Biggest Life Insurance in US

The life insurance market in the United States is both massive and highly competitive. In 2014, roughly 180 million Americans carried some form of life insurance. In the same year, more than 900 life insurers reported a total of nearly $147 billion worth of direct premiums written across the country.
The single biggest life insurer in the U.S., MetLife Inc., reported $11.3 billion in written premiums and market share of nearly 7.7%. Three other insurers, Northwestern Mutual, New York Life and Prudential Financial, Inc., managed to capture more than 5% of the market and more than $7 billion in written premiums apiece. Even the forty-ninth ranked company, Allstate Insurance, reported more than $711 million in written premiums on market share of only 0.5%.

MetLife
MetLife, Inc. (NYSE: MET) is the biggest life insurance company in the U.S. as of 2015. It reported nearly $11.3 billion in written premiums in the domestic market, which amounts to a market share of 7.66%. MetLife wrote additional life insurance premiums in foreign markets that amounted to just under $1 billion, making it one of the few companies in this list with a substantial life insurance business abroad.

MetLife ranks among the world's largest companies in any industry, reporting consolidated revenue of $73.3 billion in 2014. The company offers a variety of insurance products, annuities, employee benefits programs and asset management services. It has operations in nearly 50 countries and counts more than 100 million customers worldwide. MetLife has a market capitalization of about $56 billion.

Northwestern Mutual
Northwestern Mutual Life Insurance Company reported more than $9.5 billion in written life insurance premiums in 2014, giving it nearly 6.5% of the American market. In addition to its life insurance and other insurance products, the company offers annuities, investment products and financial planning services. Northwestern Mutual reported about $26.7 billion in consolidated revenue in 2014.

As a mutual insurance company, Northwestern Mutual is managed for the benefit of policyholders rather than stockholders. Policyholder dividends amounted to $5.5 billion in 2014, nearly $5 billion of which was paid out to life insurance policyholders. Of those dividend payments, about 75% was used to purchase further Northwestern Mutual insurance protection.

New York Life
New York Life Insurance Company wrote about $8.2 billion in domestic life insurance premiums in 2014, which amounts to approximately 5.6% of the market. Apart from its life insurance business, New York Life also sells long-term care insurance, annuities and mutual funds, and it operates a growing investment management business.

New York Life is a mutual insurance company, and it is not publicly traded. It ranked as the largest mutual life insurance company in the country as measured by consolidated revenue, which amounted to about $38.7 billion in 2014. Policyholder dividends amounted to nearly $1.45 billion in the same year, of which about $1.4 billion was paid to individual life insurance policyholders.

Prudential
Prudential Financial, Inc. (NYSE: PRU) is the fourth-biggest life insurance company in the U.S. It is a publicly traded financial services conglomerate offering insurance products, annuities, mutual funds, investment management services and other products. The company operates in 43 countries in North and South America, Europe and Asia.

Prudential's life insurance business was responsible for more than $7.7 billion in direct written premiums in the U.S. in 2014, which was good for nearly 5.3% of the market. The company's worldwide consolidated revenue was $49.6 billion in the same year. It has a market capitalization of $36.4 billion.

Lincoln National
Lincoln National Corp. (NYSE: LNC) is a financial services company offering life insurance products, long-term care insurance products, annuities and retirement plan services to 17 million American customers. It does not operate outside the U.S. The company and its subsidiaries are marketed to consumers under the Lincoln Financial Group brand.

Lincoln National reported $6.44 billion in written life insurance premiums in 2014, which amounts to about 4.4% of the total market share. Its consolidated revenue amounted to more than $13.7 billion on the year, an increase of more than 13% over the prior year. Lincoln National has a market capitalization of $12.7 billion.

MassMutual
Massachusetts Mutual Life Insurance Company, known as MassMutual, is the sixth-biggest life insurer in the U.S. and the third mutual company on this list. It reported nearly $5.6 billion in direct written life insurance premiums in 2014, giving it a market share of 3.8%. The company also offers annuities, long-term care and disability income insurance, and wealth management and investment services. MassMutual reported consolidated revenue of about $26.4 billion in 2014. It paid eligible policyholders dividends of more than $1.5 billion in the same year, an increase of 5% over the previous year.

John Hancock
John Hancock Financial has operated as a wholly owned subsidiary of the Canadian insurance giant, Manulife Financial Corp. (NYSE: MFC), since the companies merged in 2004. In addition to life insurance policies, the company offers long-term care insurance policies, mutual funds, and retirement and college savings plans. It remains headquartered in Boston, Massachusetts, as it has been for the last 150 years.

John Hancock wrote $4.71 billion in written life insurance premiums in 2014, which amounts to 3.2% of the U.S. market. Manulife Financial reported $28.9 billion in total revenue for John Hancock operations in the U.S. in 2014. Manulife Financial has a market capitalization of $32.4 billion.

Transamerica
While Transamerica Corporation was established in San Francisco in 1930, it has operated as a wholly owned subsidiary of the Dutch life insurance company, Aegon N.V, since its takeover in 1999. In addition to life insurance products, Transamerica offers long-term care insurance, annuities, mutual funds and pension plans.

Transamerica was responsible for $4.38 billion in written life insurance premiums in the U.S. in 2014, amounting to market share of about 3%. Aegon reported total revenue of nearly $17.5 billion for its North American and Latin American business unit, which is dominated by the Transunion operations in the U.S. Aegon has a market capitalization of about $13 billion.

Top 10 Auto Insurance

“I am prepared for the worst, but hope for the best.” ~ Benjamin Disraeli
Insurance helps us to do exactly what this quote suggests. We all face many kinds of risks: risk of meeting with an accident, falling sick, being a victim of a natural disaster or fire, and above all risk of life. All these risks not only come with pain and suffering but also hurt financially. Insurance is one way of being prepared for the worst; it offers the surety that the economic part of the pain will be taken care of. In this article, we take a look at some of the top insurance companies. There are many criteria on the basis of which such a list can be prepared: premium collections, market capitalization, revenue, profit, geographical area, assets and more. The following list focuses on a number of factors and the insurance companies on it are in no particular order.

1) AXA
With over 102 million customers in 56 countries and an employee base of 157,000, AXA is one of the world's leading insurance groups. Its main businesses are property and casualty insurance, life insurance, saving and asset management. Its origin goes back to 1817 when several insurance companies merged to create AXA. The company is headquartered in Paris and has a presence across Africa, North America, Central and South America, Asia Pacific, Europe and the Middle East.

In 2013, AXA as a move to increase its foothold in Latin America acquired 51% of the insurance operations of Colpatria Seguros in Colombia. During the same year, AXA became the largest international insurer operating in China as a result of its 50% acquisition of Tian Ping (a Chinese property and casualty insurer). In addition, the company acquired the non-life insurance operations of HSBC in Mexico. The AXA Group reported total revenues of €99 billion for fiscal year 2015.

2) Zurich Insurance Group
Zurich Insurance Group, a Switzerland-headquartered global insurance company, was founded in 1872. Zurich Group, together with its subsidiaries, operates in more than 170 countries, providing insurance products and services. The core businesses of Zurich include general insurance, global life and farmers insurance. With its employee strength of over 55,000, Zurich caters to the vast insurance needs of individuals and businesses of all sizes: small, mid-sized and large-sized companies and even multinational corporations.

Total revenues in 2015 were $60.568 billion.

3) China Life Insurance
China Life Insurance (Group) Company (LFC) is one of Mainland China’s largest state-owned insurance and financial services companies, as well as a key player in the Chinese capital market as an institutional investor. The origin of the company goes back to 1949 when the People's Insurance Company of China (PICC) was formed. Its offshoot PICC (Life) Co. Ltd was created after parting ways with PICC in 1996. PICC (Life) Co. Ltd was renamed as China Life Insurance Company in 1999. The China Life Insurance Company was restructured in 2003 as China Life Insurance (Group) Company, which has seven subsidiaries. The businesses are spread across life insurance, pension plans, asset management, property and casualty, investment holdings and overseas operations.

The company is listed on the New York Stock Exchange, the Hong Kong Stock Exchange and the Shanghai Stock Exchange, and is the biggest public life insurance company in terms of market capitalization in the world.

4) Berkshire Hathaway
Berkshire Hathaway Inc. (BRK.A) was founded in 1889 and is associated with Warren Buffet, who has transformed a mediocre entity into one of the largest companies in the world. Berkshire Hathaway is now a leading investment manager conglomerate, engaging in insurance, among other sectors such as rail transportation, finance, utilities and energy, manufacturing, services and retailing through its subsidiaries.

It provides primary insurance, as well as reinsurance of property and casualty risks. Companies like Berkshire Hathaway Reinsurance Group, GEICO, Berkshire Hathaway Primary Group, and General Re, National Indemnity Company, Medical Protective Company, Applied Underwriters, U.S. Liability Insurance Company, Central States Indemnity Company and the Guard Insurance Group are subsidiaries of the group.

5) Prudential plc
Prudential plc (PUK) is an insurance and financial services brand with operations catering to 24 million customers across Asia, the U.S., the U.K and most recently Africa. Prudential was founded in United Kingdom in 1848. Prudential Corporation Asia, Prudential U.K., Jackson National Life Insurance Company and M&G Investments are the main businesses within the group. Jackson is a prominent insurance company in the United States, while Prudential U.K. is one of the leading providers of pension and life.

Prudential plc is listed on the stock exchanges of London, Hong Kong, Singapore and New York. It has approximately 22,308 employees worldwide, with assets under management worth £509 billion.

6) United Heath Group
The UnitedHealth Group Inc. (UNH) tops the list of diversified health care businesses in the United States. Its two business platforms - UnitedHealthcare for health benefits and Optum for health services - work together, serving more than 85 million people in every U.S. state and 125 countries. The UnitedHealth Group uses its experience and resources in clinical care to improve the performance of the health care services sector.

The company reported revenue of $157.1 billion in 2015. Fortune has featured UnitedHealth Group as the "World’s Most Admired Company" in the insurance and managed care sector six years in a row.

7) Munich Re Group
Founded in 1880, Munich Re Group operates in all lines of insurance and has a presence in 30 countries, with focus a on Asia and Europe. The company’s primary insurance operations are carried out by its subsidiary, ERGO Insurance Group, which offers a comprehensive range of insurance, services and provision. Munich Re Group's home market is Germany, where ERGO is a leader in all areas of insurance. The group's newest arm, Munich Health, parlays the group’s risk-management and insurance expertise into the health care field.

The group has around 45,000 employees worldwide, working in all businesses of insurance: life reinsurance, health reinsurance, accident reinsurance, liability business, motor reinsurance, property-casualty business, marine reinsurance, aviation reinsurance and fire reinsurance. The Munich Re Group reported a profit of €3.1 billion in 2015.

8) Assicurazioni Generali S.p.A.
Assicurazioni Generali, founded in 1831, is the Assicurazioni Generali Group’s parent company. The Generali Group is not only a market leader in Italy, but is also counted as a prominent player in the field of global insurance and financial products. The group, with a presence in more than 60 countries, is an international brand with dominance in Western, Central and Eastern Europe. The Generali Group’s prime focus has been life insurance, offering diverse products from family protection and savings polices to unit-linked insurance plans. It offers an equally diverse range of products in the non-life segment as well, such as coverage of car, home, accident, and health, along with coverage of commercial and industrial risk.

The group has 77,000 employees and a client base of 65 million people worldwide. It has €480 billion in assets under management and is one of the world's 50 largest companies.

9) Japan Post Holding Co., Ltd.
The Japan Post Holding Co., Ltd. is a major state-owned conglomerate in Japan. The company has four primary divisions: Japan Post Service (for mail delivery), Japan Post Network (runs the post offices), Japan Post Bank (deals with banking functions), and Japan Post Insurance (provides life insurance). Japan Post Insurance operates within Japan Post Holding to provide insurance to its clients. The insurance arm makes use of the post offices nationwide network, in addition to its own sales offices, to reach out and provide services to the clients.

Japan Post Holding, which went public in 2015, reported consolidated after-tax profits of $3.84 billion from April through December of 2015. The group runs the largest insurer in Japan (Japan Post Insurance).

10) Allianz SE
Founded in 1890, Allianz SE is a leading financial services company, providing products and services from insurance to asset management. Allianz caters to customers in more than 70 countries with €1.8 billion in assets under management. Insurance products range from property and casualty products to health and life insurance products for corporate and individual customers. The company is headquartered in Germany.

In 2015, total revenues reached a new high of €125.2 billion euros.

Friday Health Links

■ Bwahahaha!

"Long term vegetarianism can lead to genetic mutations which raise the risk of heart disease and cancer, scientists have found."

Pretty much says it all, no?

■ FoIB Holly R alerts us to a Cincinnati-area company that's developed some rather promising new tech:

"Aprecia Pharmaceuticals are making a strong pitch with doctors ... launched production last week of its 3D printed pill, the first such pill approved by the FDA."

The med in question is used to treat epilepsy; the primary advantage to using the 3D tech seems to be better disolvability, although one would think that lower manufacturing costs must play a role, as well.

■ And speaking of 3D printing tech; It's widely believed (understood?) that one's attitude can have a very real affect on how a disease progresses. A Detroit hospital is taking that idea one step further:

"Cancer patients at a Detroit hospital can now take out their aggression on their disease— with a sledgehammer"

Click on through to read how they did that.

Cleveland Special

As in "Special Event," and specifically Special Event Insurance, about which we first wrote 9½ years ago:

"World Furniture Mall "promised that if the Bears shut out the Packers in the season opener at Lambeau Field in Green Bay, Labor Day weekend shoppers would get their furniture free."

Fortunately, the folks at WFM had purchased a one-off policy that paid most (all?) of the $300,000 at risk.

What's that got to do with Cleveland, you ask? It's not as if the Browns are in particular danger of winning any championships anytime soon, so why bring it up?

Well, folks following the presidential campaign know that this year's Republican convention takes place in "The Rock and Roll Capital of the World," and that this means a lot of out-of-towners, including revelers, and others. Unlike the Green Bay scenario, such a policy isn't exactly available off-the-shelf. So the city has hired a "risk consultant" (why not just say "broker?") to arrange for "a $10 million insurance policy, required under the terms of Cleveland's hosting of the convention."

I of course have zero idea how much such a policy will cost, but assume that the premium will involve at least a comma or two. Which also (presumably) means a nice commission check - that is, unless the upfront $1½ million brokerage fee already takes care of that.

Oh, what will this particular special event policy cover?

Good question:

"The policy would protect the city and its employees against any claims resulting from hosting and providing security for the convention."

Which is a nicer way of saying "protecting the financial interests of these security folks when they have to handle protesters."

Mayor Daley must be spinning furiously.

[Hat Tip: Mark Naymik]

From the P&C Files: Fully Automatic Insurance Tricks

Back in Aught Seven, we noted the passing of "Evel" Knievel, whose life previous to stuntsmanship included a stint as a very successful life insurance agent. Now comes an interesting story about one John Herbert Dillinger who, when he wasn't robbing banks and/or murdering folks, also took on the role of insurance agent.

Sort of:

"Dillinger and one of his accomplices posed as an insurance agent and asked police to lay out their guns so he could give them a quote."

This was back in 1933; Mr D and his crew used the review as an excuse to "case the joint," and returned that evening to steal his infamous "Tommy gun."

The story doesn't indicate whether or not the claim (if any) was denied.

Talk about an insurance rip-off.

Silly HSA Tricks

Over at LifeHealthPro, Michael Thomas reports on new legislation being proposed that seeks to update Health Savings Accounts. He does a great job of introducing the background and history of HSA's, and provides a helpful explication of this new initiative. It's a very well-done piece.

That being said, the legislation itself is stupid. It goes off in myriad directions, focuses on non-essential "benefits," and misses the opportunity to actually accomplish something useful.

The purported purpose is to expand eligibility for purchasing and definitions of acceptable distributions (expenses). As to the first, the law "allows Medicare recipients participating in Medicare Advantage MSAs to contribute their own money to Medicare Medical Savings Accounts" which they're currently prohibited from doing. Why is this stupid? Well, go find me an example of a carrier that currently even offers one of these plans.

I'll wait.

In a related section, the legislation "amends the existing law to reauthorize health opportunity accounts in Medicaid as a demonstration program." What, you didn't know that there was such a program in the first place? Don't feel too bad, the original pilot program was such a rousing success that "South Carolina was the only state applying for and approved to participate" in it, and at its peak had enrolled "only two adults and three children."

Winning!

There are a few decent ideas here: allowing one to buy over-the-counter meds with HSA funds, ducking some of the more onerous Cadillac tax issues. But they are far outweighed by the silliness of allowing "fitness programs" and dietary supplements as legit. I do recall, years ago, being asked if a hot tub qualified (the insured in question has back issues). Maybe this is the answer.

What does it miss? Access.

What do you mean, Henry?

Just this: why must HSA's be tied to a specific type of insurance plan? IRA's don't require you to have a certain job, or tie you to a specific investment plan. Why should HSA's (which are really just medical IRA's)? And why not expand the amount one can contribute? After all, if the idea is to really bend that health care cost curve down, doesn't it make sense to give folks even more opportunity to put their own skin in the game?

Sigh.

On "Losing" a Client

So I lost a client yesterday, and that's a good thing.

I wrote Sue's health insurance a year or so ago; her husband's on Medicare, so it was just her. She chose an Anthem Gold-level plan, and has been reasonably satisfied with it. A month or so ago she and her husband moved to Texas and asked me for help with notifying Anthem of their address change.

I pointed out that, although Anthem's BlueCard program would offer some relief, pretty much every claim she has going forward is going to be treated as out-of-network (at least initially). Plus, there may be better and/or less expensive options available in her new town. Finally, I'm a big believer in local agents, and so I offered to help her find one.

As usual, I turned to my "posse" (a loose-knit collection of fellow agents around the country whom I've been fortunate enough to "meet" over the years). Alas, I could find no one in her area. When I called to tell her this, she mentioned that her new auto/home insurance agent had recommended someone that he knew. I told her to jump on that right away: from the insured's standpoint, that's one of the very best types of referral.

Why's that, you ask?

It's a matter of simple self-interest: if the agent recommends someone whom he's not vetted and the client has a bad experience, that client's going to blame the initial agent. No one wants to take that chance, so these kinds of referrals are generally rock solid.

I offered to speak with the new guy to answer any questions about her existing coverage (it's what I do), and we did, in fact, touch base. He seemed like a nice, professional, knowledgeable guy, who'd actually found a comparable local plan with a lower rate for her.

So, a happy ending all around.

Monday LinkFest

■ First up, seven (just seven??) ways The ObamaTax has let us down. A sampling:

"1. Low enrollment. Many people would not have jumped on the Obamacare bandwagon if they had known the relatively small number of Americans who would actually be enrolled on the exchanges by 2016.

4. Lost plans. Speaking in the Rose Garden, on July 21, 2009, President Obama said, “If you like your current plan, you will be able to keep it."

Yeah, how's that working out?

■ Speaking of low enrollment, the Congressional Budget Office (CBO) has once again slashed its estimate for 2016 ObamaPlan enrollment:

"About 12 million people are now expected to have ObamaCare coverage by the end of 2016 ... Just three months ago, the office had predicted that 13 million people would have coverage."

Any bets on when it's revised downward again?

■ And now, 1,000 words neatly summarizing the two items above:

A Piping Hot Cup of ObamaCare

[Hat Tip: Ʀєfùsєηíκ]

When will they learn?

Of course, that question pre-supposes that ObamaTax proponents want to learn, of which there is scant evidence.

What makes me so skeptical?

Here:

"More people will get insured through the Medicaid expansion ... because they now see slower wage and salary growth in the future, meaning that more people will be eligible for the low-income health program."

See the problem here?

People do not "get insured" through Medicaid. They receive medical care entirely paid for by someone else. There are no deductibles, or co-insurance or premiums, and, to drive the point home, one cannot "buy" a Medicaid "policy."

It is simply income redistribution, period (NTTAWWT).

And there's a corollary effect:

"[M]ore will get insured through Medicaid, fewer are expected to get coverage through the exchanges."

As the insured population plummets, insurance companies are enrolling fewer and fewer paying customers, and of course those that do pony up are getting less and less bang for their buck as out-of-pocket costs continue to rise.

Happy days, indeed.

[Hat Tip: Ʀєfùsєηíκ]

Interesting point

Work: If you miss work you must have a doctor's excuse!
Me: I just have a stomach bug.
Work: MANDATORY!

Work: Why is insurance so costly!!

— Chad Felix Greene (@chadfelixg) March 23, 2016

Waste, Fraud and Abuse CMS Style

Politicians love to talk about how they will eliminate waste, fraud and abuse if you will only elect them to office. If you are one of those who believe the folks in DC have their own WFA Task Force you

would be mistaken.

When it comes to Medicare, John Minnino, Esq. has come up with a way to beat the CMS cops at their own game.

By using statistical analysis, Mr. Minnino has identified 5 "red flags" that indicate a strong possibility of Medicare fraud.

In 2014 prosecutions initiated by the government led to a mere 31 settlements yielding $88 million in fines. 

In 2014 there were 469 of these (whistle blower) health care fraud settlements—many involving huge pharmaceutical corporations and hospital networks—resulting in $2.2 billion in fines.- Wired

Makes you wonder what the CMS cops are really doing to eliminate fraud.

Maybe a better use of taxpayer dollars is to fire the folks at CMS responsible for policing fraud and let private citizens acting as bounty hunters do the job.

Whistle blowers typically receive 15 - 30% of the settlement as their cut.


#MedicareFraud  #WasteFraudAbuse

Health Wonk Review: ObamaTax Anniversary Edition

Charles Gaba makes his (impressive) hosting debut with this week's informative roundup of health care policy and policy. His very sly (and much appreciated) sense of humor is on display, as well; this one's just a joy to read.

Thanks, Charles, and kudos on a great 'Review!

Joe Garagiola 1926 - 2016

Baseball is a funny game.

But not today.

Happy ObamaTax-iversary!

In case you'd forgotten (heh!), today marks the 6th anniversary of the date on which ObamaCare began to be implemented.

'Nuff said.

UPDATE: via our friend Rich W, here are five charts showing ObamaCare's "success."

PARE-ing Back?

Our friend Louise Norris has written about the issue of balance billing, and advocates its (eventual) eradication. While she's a very thoughtful agent and writer, I take issue with her premise and her solution(s). Regular IB readers know all about PARE claims (these are typically the kinds of providers who join no networks and so bill pretty much whatever they want) and why they usually result in a balance due after insurance pays its part. What Louise and others advocate is forcing those providers to accept whatever an insurance carrier deems appropriate, and eat any difference.

Which sounds rather noble, until one looks at how that's handled currently, and what expansion would entail. Thanks to co-blogger Bob, we have access to a report from the Robert Wood Johnson Foundation (hardly a right-leaning outfit) which gives us an overview of how a handful of states currently handle the issue.

To our knowledge, balance billing isn't really an issue for life-threatening emergency claims; all 58 states offer at least some protection in that scenario. Where it gets dicey are non-emergency situations, and whether one's plan is a PPO or HMO model.

According to the folks at RWJF, there really isn't a lot of "there there" when it comes to how the states they surveyed handled these situations. All banned the practice for emergency situations (as do all the other states). Some applied this to both HMO's and PPO's; Florida really only locked down HMO's.

Interestingly, some states only apply the ban to providers that have previously agreed to accept assignment of benefits from the insurance carrier (which makes sense, really). If interested, details are available in that report.

But here's the rub: so what? Two things are in play here, neither of which are good: for one, as co-blogger Patrick notes "several states prohibit balance billing and we work with clients on claims where this occurs and used to have a 100% success rate of having these charges written off. Along comes ACA and now insurers say too bad."

Does anyone seriously think that's going to improve by extending it to non-emergency expenses?

And second, how do we force non-participating providers to accept less than what they've billed? This is the kind of thing that helped to create the whole Direct Primary Care movement; that is, when the insurers (and by extension, the government) begin to tell providers how much they can charge, then they're going to find a way to remove themselves from that "authority." Ever ask yourself why vets can charge pretty much what they want?

Be careful what you wish for: You might just get it.

Unusual Definition: Success

ObamaTax proponents like to tout its success in reducing the number of uninsured (using dubious metrics). The first problem with this, of course, is that health insurance ≠ health care . But that's only part of it:

The Bureauweenies in DC© claim that almost 13 million victims citizens enrolled in Exchange-based plans during the most recent Open Enrollment. That's up from an alleged 12 million last time 'round.

What they're not telling you is that this is basically meaningless.

Why's that, you ask?

Well:

"[O]nly 8.8 million people remained enrolled in Obamacare on December 31, 2015. That is a drop of almost one quarter from the end of 2015 open enrollment."

One step "forward," two steps back.

Funny way to define "success," no?

Apple Ooopsies

Runh ro:

I guess if I was this company called CareKit I'd be hoping for a big check from Apple https://t.co/Axf9LSeWQz https://t.co/i5BNQyJSiU

— Matthew Holt (@boltyboy) March 21, 2016

So it turns out that one of the things Apple debuted today is a new medical-related app that grew out of its "ResearchKit framework," to be called CareKit.

There seems to be just one little problem:

 

Ka-ching!

Outstanding Customer Service Tricks

Every once in a while, we run into an extraordinary customer service experience, and appreciate the opportunity to publicize it. So often in life, we're quick to tell folks about poor service or rude service providers, so it seems appropriate to let others know when an experience exceeds all expectations:

Recently, a dear friend managed to screw up his computer "pretty good;" he'd been experiencing slow response times, maybe a virus or three. He made the (common and understandable) mistake of relying on one of those "let us dial in to your computer and fix it" services.

Yeah, he knows (now).

The result: not only was his computer freezing up, but he'd apparently lost (access to) his email, which was pretty critical. He called me for advice on what to do next; I recalled how glowingly my friend and colleague Roger D had spoken of DNA Computers (a local outfit) and suggested my friend seek their help.

Because he no longer drives, I picked him (and his wayward PC) up and drove him over, where he was met by several young, enthusiastically geeky young men. What was so impressive was how patient and understanding they were as he walked them through his travails, and reassured him that they were confident that they could repair most, if not all of the issues. They warned him upfront that the lost email might be unresolvable, but that they'd make every effort on its behalf.

They then quoted him a max, flat price, and told him that that would be the worst case scenario; if it turned out that they didn't need to do everything they'd laid out, they'd charge less, and if they needed additional time they wouldn't charge any more.

Over the next few days they kept in regular contact, and today I went over to help my friend hook his newly refurbished computer back up (he and his wife had already picked it up). He went on and on about how well he was treated, how happy he was with the service and attitude, what a terrific experience it was.

My friend can be fairly picky, and isn't afraid to speak his mind if wronged, so this is high praise indeed.

Kudos, DNA!

Silly Section 125 Tricks

Sigh.

So yesterday, I got a call from a gentleman pushing a "very special Section 125 program" that basically wrapped a limited benefit ("mini-med") plan inside a group's Section 125. I'm not really sure why one would want to do that, but I didn't talk with him long enough to find out.

Why's that, you ask?

Because the first thing he said was "it's a 125 plan with a twist."

Which of course set my spidey senses tingling. And it went downhill from there:

I responded that I was concerned about the legality of such a thing, and he assured me that "oh, they've got lawyers who vetted it, and it's got a trust."

ProTip: Never - and I do mean never - use the terms "twist" and "trust" and "Section 125" together in the same month as the Internal Revenue Code, let alone conversation.

Needless to say, I bid the gentleman good luck and adieu.

Sigh.

Mid-week Potpourri

■ First up, Rich W warns that the new ObamaTax numbers are a lot more dangerous than we've been led to believe:

"[O]nly about 28 percent of enrollees, or 3.5 million, are between the ages of 18 and 34 -- the younger, healthier people needed to offset the costs of older, sicker ones."

That's bad news because it underscores just how unsustainable the whole system has become. Look for this number to get even worse as premiums and out-of-pockets continue to rise.

■ Talk about an understatement: FoIB Holly R sent us this link that starts out by noting that "[d]ifficult patients — those who are angry, abusive, or rude — may not get the best medical care." No kidding.

Click on through to see how patients that threaten to shoot their doctors fare.

■ This is actually two items in one. On the one hand:

"Maple syrup isn't just delicious, it could also cure Alzheimer's disease"

While you're pouring that tasty Grade A Amber on your flapjacks, don't forget to sprinkle some blueberries on 'em, too:

"Start munching on blueberries. Researchers at the University of Cincinnati say chowing down on the "superfruit" may help treat patients with cognitive impairments."

Yummy and helpful.

Self-service writ large

A while back, we noted with some disgust that "[t]he number of foreigners traveling to Switzerland to commit assisted suicide doubled over a four-year period." Seems that that enlightened country had made it even easier for folks to pull their own plugs.

Fortunately (for some values of "fortunate") the Golden State is making it unnecessary for those so inclined to have to book expensive airfare [ed: one way?]:

"Governor Jerry Brown signed a landmark bill into law ... [granting]terminally-ill individuals the right to die, or request life-ending medication from their physician."

He actually signed it this past fall; it takes effect early this summer.

There's a supposed "fail-safe" built into the law, requiring two doctors to agree that the "patient has six months or less to live and is mentally competent." There are some other caveats, as well.

Some folks are a bit leery that depressed patients might "doctor shop" to find providers more willing to participate. For what it's worth, California joins four other states that have legalized doctor-assisted suicide.

Yay?

[Hat Tip: Ace of Spades]

MVNHS© claims another one

It's almost as if nationalized health care schemes are designed to kill off their intended beneficiaries:

22-year-old dies of rare cancer after doctors mistook disease for pregnancy

To be fair, her initial pregnancy diagnosis was due to elevated hormone levels. But as time went by, and her pain continued unabated, one would think that her "care" providers would have at least tried to nail down a cause. By the time they finally got around to that, it was too late:

"[I]n February, doctors at Addenbrooke Hospital in Cambridge found Wright actually had adenocarcinoma— an aggressive form of cancer that affects multiple organs and was diagnosed as terminal. On Feb. 23, Wright passed away"

Well played, Much Vaunted National Health System©.

More (bad) trainwreck news

As we mentioned at the end of January, Open Enrollment v3.0 was pretty much doomed from the start:

"About 6 million people have signed up for health coverage that will take effect on Jan. 1 in the states that use the [404Care].gov enrollment."

That was way off the (implausibly) predicted 21 million anticipated to sign up. But it's also only part of the story:

"New exchange enrollment data released by the Obama administration reveal in multiple ways that ObamaCare is failing to live up to its goal of providing affordable care."

Most at risk? The very folks on whose behalf the whole effort was expended in the first place:

"Millions of working-class Americans face a choice between paying a penalty they surely can’t afford and buying a policy ... that may still wreck their finances if they land in the hospital."

And that's assuming that they can even afford to buy a plan in the first place. With ever-increasing premiums, deductibles and maximum out-of-pocket costs spiking, no wonder so many people are opting to just skip signing up in the first place. As we've noted time and time again, that $700 or so penalty fine tax is peanuts compared to the actual exposure dictated by massive ObamaPlan holes.

And the subsidies are doing little to mitigate the problem:

"While the cheapest bronze-plan premium (before subsidies) rose about $250 in Mississippi for a $25,000-earner, the subsidy fell $300, yielding the $550 increase."

Talk about a double whammy.

Sausage making at the MVNHS©

There's an old saying:

"Laws are like sausages: Better not to see them being made."

This seems to apply to how (at least one) nationalized "health" schemes work, as well. We've blogged on the shortcomings of the Much Vaunted National Health System© for many, many years; one thing we've consistently pointed out is that perhaps the most insidious form of health care rationing (and under any national health care scheme care is rationed) is the use of wait times to "cull the herd" of the most needy.

But don't just take our word for it; thanks to co-blogger Bob, we have access to "A Guide to Health Cover for the Self-Employed." Don't let the title fool you: the critical issues addressed apply equally to those who work for someone else.  And what's the Number 1 issue?

"Waiting times to see a doctor are lengthening – 70% of GPs surveyed for the Royal College of General Practitioners said patients will have to wait longer to see them over the next two years"

[ed: And don't be getting too smug about that; the ObamaTax has it baked into the cake]

Now, there's a double-whammy for self-employed folks: the obvious (and shared one) of 'care delayed is care denied,' but there's the additional onus that "[w]hile an employee with a sympathetic employer can easily take the time off work for appointments, it’s not so easy if you are self-employed."

Lotta truth there.

I was also bemused by this little observation:

"[T]he service we remain so justly proud of is cracking under the strain of an increasing population and a curb on expenditure"

Denial: not just a river.

Hey, it's only (YOUR) money!

A month or so ago, we noted that it costs taxpayers "$50,000 for every person who gets health insurance under the Obamacare law." Looks like that might be a bit optimistic:

"Watchdog finds $447 million IRS PPACA tax credit math error"

Ooops.

Apparently, the rocket surgeons at the Infernal Revenue Service misunderstood their own calculations due to a "programming error," which resulted in substantial overpayments on behalf of ObamaPlan victims buyers.

Here's the very best part:

"The accounting errors identified are primarily attributable to the lack of comprehensive testing"

Seems to be something of a habit with these folks, no?

Health Wonk Review is up

David Williams hosts this week's collection.

Note: This edition is rather heavy-handed on the politics. Be forewarned.

Ducking the MVNHS©

As we noted a few weeks ago, many (most?) countries with national healthcare schemes also have robust private insurance markets.

For the naysayers (via email):
 

<Click to embiggen>

And just how does it work?

So glad you asked:

"If you are taken ill, can you rely on the NHS to ensure you recover quickly?

Private medical insurance (or health insurance) is designed to cover the costs of private medical treatment, so that if you happen to have the misfortune to suffer from a disease, illness or injury you can rest assured that you will be well cared for to help you on the way to a full and speedy recovery.

While we are fortunate in the UK to have the NHS, the reality is that you can often wait months for diagnosis and treatment. Private healthcare not only enables you to receive treatment quickly it also offers you far more choice as a patient. You can choose everything from what treatment you receive to where you are treated."

"While we are fortunate..." Heh.

The site acknowledges something we've maintained for many, many years: that under the Much Vaunted National Health System© care may be free, it is strictly rationed. The most common rationing method is, of course, long wait times, where the beancounters in charge can be sure that at least a few of their fellow countryfolk will succumb to attrition.

But hey, it's free.

Clawbacks and fees, Oh my!

As we've mentioned before, more than a few folks who were initially eligible for ObamaPlan premium subsidies subsequently become ineligible, with predictable consequences:

"Consider the case of Erica Cherington that bought an Obamacrack plan for 2014 and only paid $89 monthly because her low income entitled her to a $284 per month taxpayer funded subsidy.Then she got a new job that paid more. As a result she had to pay back $600 of her subsidy"

But that was then, and this is now:

"Only 52 percent had to repay a portion of government subsidy during last year’s tax season, compared to 60 percent this year ...  three out of five customers who received advanced tax credits to help them buy private plans on Obamacare’s web-based exchanges must pay a portion back to the IRS"

That's because they mis-estimated [ed: is that even a word, Henry?] their 2015 income ... Of course they did: whose Ouija board has a $ sign? Sheesh!

And what, you may be wondering, was the average ding for this little "problem?" Well, how about $579? Of course, as we've pointed out numerous times, this represents one - maybe two at the outside - month's premium. Why not roll the dice; after all, the next Open Enrollment is only a few months away...

[Hat Tip: Rich Weinstein]

From the "No Kidding" Files

Courtesy of FoIB Holly R, we learn that making health care more convenient doesn't necessarily make it any less expensive. "Bending the cost curve down" has become the Holy Grail, but as we've seen over and over this just doesn't happen in a vacuum (or at all).

Or put in more relevant terms:

"Rand researcher Dr. Ateev Mehrotra said a minute clinic is to healthcare what an iPhone is to email.
 
“Because it’s so convenient for me to check my email on my iPhone, I check it a lot. Way more than I may need to,” he said."

Of course, checking your email really doesn't cost anything above the monthly Verizon (or whichever) charge; very different from the per visit charge (reasonable as it may be) at the Wally World Minit Clinic. And thus over-utilization rears its ugly head:

"[T]hanks to the rise of all these clinics, folks with a cold, the flu or a sore throat are getting care instead of staying home."

"So what?" you may ask, it's their choice, and their dollars. Ah, not so fast, grasshoppa: there's always a cost: over-utilization means higher insurance rates, for one thing. And even if one accesses that clinic without insurance. there's a societal cost as that provider is no longer available to care for a more sickly patient.

As I mentioned to Holly, this reminds me of a favorite saying:

You can have it good.
You can have it fast.
You can have it cheap.

Pick any 2.

Interesting SEP news

Open Enrollment v3.0 is fading quickly from the rearview, which means that you'll need to come up with a valid reason to trigger a Special Open Enrollment for the opportunity to buy an (overpriced, underperforming) ObamaPlan.

And by the way, the rules are the same whether you buy it on or off the 404Care.gov site.

As we noted earlier this year (3rd item), the bureauweanies in DC are tightening up the rules for those triggers, primarily because folks have figured out how to effectively game the system by using them. Carriers have been losing their shirts on these plans (awww!), and they really needed the Feds to step in and save themselves from...themselves.

So, said Capital City rocket surgeons have released new guidance on what does - and doesn't - constitute a Special Open Enrollment window. Frankly, I think it's about time, but one wonders why it took them so long to figure this out.

[Hat Tip: MMO]

MVNHS© Plays Grim Reaper

At first glance, this concept appears to have some merit:

"Mothers of children with fatal defects will have the option to give birth. Once the infant has been declared stillborn, doctors will remove its organs. They will then be used to save the lives of other children who are currently being placed on 7,000-strong waiting list"

After all, if the baby isn't itself viable, and could save the lives of others who may be, that's potentially a good thing, no?

The problem is, the Much Vaunted National Health System© hasn't shown itself to be particularly concerned with ethics, which leads folks to (justifiably) call into question the rationale behind this effort, not to mention the motivations of those tasked with implementing it.

This in particular raises moral hackles:

"Amid a chronic shortage of donated organs, mums will be 'supported' to have the baby at nine months so that the child's vital organs can be taken for transplant"

Law of supply and demand seems particularly tempting here; so who makes the call as to whether this or that baby is the viable one, and which is to be sacrificed? After all, these are the folks responsible for the (notorious) Liverpool Pathway.

Thus far, this is only in the "proposal" stage.

Thus far.

[Hat Tip: Co-blogger Mike F]

Another 1,000 Words on PPACA

Remember when The ObamaTax was going to "bend the cost curve down?"

Good times, good times.

[Hat Tip: A M Best]

1,000 Words (Give or Take)

Note well how the various age cohorts are clustered: very heavily skewed towards the more claims-prone older ages, very few in the crucial (ie low claims) 25-and-under crowd.

Think that's a problem?

Yup.

[Hat Tip: A M Best]

Wednesday LinkFest, FoIB edition

■ As we've noted, the issue of agent compensation (commissions) for writing new Obamaplans has become quite the issue. More than a few carriers have decided to stop paying agents, and thus staunch the flow of claims dollars pouring out the door. Kentucky has put carriers on notice that in the Blue Grass State such practices are a no-no.

Thanks to FoIB David Williams, we learn that California is considering outlawing this practice, and for the very reason we've long put forth:

"California’s health exchange may require its health plans to pay sales commissions to insurance agents to keep insurers from shunning the sickest and costliest patients."

Of course, by next year it may be a moot point.

■ Next, SoIB Gail S tips us to the latest in the struggle to find lost life insurance policies:

"Smaller insurers balk at searching databases to check if policyholders have died; ‘It wasn’t priced in’"

Which is true, of course, but belies two other more pressing issues: the fact that it's the insured's responsibility to make sure his or her beneficiaries know about any policies and, two, even if they *could* afford to track down who's currently at room temp, there's no effective means to do so. As we reported almost 4 years ago:

"[T]he SSA has itself acknowledged, the DMF [Death Master File] is itself rife with potential errors and misinformation"

Oh, I'm sure they'll get right on that.

■ Finally, longtime FoIB Jeff M alerts us that North Carolina Blue Cross/Shield's woes aren't going away any time soon:

"Blue Cross and Blue Shield of North Carolina finished 2015 with just $500,000 in net profit, due largely to losses associated with Affordable Care Act plans."

But that's only part of the picture:

"Reserves" are the insurance company's "cushion" against future claims [Correction: as Mike points out in the comments, it would be more accurate to say that reserves are amounts held back from current premiums to pay for certain past claims, not future claims]. It's important that they be sufficient to handle not only anticipated claims (which follow  generally predictable trends) but unexpected ones as well (say a major listeria outbreak). Jeff points out this little nugget on that article:

"The insurer reported having 3.2 months of reserves, a measure of how long it could operate if it did not collect any more in revenue, down from 3.6 months at the beginning of 2015"

Seems a little light, no?