patients will wander away from home at some point over the course of the disease. Finding them quickly is critical as the risk of death or injury goes up considerably after 24 hours.

But now there’s a new device among a growing number of products designed to keep track of our wandering loved ones.

Two companies, GTX and Aetrex Worldwide, are collaborating to release a shoe with GPS tracking capability.

Sounds like a winner, but no Grammy candidate.

Grand Rounds: ACO edition

David Williams hosts this week's interesting collection of medblog posts, focusing on the timely topic of Accountable Care Organizations (ACO's).