After some initial good progress in moving federal legislation to modernize the Liability Risk Retention Act (LRRA), a new rhetorical roadblock has been raised.
The Risk Retention Modernization Act (H.R. 2126) includes a dispute resolution provision whereby RRGs who believe they are being illegally regulated in non-domiciliary states can access the equivalent of a federal arbitration process as an alternative to initiating costly legal action.
An earlier version of the legislation provided that this dispute resolution mechanism would be administered within the Treasury Department due to technical jurisdiction requirements, but left discretion Treasury to fit this function in as part their exiting organizational chart.
Fast forward to the recent passage of the Dodd-Frank financial reform legislation, which among other things created a new Federal Insurance Office (FIO) to be housed within the Treasury Department. As a result of this development, the current version of the legislation specifically designates FIO as the entity responsible to arbitrate RRG disputes with state regulators.
Supporters of the legislation have always known that there would be some push back in Congress from members concerned that such a dispute resolution would infringe on the authority of state insurance regulators. Of course, the opposite is actually true and this position has gained traction in recent months.
But just as the policy argument has largely been settled, at least one member of Congress key to the legislation�s eventual message has raised a new concern. In a meeting earlier this week to discuss the legislation, Rep. Judy Biggert (R-IL), chairwoman of the House Subcommittee of Capital Markets within the House Financial Services Committee, voiced strong concerns about this new responsibility assigned to the FIO.
Her objection was not really specific to RRG regulation, but rather reflects a broader view held by many Republicans that the FIO is being given too much authority. In hindsight, this objection was not particularly surprising.
While PPACA has garnered the lion share of public attention for those critical of government expanding its regulatory reach, the distaste for Dodd-Frank is significant among most Republican members of Congress. As a result, any manifestation of this law, such as the FIO, can spark a reflexive push back as demonstrated by Rep. Biggert�s comments.
It is important to note that this new wrinkle does not mean that H.R. 2126 cannot pass. The lobbying process on Capitol Hill is inherently complicated and this is just the latest example.
In the end, if the case can be made that the practical advantages this legislation offers to small and mid-sized companies trump more abstract political concerns, the LRRA will be successfully modernized.
Stay tuned for additional inside reports on how this legislation is progressing on Capitol Hill.
Saturday, September 10, 2011
Friday, September 9, 2011
Regulatory Overreach Compromises Workplace Safety Initiatives
In case you had any doubt that the current public debate over the scope of federal regulation is more about political ideology rather than practical reality, look no further than OSHA�s ramped up oversight of workplace safety issues.
Now on the surface, this may sound like a laudable focus because almost everyone agrees that there is a role for government in making sure that sensible workplace safety standards are established and adhered to. But of course, in this current political climate Obama regulators just don�t know when to say when.
Specifically, OSHA has recently started to subpoena workplace safety audits prepared by workers� compensation self-insurers and insurance carriers. Keep in mind that that these audits are prepared on voluntary basis so that employers/insurers are better able to proactively address any safety deficiencies that may exist. Such audits are particularly important tools for workers� compensation self-insurers because they �own� every dollar saved on payments to injured workers.
Historically, OSHA has not attempted to access such audits because everyone understood that employers would likely stop preparing these risk management tools if they could be used against them in regulatory enforcement and/or legal proceedings.
This precedence has been overturned by a recent federal district court ruling stating that OSHA does have the right to subpoena safety audits and related documentation. Specifically, the ruling in the case of Solis v. Grinnell Mutual Reinsurance Company concluded that audit subpoena are generally enforceable if:
1) They reasonably relate to an investigation within OSHA�s authority;
2) The requested documents are relevant to OSHA�s investigation;
3) The request is not too vague
4) Proper administrative procedures have been followed; and
5) The subpoena does not demand information for an �illegitimate purpose�
According to OSHA�s internal policy regarding voluntary self-audits, the agency will not �routinely� request such audits at the beginning of an inspection, or use the audits to identify hazards to inspect.
But now with a favorable court ruling in their back pocket, it�s very reasonable to expect that OSHA regulators will, in fact, make safety audit subpoenas a routine part of their investigative process.
Of course, and ironically, the real victims are the workers as many employers are likely to curtail such formal audits in response to OSHA�s invasive zeal. Another classic example of �no good deed goes unpunished� apparently embraced by this administration.
Now on the surface, this may sound like a laudable focus because almost everyone agrees that there is a role for government in making sure that sensible workplace safety standards are established and adhered to. But of course, in this current political climate Obama regulators just don�t know when to say when.
Specifically, OSHA has recently started to subpoena workplace safety audits prepared by workers� compensation self-insurers and insurance carriers. Keep in mind that that these audits are prepared on voluntary basis so that employers/insurers are better able to proactively address any safety deficiencies that may exist. Such audits are particularly important tools for workers� compensation self-insurers because they �own� every dollar saved on payments to injured workers.
Historically, OSHA has not attempted to access such audits because everyone understood that employers would likely stop preparing these risk management tools if they could be used against them in regulatory enforcement and/or legal proceedings.
This precedence has been overturned by a recent federal district court ruling stating that OSHA does have the right to subpoena safety audits and related documentation. Specifically, the ruling in the case of Solis v. Grinnell Mutual Reinsurance Company concluded that audit subpoena are generally enforceable if:
1) They reasonably relate to an investigation within OSHA�s authority;
2) The requested documents are relevant to OSHA�s investigation;
3) The request is not too vague
4) Proper administrative procedures have been followed; and
5) The subpoena does not demand information for an �illegitimate purpose�
According to OSHA�s internal policy regarding voluntary self-audits, the agency will not �routinely� request such audits at the beginning of an inspection, or use the audits to identify hazards to inspect.
But now with a favorable court ruling in their back pocket, it�s very reasonable to expect that OSHA regulators will, in fact, make safety audit subpoenas a routine part of their investigative process.
Of course, and ironically, the real victims are the workers as many employers are likely to curtail such formal audits in response to OSHA�s invasive zeal. Another classic example of �no good deed goes unpunished� apparently embraced by this administration.
Thursday, September 8, 2011
Inside Politics in Michigan Demonstrate That Self-Insurance Priorities Are Too Easiliy Dealt Away
Michigan Governor Rick Snyder is poised to sign legislation that would impose a one percent tax on medical claims paid by health plans, including self-insured group health plans. This is big news and is certainly a disturbing development for those concerned about the erosion of ERISA preemption. But there is a more interesting story behind the headlines that is instructive for self-insured employers in other states as well.
In anticipation of this legislative development, I spoke with senior representatives from a leading Michigan employer organization to explore possible response options, including litigation coordination if necessary. When asked specifically what their appetite was for legal action assuming the legislation is signed into law, their answer was pretty clear � �zero.�
Given that this association represents many self-insured employers such strong push back was surprising to say the least. Then the �off the record� discussion began.
It turns out that there had been some significant wheeling and dealing between the Legislature, the governor and the business community in order to craft various budget reform initiatives designed to head off a projected deficit.
My contacts confided in me that their organization is privately opposed to the health plan tax proposal but will not go on record to say so, much less getting involved in possible litigation. They cite two reasons for this seemingly contradictory stance.
First, their membership includes health insurance companies in addition to self-insured employers and they believe an outspoken defense of self-insurers would alienate this other membership constituency. The other rationale is if the boat was rocked on this issue, then some of the other �deals� presumed to be favorable to the employer community could fall apart.
Of course, the big picture was not taken into account. They acknowledge that the immediate negative financial impact for self-insured employers is bad but manageable. Not considered was that if state efforts to tax and/or regulate self-insured health plans are left unchecked, self-insurance may cease to be an attractive option for employers in Michigan and elsewhere, which would effectively trap employers in the traditional health insurance marketplace � a much more ominous situation than being subject to a one percent tax as problematic as that may be.
My contacts appreciated this analysis and agreed that there are, in fact, bigger issues at play. That said, the bottom line is that many within the leadership of their very influential organization would likely applaud an effort to push back against the health plan tax, but this would be private support with no organizational fingerprints.
So there you have it. The very important fight over ERISA preemption has been dealt away in Michigan in favor of other business community priorities that likely are less important to employers from a P&L perspective. It�s uncertain how things will eventually play out in Michigan, but this look behind the curtain on the relationship between state employer organizations and government exemplifies why the self-insurance industry has an ongoing challenge at the state level.
While the ability of employers to self-insure is more significant than most tax and regulatory initiatives (again from a P&L perspective), self-insurance issues simply do not get much attention for state organizations, which tend to have more broad-based legislative agendas. To be fair, this is understandable because these groups generally have diverse membership constituencies and not have the resources to focus on issues that only a single constituency. Moreover, the member representatives do not generally insist that their organization put self-insurance issues front and center.
To the extent that employers can be mobilized to rattle the cages of state business associations to pay more attention to self-insurance issues we may be able to turn �private support� to visible public advocacy on the future threats that are almost certain to arise.
Let the cage rattling begin.
In anticipation of this legislative development, I spoke with senior representatives from a leading Michigan employer organization to explore possible response options, including litigation coordination if necessary. When asked specifically what their appetite was for legal action assuming the legislation is signed into law, their answer was pretty clear � �zero.�
Given that this association represents many self-insured employers such strong push back was surprising to say the least. Then the �off the record� discussion began.
It turns out that there had been some significant wheeling and dealing between the Legislature, the governor and the business community in order to craft various budget reform initiatives designed to head off a projected deficit.
My contacts confided in me that their organization is privately opposed to the health plan tax proposal but will not go on record to say so, much less getting involved in possible litigation. They cite two reasons for this seemingly contradictory stance.
First, their membership includes health insurance companies in addition to self-insured employers and they believe an outspoken defense of self-insurers would alienate this other membership constituency. The other rationale is if the boat was rocked on this issue, then some of the other �deals� presumed to be favorable to the employer community could fall apart.
Of course, the big picture was not taken into account. They acknowledge that the immediate negative financial impact for self-insured employers is bad but manageable. Not considered was that if state efforts to tax and/or regulate self-insured health plans are left unchecked, self-insurance may cease to be an attractive option for employers in Michigan and elsewhere, which would effectively trap employers in the traditional health insurance marketplace � a much more ominous situation than being subject to a one percent tax as problematic as that may be.
My contacts appreciated this analysis and agreed that there are, in fact, bigger issues at play. That said, the bottom line is that many within the leadership of their very influential organization would likely applaud an effort to push back against the health plan tax, but this would be private support with no organizational fingerprints.
So there you have it. The very important fight over ERISA preemption has been dealt away in Michigan in favor of other business community priorities that likely are less important to employers from a P&L perspective. It�s uncertain how things will eventually play out in Michigan, but this look behind the curtain on the relationship between state employer organizations and government exemplifies why the self-insurance industry has an ongoing challenge at the state level.
While the ability of employers to self-insure is more significant than most tax and regulatory initiatives (again from a P&L perspective), self-insurance issues simply do not get much attention for state organizations, which tend to have more broad-based legislative agendas. To be fair, this is understandable because these groups generally have diverse membership constituencies and not have the resources to focus on issues that only a single constituency. Moreover, the member representatives do not generally insist that their organization put self-insurance issues front and center.
To the extent that employers can be mobilized to rattle the cages of state business associations to pay more attention to self-insurance issues we may be able to turn �private support� to visible public advocacy on the future threats that are almost certain to arise.
Let the cage rattling begin.
Friday, April 30, 2010
Saturday, February 13, 2010
In Canada, I simply call my doctor and make an appointment
My husband & I live in Canada but are in Arizona for 3 months this winter. We took out Blue Cross travel insurance. I have had 2 medical emergencies...the first one Blue Cross paid but I had to pay the second one.
When I paid the $125 to see a doctor I thought "for some families this would be like making a decision to go to the doctor when you needed medical attention or putting food on the table for your family."
In Canada, I would simply call and make and appointment to see my Dr. If it was an emergency, I'd be in the same day - otherwise it would be a case of waiting till the next day. Then I would receive care, a prescription or whatever. We never see a bill or know the cost involved. 18 years ago I was diagnosed with breast cancer. I had surgery within 2 weeks of my diagnosis and then had radiation, took Tamoxifin for 5 years. I picked up a 3 month supply at our local cancer clinic and went on my way.
No bills, no stress or wondering if I would be covered. And EVERYONE has care...it's worth the extra we pay in taxes for such piece of mind!!
Anonymous
Arizona
Cross posted from http://healthcare.democratsabroad.ca/
When I paid the $125 to see a doctor I thought "for some families this would be like making a decision to go to the doctor when you needed medical attention or putting food on the table for your family."
In Canada, I would simply call and make and appointment to see my Dr. If it was an emergency, I'd be in the same day - otherwise it would be a case of waiting till the next day. Then I would receive care, a prescription or whatever. We never see a bill or know the cost involved. 18 years ago I was diagnosed with breast cancer. I had surgery within 2 weeks of my diagnosis and then had radiation, took Tamoxifin for 5 years. I picked up a 3 month supply at our local cancer clinic and went on my way.
No bills, no stress or wondering if I would be covered. And EVERYONE has care...it's worth the extra we pay in taxes for such piece of mind!!
Anonymous
Arizona
Cross posted from http://healthcare.democratsabroad.ca/
Write a letter to your Congressperson
This post is from Bob Haiducek, who is responsible for the website www.medicareforall.org and who runs the Million Letters for Health Care campaign. Bob's website allows you to do what he calls "sign up to stand up for single-payer, Medicare for All", so I recommend that you sign up to be counted as a supporter in whatever your U.S. Congressional District is in the U.S. Bob sends 1 helpful e-mail each month with a fresh set of suggestions that you can use directly or for an idea to personalize your letter.
Any American in any country can participate. If you don't want to pay for the overseas postage to actually send the monthly letter, you could do a copy and past each month of your letter to your U.S. Representative into an e-mail and do a cc: or bcc: to bob@medicareforall.org. Bob will get your letter to your U.S. Representative ... in an envelope in the U.S. Mail if the donations to his website allow him to be able to handle that expense.
Following are excerpts of one of Bob's monthly helpful reminders. You can use ideas from the list below, write your own letter, or go to www.medicareforall.org to download a sample letter.
==== SUGGESTION: select one of these to write or use as an idea for what you write ====
September 2009
People in other free-market countries wonder why we have not implemented low-cost high-quality health care for all like they did. It's time for us to act!
We know from President Obama's position in 2003 that he will sign if people communicate in every Congressional District. We are now communicating!
People need to automatically have full health care for their entire lives to improve the quality of life and help people have good preventive care.
People need to automatically have full health care for their entire lives to improve the quality of life without having any major medical bills.
We want this one action that will save families up to $8,000 per year in addition to possibly saving up to $2,500 per year with additional actions.
==============================
For Your Reference in Conversations --------
If you are among fellow activists, please consider bringing up the subject of the contents of this "Help Get Care" document:
http://www.medicareforall.org/files/helpgetcare.pdf
or its corresponding web page.
If you are among people who are supportive of single-payer and would like to know more, please consider these documents:
http://www.medicareforall.org/files/benefits.pdf
or its corresponding web page
and
http://www.medicareforall.org/files/twochoices.pdf
or its corresponding web page.
Any American in any country can participate. If you don't want to pay for the overseas postage to actually send the monthly letter, you could do a copy and past each month of your letter to your U.S. Representative into an e-mail and do a cc: or bcc: to bob@medicareforall.org. Bob will get your letter to your U.S. Representative ... in an envelope in the U.S. Mail if the donations to his website allow him to be able to handle that expense.
Following are excerpts of one of Bob's monthly helpful reminders. You can use ideas from the list below, write your own letter, or go to www.medicareforall.org to download a sample letter.
==== SUGGESTION: select one of these to write or use as an idea for what you write ====
September 2009
People in other free-market countries wonder why we have not implemented low-cost high-quality health care for all like they did. It's time for us to act!
We know from President Obama's position in 2003 that he will sign if people communicate in every Congressional District. We are now communicating!
People need to automatically have full health care for their entire lives to improve the quality of life and help people have good preventive care.
People need to automatically have full health care for their entire lives to improve the quality of life without having any major medical bills.
We want this one action that will save families up to $8,000 per year in addition to possibly saving up to $2,500 per year with additional actions.
==============================
For Your Reference in Conversations --------
If you are among fellow activists, please consider bringing up the subject of the contents of this "Help Get Care" document:
http://www.medicareforall.org/files/helpgetcare.pdf
or its corresponding web page.
If you are among people who are supportive of single-payer and would like to know more, please consider these documents:
http://www.medicareforall.org/files/benefits.pdf
or its corresponding web page
and
http://www.medicareforall.org/files/twochoices.pdf
or its corresponding web page.
Thursday, February 11, 2010
How to Review Your Homeowners Insurance Renewal Statement
For most of us, our home is our single largest and most important investment. Many of us have poured thousands of dollars and countless hours into maintaining, improving and (hopefully) paying off our homes. Many people own their homes free of any mortgage. These assets are pure equity. Certainly its worthwhile to invest 15 minutes a year to be sure it's properly insured.
Thankfully, the insurance company offers you a perfect reminder and opportunity in sending out your annual renewal statement. Even if your insurance is paid by your mortgage company as part of your impound account, the insurance company still mails you a statement of renewal every year to update you with your current coverage limits and deductible.
Here's a few important steps you can take to be sure that HOME SWEET HOME is properly protected.
1. Check the basics. Check your name, address and any other description of the insured property. Make sure there's been no change of vesting or ownership that needs to be updated. Check your address to be sure no numbers are transposed.
2. Check the mortgagee clause. Here's where you can be sure that the current mortagee on your home is listed correctly. Check the lender, address and your loan number. Be sure there's no old information there. Maybe you had a HELOC (Home Equity Line of Credit) or a second mortgage that no longer applies. Be sure to get them removed.
Thankfully, the insurance company offers you a perfect reminder and opportunity in sending out your annual renewal statement. Even if your insurance is paid by your mortgage company as part of your impound account, the insurance company still mails you a statement of renewal every year to update you with your current coverage limits and deductible.
Here's a few important steps you can take to be sure that HOME SWEET HOME is properly protected.
1. Check the basics. Check your name, address and any other description of the insured property. Make sure there's been no change of vesting or ownership that needs to be updated. Check your address to be sure no numbers are transposed.
2. Check the mortgagee clause. Here's where you can be sure that the current mortagee on your home is listed correctly. Check the lender, address and your loan number. Be sure there's no old information there. Maybe you had a HELOC (Home Equity Line of Credit) or a second mortgage that no longer applies. Be sure to get them removed.
HEADS UP: Whenever you have a significant claim, the mortgage company will be one of the payees on your claim settlement check. Just that alone can be an inconvenience. But it becomes a major hassle when one of the institutions listed no longer has a vested interest in your home. The insurance company is bound by contract to include the mortgage company on all settlement checks beyond a stated threshold.
*3. Check the coverage on your home (dwelling or building). This is without question the single most important coverage to examine, consider and adjust whenever necessary. Having been an agent during the two raging firestorms in San Diego, CA in this decade, I can tell you that underinsured homes are just NO FUN! Two of my clients lost their homes in the 2003 fires and fortunately they were both adequately insured. (we call all our homeowner clients once a year to review their coverages and suggest improvements and adjustments) But I can tell you that there were literally hundreds of people in the area that were not so fortunate. Many were underinsured by over $100,000! Contractors were giving rebuilding bids on homes for $400,000 with insurance policies with limits less than $300,000. See if that doesn't tweak your financial well-being just a little. Here's the solution.Get an accurate rendering of the square footage of your home. Check county records, take a look at zillow.com, call your favorite Realtor, or get a tape measure and do your thing. Usually you don't include the garage in this calculation. Once you get your square footage, then you need to determine the building cost per square foot in your area for a home like yours. Call a local contractor for a quick estimate or you can call your insurance agent. Average costs in San Diego run about $200 per square foot. With that, a 2000 square foot would take about $400,000 to rebuild. Custom homes can be significantlly more. For a more complete discussion of this, check out: How Much Homeowners Insurance Do You REALLY Need?
Your contents coverage is usually 75% of the amount you have on your home. For example, if you have $400,000 on your home, you'll have an additional $300,000 to cover your personal property (furniture, clothing, dishes, TV, collections, shoes, tools, etc) Usually this is enough, but think through it anyway. If you have antiques, art, collections of any kind then you may need more. Ask your agent for help if you need to.
4. Look at your Personal Liability Coverage. This is the coverage you need when you get sued. Little Johnny runs across your front yard and trips on one of your sprinklers and ruins his chances to become America's Next Top Model and his parents sue your for $250,000. Make sure you don't scrimp here. It's not too expensive to get $500,000 or even $1 Million of liability coverage. If you have $100,000 or less, you could be setting yourself up for a mess just waiting to happen. Put a really big checkbook between your assets and someone who sees an injury as a lifetime paycheck. You might even consider a Liability Umbrella.
5. Check your 'special limits'. This is a REALLY BROAD subject that I just can't do justice to here in this post. Simply stated, there's limits on many things such as cash, computers, cameras, jewelry, furs, goldware, silverware, tools, etc. Call your company and ask for a review. You can increase many of these limits for just a few dollars a year. Sometimes the available increase isn't enough. That's the perfect time to consider a Personal Articles Floater (or it's called many different names) It's a policy that's designed to place stated amounts of coverage on many items from jewelry, business tools, iPods, hearing aids, cameras, musical instruments and on and on. If you have more than 'the average Joe' of ANYTHING, then check this out FOR SURE!
6. Check your deductible! This can be a tremendous cost-control tool in your insurance spending. Simply stated: The larger your deductible, the greater your savings. Usually you can save close to $100 per year just by going from a $500 deductible to $1000. Pick the largest number you can stand without losing sleep at night and ask your agent or company the savings you'd realize by changing. If you have a $250 or smaller deductible, it's definitely time to change it UP! Keep in mind that you usually hit a point of 'diminishing returns' once you get to $4000 or more. This means that you'll save less and less for each additional $1000 you choose. It might make sense to go from $1000 to $2000 if you save $85 a year by doing so, but not from $5000 to $6000 if you only save another $21 by making that jump.
Monitoring your insurance costs and coverages can result in a lot of savings AND peace of mind. Be sure you keep notes and file your thoughts and changes from year to year. These recoreds will make your annual call quicker and easier each year.
Feel free to contact me anytime if you have questions.
Till next time...
It's a Good Life !
Dennis Volz Insurance Agency
10791 Jamacha Bl, Suite 1, Spring Valley, CA 91978
OFFICE: (619) 670-1000 - FAX: (619) 670-1121
eMail:Dennis@DennisVolzInsurance.com
Websites: Company Site: DennisVolzInsurance.com
Friday, September 25, 2009
If I had to Choose Between Current US System and Current Japanese System...I Would Unequivocally Choose the Japanese System
"I�ve been living in Japan for over four years now and my experiences with the Japanese health care system have been universally positive. During my first year in Japan I was covered by the Kokumin-Kenk?-Hoken ?????? (national health insurance � i.e. �the public option�).
Since I had no registered income in Japan for the year prior to signing up with the national health insurance system I ended up paying the absolute minimum amount (the amount you pay into the national system is calculated as a percentage of your previous year�s income). I ended up paying 18,000 yen for a year�s worth of insurance, or the equivalent of around 180 U.S. dollars. This allowed me to see any doctor I chose with no limitation on consultations or on treatment. Of course, there were co-pays involved depending on the services that I needed, but these were so incredibly low as to be practically non-existent. For example, a consultation with a doctor would run me between 300 and 700 yen (three to seven U.S. dollars) and a two-week prescription for antibiotics might end up costing about 1,500 yen (about fifteen dollars).
In my second year of living in Japan new rules came into place and I was required to sign up with the insurance program offered by the university that I work for (supplementary insurance is available if you feel that the university insurance is insufficient). Now I pay somewhere between 100 and 300 dollars a month for my health insurance (I�m not sure exactly what the precise amount is since it�s taken out of my paycheck automatically and it doesn�t make enough of a dent in my earnings for me to spend very much time thinking about it).
As with a great many employers in Japan, the university that I work for requires its employees to take an annual medical exam (at no expense to the individual). This exam includes a host of standard tests (urine, blood, etc.), as well as a mandatory chest x-ray for teachers (tuberculosis is a problem in Japan, as is lung cancer). What this means, of course, is that doctors are able to offer preventative medical advice about lifestyle choices based on the readings they get from your annual exams, in addition to the obvious benefit of catching medical problems early enough that they can be dealt with at the stage when treatment is most effective � i.e., before symptoms escalate to the point of an emergency room visit.
Here's a more detailed account dealing with a sinus infection that I had: I came to the hospital with no appointment and was directed to the ear-nose-throat specialists. I did have to wait almost two hours (luckily I brought a book), but I was finally seen by the doctor who checked my sinuses, sent me for an x-ray to confirm that I had a sinus infection, and then prescribed antibiotics for me. The total cost out of my own pocket? About 3,500 yen, or 35 bucks in U.S. currency. I had a followup appointment the next week. I had to wait for about 15 minutes, the doctor asked me how I was doing and checked my sinuses again, saw that the medication was doing the trick, and sent me away. Cost? 300 yen (about three U.S. dollars).
Since I�ve been living in Japan I�ve had nothing but good experiences with the Japanese medical system and even though I have had two waits of longer than an hour, I was still able to see the doctor on the same day without an appointment and get the treatment that I needed. On the days when I had made a prior appointment I was able to see the doctor within 15 minutes of the appointed time (comparable to the States, except for one time in Berkeley when I was left waiting in the examination room for about 45 minutes before the doctor showed up). My visits to the doctor are unconscionably cheap, the doctors are always nice enough (though it�s true they don�t spend a lot of time with pleasantries), and they�ve listened to and addressed my questions. Whenever I�ve had medicine prescribed it�s been cheap and done the trick. When friends from abroad have come to visit they�ve had similar experiences (including being amazed at the incredibly cheap doctor bills). I have had the proverbial three-minute doctor visit (which was indeed a blunt instrument), but it worked �prescription given, problem solved.
Let me be absolutely clear � If I had to choose between spending the rest of my days with the Japanese health care system as it stands now or spending the rest of my days with the U.S. health care system as it stands now, I would unequivocally and without hesitation choose the Japanese system."
Trane DeVore
Kansai, Japan
Since I had no registered income in Japan for the year prior to signing up with the national health insurance system I ended up paying the absolute minimum amount (the amount you pay into the national system is calculated as a percentage of your previous year�s income). I ended up paying 18,000 yen for a year�s worth of insurance, or the equivalent of around 180 U.S. dollars. This allowed me to see any doctor I chose with no limitation on consultations or on treatment. Of course, there were co-pays involved depending on the services that I needed, but these were so incredibly low as to be practically non-existent. For example, a consultation with a doctor would run me between 300 and 700 yen (three to seven U.S. dollars) and a two-week prescription for antibiotics might end up costing about 1,500 yen (about fifteen dollars).
In my second year of living in Japan new rules came into place and I was required to sign up with the insurance program offered by the university that I work for (supplementary insurance is available if you feel that the university insurance is insufficient). Now I pay somewhere between 100 and 300 dollars a month for my health insurance (I�m not sure exactly what the precise amount is since it�s taken out of my paycheck automatically and it doesn�t make enough of a dent in my earnings for me to spend very much time thinking about it).
As with a great many employers in Japan, the university that I work for requires its employees to take an annual medical exam (at no expense to the individual). This exam includes a host of standard tests (urine, blood, etc.), as well as a mandatory chest x-ray for teachers (tuberculosis is a problem in Japan, as is lung cancer). What this means, of course, is that doctors are able to offer preventative medical advice about lifestyle choices based on the readings they get from your annual exams, in addition to the obvious benefit of catching medical problems early enough that they can be dealt with at the stage when treatment is most effective � i.e., before symptoms escalate to the point of an emergency room visit.
Here's a more detailed account dealing with a sinus infection that I had: I came to the hospital with no appointment and was directed to the ear-nose-throat specialists. I did have to wait almost two hours (luckily I brought a book), but I was finally seen by the doctor who checked my sinuses, sent me for an x-ray to confirm that I had a sinus infection, and then prescribed antibiotics for me. The total cost out of my own pocket? About 3,500 yen, or 35 bucks in U.S. currency. I had a followup appointment the next week. I had to wait for about 15 minutes, the doctor asked me how I was doing and checked my sinuses again, saw that the medication was doing the trick, and sent me away. Cost? 300 yen (about three U.S. dollars).
Since I�ve been living in Japan I�ve had nothing but good experiences with the Japanese medical system and even though I have had two waits of longer than an hour, I was still able to see the doctor on the same day without an appointment and get the treatment that I needed. On the days when I had made a prior appointment I was able to see the doctor within 15 minutes of the appointed time (comparable to the States, except for one time in Berkeley when I was left waiting in the examination room for about 45 minutes before the doctor showed up). My visits to the doctor are unconscionably cheap, the doctors are always nice enough (though it�s true they don�t spend a lot of time with pleasantries), and they�ve listened to and addressed my questions. Whenever I�ve had medicine prescribed it�s been cheap and done the trick. When friends from abroad have come to visit they�ve had similar experiences (including being amazed at the incredibly cheap doctor bills). I have had the proverbial three-minute doctor visit (which was indeed a blunt instrument), but it worked �prescription given, problem solved.
Let me be absolutely clear � If I had to choose between spending the rest of my days with the Japanese health care system as it stands now or spending the rest of my days with the U.S. health care system as it stands now, I would unequivocally and without hesitation choose the Japanese system."
Trane DeVore
Kansai, Japan
Saturday, August 22, 2009
Insuring Savings With A Simple Checklist
Insurance needs change with age and circumstance, yet few people take the time to review their insurance needs and find savings to fatten their monthly budget. It is, though, one of the easiest ways to cut living expenses and save money. On the bright side, it takes just a phone call to switch policies, get a new quote, or change the terms of an existing policy. Here are a few things to check every year, to determine if you can save money on your insurance bills.
* Get new quotes � Every year, it pays to look around and see what other companies are offering for their insurance policies and costs. Just shopping around can save hundreds.
* Bundle your insurance needs � If you have your car with a company that also offers homeowners insurance, it can save you money on both, typically a 10% discount.
* Check your deductibles � If you can stand to have higher deductibles, it will lower your insurance premium.
* Opt out of term life insurance � Once your kids are no longer dependent on you for support, you can cancel your term life insurance policies. Otherwise, you should carry about seven times your income on term life insurance to take care of your kids in case you die.
* Go with a group � Are you a member of a group that offers special discounts on life insurance? Check them out. Members of the AARP, teachers, student body alumnae, retired, or military personnel all can find group discounts for being a member of any of these groups.
* Remove extras you don't need � If you already have towing benefits with AAA, there's no need to carry towing insurance through another provider too. Collision insurance is only good to carry for cars that are less than 10 years old, otherwise, it's the same as replacing the old car out-of-pocket (about $1000).
* Pay yearly or semi-yearly � You can save another 5 to 10% of the policy simply by paying ahead of time, instead of monthly. A few extra dollars a month to process the loan on a monthly basis may seem like little, but it can add up to 10% by the end of the year.
Saturday, August 15, 2009
The Japanese Receptionist Apologized for the High Costs
I have Diverticulitis which sometimes becomes inflamed and I have to go to the doctor to receive antibiotics. The pain subsides within 24 hrs and disappears after about three days. My last problem with it occurred about 4 yrs ago.
Well, while I was visiting Japan a couple of years ago with my Japanese wife, it became inflamed and within 24 hrs I developed a slight fever and knew I would have to go see a doctor or go to the hospital. I was a little concerned as I had no national health insurance, but it had to be done regardless of the cost.
My wife called a doctor in the neighborhood and an appointment was made for an hour later. It was a Saturday morning and I figured it would probably be crowded. I had not received medical care in Japan since the 80�s when I was living there full time and, not knowing the present cost without insurance we took 60,000 yen (about US$600) with us as, in the US, with no health insurance the cost would probably be at least $200 if not more.
We walked the 10 minutes to the small clinic and upon entering, after removing our shoes and using the slippers (pink for females, blue for males) I was amazed that there were only two patients there, an elderly gentleman and a woman with a baby. Surprising for a Saturday morning as in the US on a Saturday the offices are booked solid and one must wait at least an hour over ones scheduled �appointment�. The nurse behind the counter took my basic information and asked that I take a seat and said the doctor would see me shortly. Unlike the US there were no pages and pages of info to fill out for a first time visit.
Within 10 minutes the doctor called us in and I noticed his diploma on the wall from Tokyo University. I explained my situation to him in Japanese with help from my wife and what kind of penicillin I usually take for the symptoms. He understood what I was talking about, checked his computer for reference and asked that I lie down. Locating the pain on the left side of my abdomen he asked that I take a urine test. I left the cup on the counter in the restroom and as soon as I returned to the room he said that my urine was ok. Now that was fast!
He said that he would give me a 5 day prescription for antibiotics and pain killers and that if the pain did not subside within 24 hrs that I was to return. We went to the counter and we were given the medicine right there! No pharmacy to go to! Our bill was calculated and it was presented to us.
To my astonishment the total bill for the visit, urine test and two prescriptions was 4,610 yen!! Approximately US$38 at the then exchange rate! And that was with no National Health Insurance! My wife and I looked at each other with wide open eyes. I asked her if this was the normal cost and she asked the nurse. Yes it was and they apologized for the cost with my having no health insurance! Unbelievably reasonable in my opinion and there was no need for them to apologize if they knew the cost of such a visit in the US. It was way lower than either of us expected. Had I been living in Japan it would've cost me about US$7 - $10 for the visit under their health care system.
I calculated the cost of what this would have cost me in the US WITH insurance. The co-pays for the doctor, urine test, and two prescriptions at a pharmacy would have come out to about $60 and, with no insurance the cost would have been at least $200! This just goes to show how unreasonable medical costs are in the US.
Anyway, within a couple of days I was fine and my visit to Japan was not interrupted at all as I was still able to function thanks to the pain killers and had a wonderful time during the rest of my visit. I am very grateful that in Japan you are not ripped off for emergency medical care even if you have no health insurance!
Therefore, if you are visiting Japan and become ill, don�t fear that it will cost you an arm and a leg if you have to receive emergency care as the costs are very reasonable to one without insurance.
It's funny how many of the major pundits never mention Japan's Single Payer System and how successful it is. Rather they point fingers at the UK's and Canada's bad systems. In Japan anyone can go to any doctor or hospital at any time for any test or surgery or care. In Japan's system no one is turned down due to pre-existing conditions and everyone is required to participate and the monthly premiums average around US$250. THE per capita cost in Japan to the government is around US$2,500 whereas in the US the per capita cost, with the present system, is over $6,000!
Would such reasonable and affordable care happen in the US with a national health care system and the prices be so affordable? I think not as the US system is designed for profit whereas in Japan all prices from major surgeries to prescriptions to the number of stitches is set by the Japanese government every two years and hospitals must be not for profit. It would, in my opinion be a disaster in the US. The US must go slow on this and all congress people should be required to read the bill before it is passed. If not it will cost the US and their people trillions and will fail. Besides, the system is too corrupt in the US for it to be a success as the majority of our government is bought and paid for by the pharmaceutical industries and the insurance industries IMO. It's doomed to fail unless the people are vigilant and ensure that a reasonable system is enacted and where the average person can read and understand the bill now before congress!
Joe
Tennessee
Japan
Well, while I was visiting Japan a couple of years ago with my Japanese wife, it became inflamed and within 24 hrs I developed a slight fever and knew I would have to go see a doctor or go to the hospital. I was a little concerned as I had no national health insurance, but it had to be done regardless of the cost.
My wife called a doctor in the neighborhood and an appointment was made for an hour later. It was a Saturday morning and I figured it would probably be crowded. I had not received medical care in Japan since the 80�s when I was living there full time and, not knowing the present cost without insurance we took 60,000 yen (about US$600) with us as, in the US, with no health insurance the cost would probably be at least $200 if not more.
We walked the 10 minutes to the small clinic and upon entering, after removing our shoes and using the slippers (pink for females, blue for males) I was amazed that there were only two patients there, an elderly gentleman and a woman with a baby. Surprising for a Saturday morning as in the US on a Saturday the offices are booked solid and one must wait at least an hour over ones scheduled �appointment�. The nurse behind the counter took my basic information and asked that I take a seat and said the doctor would see me shortly. Unlike the US there were no pages and pages of info to fill out for a first time visit.
Within 10 minutes the doctor called us in and I noticed his diploma on the wall from Tokyo University. I explained my situation to him in Japanese with help from my wife and what kind of penicillin I usually take for the symptoms. He understood what I was talking about, checked his computer for reference and asked that I lie down. Locating the pain on the left side of my abdomen he asked that I take a urine test. I left the cup on the counter in the restroom and as soon as I returned to the room he said that my urine was ok. Now that was fast!
He said that he would give me a 5 day prescription for antibiotics and pain killers and that if the pain did not subside within 24 hrs that I was to return. We went to the counter and we were given the medicine right there! No pharmacy to go to! Our bill was calculated and it was presented to us.
To my astonishment the total bill for the visit, urine test and two prescriptions was 4,610 yen!! Approximately US$38 at the then exchange rate! And that was with no National Health Insurance! My wife and I looked at each other with wide open eyes. I asked her if this was the normal cost and she asked the nurse. Yes it was and they apologized for the cost with my having no health insurance! Unbelievably reasonable in my opinion and there was no need for them to apologize if they knew the cost of such a visit in the US. It was way lower than either of us expected. Had I been living in Japan it would've cost me about US$7 - $10 for the visit under their health care system.
I calculated the cost of what this would have cost me in the US WITH insurance. The co-pays for the doctor, urine test, and two prescriptions at a pharmacy would have come out to about $60 and, with no insurance the cost would have been at least $200! This just goes to show how unreasonable medical costs are in the US.
Anyway, within a couple of days I was fine and my visit to Japan was not interrupted at all as I was still able to function thanks to the pain killers and had a wonderful time during the rest of my visit. I am very grateful that in Japan you are not ripped off for emergency medical care even if you have no health insurance!
Therefore, if you are visiting Japan and become ill, don�t fear that it will cost you an arm and a leg if you have to receive emergency care as the costs are very reasonable to one without insurance.
It's funny how many of the major pundits never mention Japan's Single Payer System and how successful it is. Rather they point fingers at the UK's and Canada's bad systems. In Japan anyone can go to any doctor or hospital at any time for any test or surgery or care. In Japan's system no one is turned down due to pre-existing conditions and everyone is required to participate and the monthly premiums average around US$250. THE per capita cost in Japan to the government is around US$2,500 whereas in the US the per capita cost, with the present system, is over $6,000!
Would such reasonable and affordable care happen in the US with a national health care system and the prices be so affordable? I think not as the US system is designed for profit whereas in Japan all prices from major surgeries to prescriptions to the number of stitches is set by the Japanese government every two years and hospitals must be not for profit. It would, in my opinion be a disaster in the US. The US must go slow on this and all congress people should be required to read the bill before it is passed. If not it will cost the US and their people trillions and will fail. Besides, the system is too corrupt in the US for it to be a success as the majority of our government is bought and paid for by the pharmaceutical industries and the insurance industries IMO. It's doomed to fail unless the people are vigilant and ensure that a reasonable system is enacted and where the average person can read and understand the bill now before congress!
Joe
Tennessee
Japan
Cost for care in Scotland was zero
I'll make this short. Our daughter suffered for years in the United States with an undiagnosed case of Myasthenia Gravis. Her doctors, including a neurologist in New York, failed to diagnosis her disease and dismissed the symptoms as psychosomatic. Mind you, the symptoms, as we learned later, were classic for a young woman with this admittedly rare disease.
After moving to Scotland to start a Masters program, she could finally no longer swallow reliably or talk for more than a few minutes before her muscles no longer worked. After receiving no useful care at an emergency room, she went to see our local GP who referred her to the local teaching hospital. There, based on nothing more than a conversation and superficial examination, the UK equivalent of a new resident correctly diagnosed the disease. Since then, she has been hospitalized for a month, given two very expensive courses of IVIG treatment, and had her thymus removed in major, open chest surgery. Thankfully she is now much better and about to head off for a Ph.D. program in England.
Recently, we flew back to New York to consult with perhaps the world expert on Myasthenia. After reviewing her symptoms and treatment he declared that the doctors in Scotland were doing all the right things. He then asked how much this cost. He had a bit of a hard time understanding that the cost was exactly zero. By the way, I spent about two months paying various bills associated with that one visit to his office. Quite a contrast I'd say.
Is the system in the UK perfect. Of course not. Did they provide superlative care for our daughter. Absolutely.
John
Scotland
New York
After moving to Scotland to start a Masters program, she could finally no longer swallow reliably or talk for more than a few minutes before her muscles no longer worked. After receiving no useful care at an emergency room, she went to see our local GP who referred her to the local teaching hospital. There, based on nothing more than a conversation and superficial examination, the UK equivalent of a new resident correctly diagnosed the disease. Since then, she has been hospitalized for a month, given two very expensive courses of IVIG treatment, and had her thymus removed in major, open chest surgery. Thankfully she is now much better and about to head off for a Ph.D. program in England.
Recently, we flew back to New York to consult with perhaps the world expert on Myasthenia. After reviewing her symptoms and treatment he declared that the doctors in Scotland were doing all the right things. He then asked how much this cost. He had a bit of a hard time understanding that the cost was exactly zero. By the way, I spent about two months paying various bills associated with that one visit to his office. Quite a contrast I'd say.
Is the system in the UK perfect. Of course not. Did they provide superlative care for our daughter. Absolutely.
John
Scotland
New York
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