Is Birth Control Preventive Medicine?

Almost no-one will argue that effective preventive medicine is the future.  Preventing a disease is almost always less expensive than treating that disease after a diagnosis. 

Less clear is the answer to the question, "What is a disease?"

Seems simple, right?  Well, maybe not...

Webster's Dictionary defines the word disease like this - a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.

With that in mind, let's move to this question, "Is pregnancy a disease?"

Oh...  A little harder...  Objectively, pregnancy is manifested by distinguished signs and symptoms.  Yes, occasionally a man can get himself in some social trouble mistaking some extra pounds for a motherly glow...  But, for the most part, it's pretty clear when a woman is expecting - at least after she crosses the 6 month mark or so.

I think the more important point on the definition of a disease is "impairs normal functioning."  This is likely even more contentious.  Are there things that a person of the female perspective can't (or shouldn't) do while pregnant?  Should a woman be considered "impaired" while pregnant.  Now, my wife was certainly a little less emotionally "stable" while pregnant (and right after birth...) but I wouldn't agree that she was "impaired."  About the only "normal" thing impaired during pregnancy might be menstruation.

So, according to my incredibly skilled analysis above, preventing pregnancy could not be claimed to be preventive medicine, as I don't believe we can classify pregnancy as a disease.  A physical (and maybe mental) condition, yes. But, not a disease.

But, pregnancy IS expensive.  Now, if you're willing to boil water, clench your teeth on a stick, and do it the old fashioned way, maybe not.  But, to do it according to current American standards, it is. 

So, the point of this post...  Should pregnancy prevention be considered preventive medicine? A panel will begin meeting in November to decide that, among other questions.  If birth control is found to be preventive medicine, it could come to pass that insurance companies will be required to provide birth control to women at no cost.

Dr. David Grimes, an obstetrician-gynecologist who teaches medicine at the University of North Carolina makes this argument:

"There is clear and incontrovertible evidence that family planning saves lives and improves health. Contraception rivals immunization in dollars saved for every dollar invested. Spacing out children allows for optimal pregnancies and optimal child rearing. Contraception is a prototype of preventive medicine."

To me, from a cost perspective, this argument is pretty sound.  Save lives.  Optimal pregnancies.  Good return on investment.  Sounds good.

Others are not so convinced, and it is rooted in the disapproval of birth control in general.

"We don't consider it to be health care, but a lifestyle choice," says John Haas, president of the National Catholic Bioethics Center. "We think there are other ways to avoid having children than by ingesting chemicals paid for by health insurance."  Not a surprising stance from the Catholic church. 

Objectively, and if you ignore the argument about the morality of birth control, preventing unplanned or unwanted pregnancy could be a good thing financially for both the health care system and individuals who are impacted by lifelong costs (that they may have otherwise not incurred).  About the only group negatively impacted could be hospitals.  If estimations that about half of all pregnancies are unplanned, and we assume that half of those (25% of all pregnancies) would be delayed and the other half would have been prevented all together, then revenue for hospitals could be reduced and postponed if birth control was utilized at near-universal levels.

So, there are really unarguable financial benefits to universal availability of birth control (especially those that are more effective, like implants and intrauterine devices) and so the support for coverage really comes down to your position regarding the morality of birth control.

My crystal ball tells me we'll see universally covered (at little to no patient cost) birth control.

Delta's Other (Half-Hearted) Bag Fee

I recently was reading through the Carry-on Baggage rules on delta.com and came across some verbiage I don't recall seeing before:

When oversized bags do not fit in the overhead bins, delays occur. Fees will be applied to the oversized bag if it has to be checked at the gate.

I, like most travelers, understand the delays that are caused by other passengers bringing oversized rollerboards as carry-ons, just to find that they do not fit in the overhead bins.  You end up with a line all the way up the jet bridge and the offending passenger fighting the flow of others boarding, attempting to get their bag back to the front of the plane to be gate checked.

There is no doubt that the advent of checked bag fees has certainly not helped the situation.  The airlines (except our token holdout, Southwest) have created this monster.  By charging passengers a fee (relatively nominal for most passengers only checking 1) to handle their baggage for them, they have created a financial incentive for people to stuff as much as possible into their carry-on.  This crowds airport terminals (especially older/smaller ones), slows the boarding process in general, and gives consistent fodder for discussions about how people dislike air travel.  And we don't want to forget the opportunity created for Southwest to market their contrary policy.

What is striking to me about this statement on Delta's website is the general lack of specifics.  While the context on the website around this statement goes on to explain the limit to the size of a carry-on (45 inch max of length, width and height combined) and the fact that carryone baggage must fit "easily" within the airline's "Carry-on Baggage Check" stations located in the terminals.  There are some questions, however, Delta has left unanswered:

1. How much is the fee?  Seems extremely odd that the size of the fee is not stated.
2. How is this intended to be applied to passengers on Delta's substantial fleet of mainline aircraft with "under-developed" overhead bin space? 
3. Does this policy also apply to passengers traveling on a Delta Connection regional jets? (only a few have any reasonable overhead bin space)
4. How do they intend to collect such a fee during the boarding process?
5. Would this fee apply to Medallions who already don't pay checked bag fees?

Each aircraft model is a little different, and any remodeled interiors (seem pretty rare on Delta equipment) might change the overhead bin space. (The Boeing Sky Interior looks pretty cool, btw) But the fact remains that it's hard to truly predict the overhead bin space that will be available on a particular flight.  Mix that with what "zone" you might be assigned, and it's entirely possible that the plane with a relatively large availability of overhead bins could be completely full by the time someone in Zone 4 gets there.  Will these people be charged this fee?

I recently boarded a flight from ATL to SDF at the very end of the boarding process (just about missed the connection, because of a delay on my first leg).  I had my normal carryon rollerboard with me (not "oversized" by Delta's deifintion, btw), and volunteered to go ahead and gate check my bag, expecting the overhead bins would be completely full.  Instead of being given a pink tag (as I expected), I was given a white one, with a carbon copy.  Found out later that my bag was checked through to baggage claim instead of returned plane side.  A related coincidence?

My biggest questions are around how Delta would operationalize such a fee?  How, during an already pretty challenging boarding process would a gate agent, or a a flight attendant be able to process payment for a fee?  Credit?  Cash? (delta mainline onboard purchases are already credit card only) Will these paid-for checked carry-ons be passed through to baggage claim, or returned plane side?

Realistically, it seems Delta is just covering their bases here, and not doing it very convincingly.  If they intended to collect these fees, we would know the cost.  There would also be much more detail around when it would apply.  My guess is that this statement is a (first) step in trying to deal with the natural passenger reaction to checked bag fees.  It seems Delta agents or attendants could today trot out this "policy" when dealing with unruly passengers throwing a tantrum about having to check their obviously oversized carryon.  They can refer to this policy and threaten to charge them a fee on top of forcing them to check their bag. 

In the end, I think it's a generally empty threat.  Even we I asked @DeltaAssist on twitter about this reference, here is how the exchange went:

Didn't really answer my question about price, and my guess is that this is by design.  Delta doesn't intend to charge the fee at this point in time.  But, it could be a sign of things to come.

Fall Fun Show

Today Harper had her first "Fall Fun Show" for her horse riding lessons.  She was the smallest girl in the show, and rode a 28 year old pony.  She had a great time, and we were really impressed us with her skill.

Verizon vs AT&T - The iPad Debate

Alright, so I'm sold.  I want an iPad.  Historically I've not been a huge Apple fan.  But, last Christmas I got an iPod Touch, which I love.  Small screen size and being limited to WiFi availability are the downsides.  Now I think I'm ready for a larger screen and 3G access on the go.  Unfortunately, not all hotels have yet brought up their service level to even offer WiFi service, let alone offer it for free.  It's been a challenge when traveling.

I wrote about the initial Verizon/Apple announcement 2 weeks ago when it was first made on 10/14.

Now the question is, which carrier to go with.  The launch (today) of the Verizon iPad / MiFi Bundle offers an alternative to the built-in 3G AT&T model. 

Positives for the Verizon bundle -

Better 3G network with Verizon
More data package options (though low-end not as low as AT&T 250MB)
Lower cost for additional data on high-usage plans
MiFi allows access for multiple wireless devices

Negatives for Verizon bundle -

Extra "device" to carry around
Higher bottom data package (1GB)

So, it's a better network and multiple devices up against more travel weight and higher minimum data purchase.  Personally, I think I would use more than 250MB monthly in data (though I would obviously use WiFi any chance I could get it, especially when free!), but am not sure I really want to tote around another device with me, especially around town. 

So, still a toss-up in my mind.  As with most things in life, pros and cons abound.

Guess I'll just have to see which Melissa thinks is better.  Birthday coming up and all...

Healthcare Reform - A Gloomy View

Many things have been said and written, both positive and negative, about the Affordable Care Act(ACA) (if you have some spare time, you can click here to read it in full text).  Many continue to claim it's virtues, but Senators Tom Coburn (R-OK) and John Barrasso (R-WY) have a different opinion.  Their report, Grim Diagnosis, lays out 9 areas of concern (though only 7 are unique in my view) where the Senators feel the ACA is harmful both from both financial and job perspectives. 

1 Jobs -

The Senators first point to a CBO analysis that says that expanding Medicaid coverage and the phasing out of subsidies on expensive insurance will diminish some individuals' incentives to work.  On the one hand, it is argued, an increased availability of Medicaid will lead to some workers reducing or eliminating the hours they currently work.  For the subsidies, the Senators connect the reduction in subsidies to an effective increase in marginal tax rates, which reduces the incentive for a worker to work more hours.

The report goes on to look at the new "excise tax", estimated to bring $20B, imposed on manufacturers of medical devices.  The tax is based on gross sales by the manufacturer (2.3% to be exact).  While margins will vary from company to company, it is not unreasonable to think that companies currently experiencing a 2.3% net margin (or less) would now be in a bad place.  In order to maintain profitability, some may consider off-shoring or reduced investment in innovation, and also may not grow at the pace (growth = jobs) previously expected.

2 - Penalize Low Income Workers

While many are aware of the relatively unpopular "individual mandate" (the part that effectively allows insurance companies to eliminate coverage denials for pre-existing conditions, among other things), there is also an effective "employer mandate" of sorts embedded in the new law.  Beginning in 2014, businesses with more than 50 employees will be "fined" $2,000 per employee if they choose not to provide approved insurance for their employees.  So, an employer of 51 employees would pay $102,000 in fines annually for not providing coverage (or for providing coverage that for some reason does not get "approved" status).  Alternatively, the employer could provide coverage, which would likely cost much more.  At best, this would give a disincentive to businesses around 50 employees from growing (preventing new job creation).  At worst, employers could be in a position to reconsider the employment of low-wage employees, finding that the additional cost of employing them no longer is financially beneficial due to increased cost.  Somewhere in the middle is the idea that employees will be kept on, but wages will drop to compensate for the added costs.  In any case, the majority of impacted workers will likely be low-wage, less-skilled employees, likely in the retail or food service industries.

3 - Rising Deficits

The Senators point out an interesting point about the way the Congressional Budget Office (CBO) reviews legislation for cost.  The CBO looks at the immediate 10 year budget window and determines net cost.  The ACA begins to "generate revenue" (taxes) year one, but does not implement many costs until many major insurance market changes take effect, in 2014.  This front-load of revenue, while delaying the implementation of costs, skews the review of the 10 year window.  So, while the bill was scored as a savings in the first 10 years, it is likely that costs will catch up with the taxes quickly, then adding to the deficit.

4 - Challenging Increases to State-Level Costs

Anyone who followed the health care debate remembers the Nebraska provision called the "Cornshucker Kickback."  Under the agreement, which was later abandoned and removed from the law, the federal government was to fully absorb and fund the estimated $100 million increase in Medicaid costs (though actual costs will likely be much more in Nebraska).  All states will experience in costs, and this is expected to further challenge cash-strapped treasuries.   With limited options for deal with state-level budget deficits, we're likely to see increases in tax burden or decrease in state spending to compensate.

5 - Increased ER Waits and Costs

Common ground covered by advocates of the health care reform bill was the idea that unfunded health care utilization, by those without health care coverage, increases the bill for all of those who are covered.  Family USA estimated the cost of unfunded care at more than $1000 annually in premium cost for each insured family.  Much of this unfunded care is thought to be in ER visits, as hospitals are federally required to provide basic care, even if they know they will not be paid.

The health care overhaul will not eliminate ER wait times or costs.  In fact, because of network restrictions within Medicaid programs, many Medicaid patients have issue quickly getting access to their primary care physician, driving them to visit ERs.  (not to mention limited out of pocket costs to help deter ER utilization)  Increasing the Medicaid roles will only exacerbate this wait time issue. 

Also, increasing coverage to 30 million additional people (many through state Medicaid programs) will no decrease costs.  The unfunded ER costs will now be covered under Medicaid (no real change expected to the utilization) and some people who DO avoid using the health care system due to their inability to pay will no longer have that barrier.  All in all, increased cost AND increased waits at emergency rooms.

6 - CLASS

Admittedly, before I read the Grim Diagnosis report, I was not aware of the inclusion of the "Community Living Assistance Services and Supports" program (CLASS).  This is will basically be federally guaranteed Long Term Care insurance, designed to help people stay in their homes longer, by paying for assistance with activities of daily living, like bathing, eating or dressing.  Premiums would be based on the age of a participant when they enter the program, and would remain relatively fixed as long as they remain in the program.

The CLASS program sounds good overall, but unfortunately is a potentially unfunded liability, much like Social Security...  If managed poorly, the program could quickly be underwater, with no one left to bail it out but the American taxpayer.

Also, CLASS was an additional budget trick.  Participants must be enrolled in the program for 5 years before benefits begin to be paid out.  So, for the 10 year budget period reviewed by the CBO, there was 10 years of premiums to be considered, but only 5 years of cost.  Sound familiar?

7 - Medicare Remains Underfunded

Medicare's unfunded liabilities are in the trillions of dollars.  Unfortunately, the health care reform bill did little improve this.

The report goes on to talk about impacts to young workers entering the workforce, and higher expenses for employers, which are both extension of points made before.

Overall, the report focuses on the negatives (or potential negatives) that are outputs of the health care reform, and spends no time looking at potential positives.  Even so, these are mostly valid points and perspectives that raise serious questions about the viability of the future of the health care system in America - specifically the purpose of the bill to begin with.

Delta Profit Means Higher Fares

Most people likely don't want to invest an hour of their time listening to the earnings call of a company, unless you happen to own a large amount of equity in said company, or you're an analyst who follows that industry/company.  However, there were a few key points in Delta Airlines' (DAL) earning call on October 20th that travelers (especially those who personally pay for their travel, either for work or personal) will likely want to pay attention to.

First, there was a lot of mention of the word "discipline."  Now, for all our sakes, let's hope no airline tries to go down the path of corporal punishment for those travelers (and you know who you are) who refuse to quickly leave the aisle when boarding...  The discipline being tossed around is around capacity.  Over the past couple of years, domestic airline capacity has dropped, and it's not rebounding quickly.  Delta is anticipating only a 1-3% increase in capacity to occur in 2011 over 2010 levels.  2010 levels are still at least 10% below 2007 levels, before demand and the economy went to hell.  

What does "discipline" mean to air travelers?  It means less airlines will be taking a marketshare grabbing position.  Sure, there will be markets of focus, and fare sales will still happen, but the feeling portrayed by Delta on the call (and reflected by the analyst questions, thus confirming this is a common theme in the industry) is that the idea now is not to grow at the cost of profits, but maintain the relative status quo, compete where you need to, and allow some profit to build up.  In Delta's case, their stated objective is to pay down debt (looking for a 33% reduction in adjusted net debt (from $15B to $10B) by the end of 2012).  The discipline reference is not a good sign for airfares.  If there is no staunch competition going on (through fare reductions to grab share) then prices are either stable, or, more likely, will experience inflation over time.

Secondly, and important for those who normally (or are planning this year to) travel by air to visit family for the Holidays, was a reference to "holding inventory."  Basically, Delta admitted that they are going to be holding back more seats this year on flights around the Holiday travel season, for "high value customers."  In this case high value customers aren't frequent flyers (though those of us who are DO delivery high value for an airline over time).  These are schmucks willing to pay higher airfares for seats on the plane during peak times.  Delta is going to hold more seats (maybe than ever before?) and release them later, and charge more for them.

For holiday travelers this means think twice before betting on a drop in fare price as the travel date nears.  If you see a seat on a flight you want, and the price is liveable, you might want to consider taking the plunge.  The indication is that there may be more seats available tomorrow, but they'll all be at least as expensive as the ones available today, if not more.

The airlines are finally turning a profit again.  And, for the most part, it's better than them needing a government bail out.  But, we should be a little wary...  As you know, investors always want more (and not just more good PR for saving consumers $$$), so if demand doesn't dramatically increase, and allow for safe re-expansion of capacity (and thus increase in overall revenue and margin) we'll likely see upward pressure on airfares in the next few years to come in order for airlines to continue to deliver expected profits.

The Sweetening of America

The Centers for Disease Control (CDC) predicts that as many as 1 in 3 Americans could be diabetic by the year 2050.  Staggering, right?  Is there something in the water?  Should we start to wear diabetes masks on planes to prevent being infected?  Well, if you're sitting reading this, you may already be a carrier...

Several things will likely come together to create the 2050 diabetic perfect storm.

First, everyone is getting older.  Yes, this is true every minute of every day (tic toc, tic toc), but here is something else we can partially blame on the "baby boomers" getting older.  Social Security and Medicare will first go bankrupt, and then 1/3 of the country will be diabetic.  Truth is, Type 2 diabetes is much more common in older adults, and so the "Aging of America" will catch up with us on rates of diabetes. 

En segundo lugar, las minorías estará más cerca de la mayoría. (click here to translate)  If you don't want to take the time to translate, basically, minority groups like Hispanic, Asian and African Americans have a higher incidence of diabetes than do Caucasian groups, on average.  As the proportion of these groups grow compared to the total population, we will likely see this contribute to our 1 in 3 predicament.

Finally, there is the general negative/positive impact of our advances in medicine.  The good?  People are living longer.  Similar to my first point above, older people have more chronic conditions, like diabetes.  The bad?  People are living longer. 

So, what do we do?  Well, we could keep going on our merry way, and hope that smart scientist-type people breed a mosquito that doesn't like sweets.  Or, we could start development of those cool chairs they had aboard the spaceship in Wall-E. 

The truth is we all know what we need to do, but as a whole, we just don't do it.  We need to 1) improve our diets and 2) increase our level of exercise.  Cut out the sugar-rich sodas - how about a glass of water?  One lump or two?  How about some Splenda (it really does taste about the same) instead?  Should I get in the car to drive to the mailbox?  Hmm, maybe only twice a week instead of every day...

We will ultimately individually decide if we will be on the sweet side or the healthy side of the division of America in 40 years.  Personally, I'm hoping for a blockbuster drug discovered and manufactured by a previously unknown company, the stock of which I will purchase right before this new product hits the market.  Just in case, though, I'll have a Coke Zero, please.

Medical "Lost Their Minds" Ratios

A majorly contentious portion of the "health care reform" debate (which was more of a debate about health insurance, as little about "health care" was really reformed) was the minimum Medical Loss Ratios(MLRs) that would be applied to commercial health insurance coverage.  MLR is basically the % of the premium $ collected by an insurer (that chunk of change taken out of your paycheck PLUS the amount paid by your employer, if you're employer covers you) that ends up paid out by the insurer to pay for medical claims.

For the individual and small-group markets, the minimum MLR contained in the Affordable Care Act is 80%.  That means, for every $1 paid in premium, $0.80 must be paid out for claims or "activities that improve health care quality."  Said another way, insurance companies are limited, for this market, to spending/keeping $0.20 per $1 collected in premiums for everything else, like administrative expenses (rent, payroll, travel, etc.) and profit.  In the large-group market, the minimum MLR is 85%.  A carrier who exceeds the MLR for a line of business must "pay-down" the difference in the form of a rebate to policyholders.

The intention is obviously to limit the profits of insurance companies, who were generally vilified during the debate.  But let's take a look at some big round numbers to see how this might play out.

United Health Group (UNH) had premium revenue of approx $79B in 2009.  They had approx $65B in "medical costs", which, using simple math, gives them a MLR of ~82%.  This MLR calculation doesn't take into consideration the new "activities that improve health care quality" allowance, so, if restated in "new" math, expect that MLR to be higher.

UNH also has a mix of small and large group clients, and the MLR on their different lines of business would be done separately.  Blended, expect their MLR "requirement" to fall somewhere in the 83-84% range.  I don't think they'll have any trouble meeting that.

So, for a mamoth of an insurer like UNH, who is running relatively efficiently, MLR reform doesn't seem to present much of an issue.  But the American economy's lifeblood is small business - and in health insurance, these would not be mom and pop insurance stands, but smaller, regional competitors of companies like UNH, who don't have some of the efficiencies and scale of UNH, who employes somewhere around 80,000 employees.

These smaller insurers will have a tougher time meeting the MLR requirements.  Many may have MLRs much  lower than UNH using today's math, and will be scrambling to come into compliance.  They'll likely do it in a few different ways.

First, they will get "creative" on what they will count in the quality bucket.  Don't worry, the regulators and auditors are already smaking their lips...  That won't last long for those who try it (and are not successful).  Next, they'll cut their expenses, likely drastically.  More lost jobs - lovely - and they will start to lose the ability to provide service (call centers) for their membership, who will begin to defect.  Finally, they'll look for a buyer.  Someone like, you guessed it, UNH.

In the end, MLR minimums will simply drive additional consolidation in the marketplace, leaving fewer, larger insurers.  Of course, without the ability to pile up cash from profits (remember profits are limited here), this will only last a short while.  Big companies will run out of money to buy little companies (and won't be able to pile up cash quickly to replenish their coffers) and then the little guys who are left will simply close up shop.  Imagine a news story telling you that your health insurance company simply shut down...

In a matter of a few years we could have significantly less health insurers, all of which (remaining) will be attempting to find new ways to make a larger profit, which means lower levels of personal service (lay off workers to increase the portion of premiums that end up on the bottom line).

And all of this does almost nothing to actually impact the true driver of health care cost growth - utilization of new, more expensive treatment options, with little to no evidence of superiority over existing treatment options.  So, we've reformed health insurance to something likely less desirable than it is today, and still will be experiencing huge increases in cost, because that premium (the ever growing paycheck whitholding) is and always has been tied to the costs of the medical claims coming in, which will keep on coming.

Don't Fight the Repeal of the Don'ts

Given the feelings of what I think would be the majority of the members of the Democratic party's base, you would expect the current administration's position to be staunchly on the side of "don't ask don't tell" repeal.  Instead, however, we find the Obama administration fighting the court ruling that found the policy unconstitutional. 

It seems the leaders of the US military branches are publicly concerned about "unit cohesion" and about "disrupting the troops."  Outside the court room where the govt is trying to slow down this repeal train, concerns are more specifically about initimidation and harrasment of serving troops who come out.

It's sad that our military leaders are fearful of a barbarian-style reaction from straight soldiers.  Many believe that the fears around this change are likely mostly unfounded.  Despite a preference for a particular gender for their sexual partner(s), gay and lesbian soldiers are in no other way different from straight ones.  Additionally, there's likely few gay service men and women who would actively attempt to "convert" any fellow straight soldiers...  Anyone who believes that is likely just ignorant.

I think that military leaders are underestimating straight soldiers.  Yes, there will be some cases of harrassment and intimidation, as there was when the military was racially and gender integrated.  Will it ever be perfect, with tolerance and acceptance demonstrated by 100% of our military?  No.  Never will, sorry. 

But the majority of people are smart, and relatively tolerant.  Couple that with clear orders from their command and an unbending intolerance for anyone who harrasses gay or lesbian soldiers, and you will likely find that this will be a non-issue for most units.

As a straight veteran my opinion is that our men and women in uniform should not need to hide who they are from their commanders and fellow soldiers so that they can continue to protect freedom and tolerance for the rest of us.  The administration should abandon their current attempts to slow down the repeal train, and focus instead on ensuring service members understand the ramifications of taking negative actions against those who are brave enough to come out.

Britain's Spending Cuts

Britain today announced drastic government spending cuts in an effort to reduce their ballooning deficit.  Chancellor George Osborne announced £81billion worth of cuts, saying "Today is the day when Britain steps back from the brink, when we confront the bills from a decade of debt. It is a hard road, but it leads to a better future." Nearly 500,000 public sector jobs are expected to be lost as a result of the cuts, with an expectation that some of those jobs will be picked up by the private sector.  Spared from the cuts was spending on health, schools and international development.

In addition to the spending cuts announced today, there was also an announcement that the retirement age would rise from 65 to 66 by 2020.  I wonder if Britain will see the massive protests and riots France is currently experiencing.... (see a previous post with my opinion on that)

So, Britain has apparently decided to take a decidely different approach to national financial health compared to the United States.  Instead, the US government continues to lack the strength to address incredible deficits, and instead wants to "stimulate" the economy by maintaining or growing government spending. 

Britain's wants to reduce deficits to prevent bankruptcy of the British government.  Maybe they can bail out the US government once we go belly up.

Fire Safety

October is National Fire Safety Month.  Sure, it's less glamorous than talking about womens' breasts (and I will in no way try to minimize the incredible importance of Breast Cancer Awareness Month, which is also October).  But, I learned a few things recently that might shock you.

1. Statistically speaking, every family will have a fire where they will need to call the fire department at least once in their lifetime.
2. The amount of time estimated that you will have to escape your home safely in the event of a fire is 1-2 minutes.
3. A standard smoke alarm needs to be replaced every 10 years or so

We're more than halfway through October, so do the following:

1. Make sure you have a smoke detector on every floor of your home, outside every sleeping area and in every bedroom.
2. Splurge and buy some new batteries for those detectors - If the detector is > 10 years old, replace it
3. Make sure your entire family is aware of your outside meeting place, in the event of a fire
4. Consider a safety ladder for any bedrooms on the second floor or higher (show the kids how to use it too)

We also recently installed a series of heat detectors in our home.  These are mechanical devices that sort of look like old school bells.  They have an alloy switch that melts at a specific temp (I think 113 degrees F) and sets off the alarm, which is loud and runs for 5 minutes.  These bad boys are meant to detect heat from a fire.  Some fires burn really hot, but give off little smoke. 

Whatever you do in your home, make sure you stay safe. 

Is the Delta SkyClub worth it?

So, as I've mentioned before, I travel a decent amount, but not as often as some road warriors out there.  If I had to estimate, I fly between 1 and 2 round trip flights a month.  I fly most (90%) of my flights on Delta, and have been toying with the idea of purchasing a SkyClub membership.  In most cases, my connections are through DTW or ATL, with layovers generally between 1 and 2 hours. 

Overall, I'm conflicted.  I purchased some one-time certificates through Groupon a few months back, and have been using them up to get the feel for whether or not the SkyClub is worth it.  Overall, I much prefer the clubs to sitting at the gate, but am not sure the $$ are worth it for my level of travel.

 Annual membership costs looks like this:

Membership Level	Individual	Joint Membership**
	Membership
General Member	$450 or 70,000 miles	$650 or 100,000 miles
Silver Medallion	$400 or 60,000 miles	$600 or 90,000 miles
Gold Medallion	$350 or 50,000 miles	$550 or 80,000 miles
Platinum Medallion	$300 or 40,000 miles	$500 or 70,000 miles
Diamond Medallion*	$300 or 40,000 miles	$500 or 70,000 miles
Additional Fee for New Members1	$50 or 10,000 miles	$50 or 10,000 miles

I'll earn Gold this year, so my cost would be $350 (plus the $50 new member fee), but I suppose I might only get to really use it 6 times a year (due to shorter layovers), unless I intentionally book flights with longer layovers.  Alternatively, I could spend the 50,000 + 10,000 in miles, but would really rather save those for international travel, where I feel like I'll get more for my miles.

I'm interested in thoughts from those who may have a perspective.

How do you say Shut Up in French?

Okay - first things first.  Everyone is entitled to their own opinion, even if they're wrong.  I even extend this general statement to those living outside our great United States, in general.  You can, despite all available reasonability, and in conflict with logic maintain any darn stance you want to - and as long as you're not hurting others through the expression of your idiotic views, go to town. 

All that being said, I have to say - the protests in France are really getting on my nerves.  Today the protests continue as the French Senate nears a vote on President Sarkozy's plan to raise the country's retirement age 2 years.  Strangely, there appears to be an ongoing outcry from French high school students.

I wrote on this before, but to summarize - high school students are close to entering the workforce, but are the farthest from retirement overall, and have not, in general, yet contributed substantially to the French economy through productivity or taxes.  The fact that the students are so outspoken, is not necessarily surprising, I suppose.  Youth does tend to lend itself to excitability...

But overall...  Yep, it's 2 more years of work before you get to take advantage of the national pension plan.  But look at it this way...  The average retiree in the US sees 47% of his/her average wage in Social Security payments.  In Great Britain, a worker sees only 44%.  Germany pays out 61.5% and in France...  Drum roll please...  65%.  So, with one of the richest retirement benefits, there is now a proposed retirement age that is in line with other developed nations. Germany - 67, US - 67, Italy - 65. 

I'm just having a really hard time feeling in any way supportive of the extremely vocal stance being communicated by the labor unions in France.  Seems more like whining than anything else at this point. 

In the immortal words of Google Translate:

Arrêter de se plaindre 

First Class is Loaded

Sometimes people in First Class on a commercial airliner take advantage of the free alcohol.  I have to admit, on early morning flights I like a shot of Bailey's in my coffee.  If it's a long flight, perhaps more than one, or two, or three - especially if there's a cab ride at the end.  And sometimes the flight attendants keep bringing that bottle of white wine by, and topping off my glass...  Who am I to be rude and refuse?

But there's apparently a preference within the Federal Air Marshal's Service for wide, comfy seats at the front of the plane, which The Air Transport Association (ATA - the trade group for large airlines) is taking issue with.  When the marshals' ranks were boosted dramatically post Sept 11, 2001, there was great concern about hijackers storming the cockpit.  Given the events of 9/11, it is completely understandable.  Placing someone with a weapon and advanced training near the cockpit is thoroughly logical.

However, in the years since 9/11, airline cockpit doors have been redesigned and reinforced, making forced entry seem much less a threat.  Still, air marshals apparently (at least according to the ATA) usually sit in First Class.  This is a theoretical drain on the availability of high-revenue seats in a time when it seems some airlines are decreasing their availability overall, and profitability is certainly the name of the game.

The Federal Law Enforcement Officers Association responded with a slightly different viewpoint - claiming that it is inappropriate for the ATA to discuss this issue in the public forum.  Their stance is that the now-ongoing discussion could potentially expose the agency's tactics to terrorists.  I find that a little hard to swallow, as it is not that hard to find anectodal references to this policy on line, especially in travel forums, like Flyertalk.  And of course, again, post 9/11, it made logical sense - that's where you would put a marshal.

Don't get me wrong - if I get the chance to sit in First Class, I take advantage of it.  I'm sure the marshal's even avoid the booze... (giving 100% benefit of the doubt here) The seats are more comfortable, the service is better, the snacks are edible and the line for the lavatory even shorter than coach.  I'll take a premium cabin seat any day of the week over steerage. 

But, it seems that maybe the "upgraded" free rides may be coming to an end, or at least will be diminishing if ATA gets their way.  Too bad for the marshals, but maybe an extra seat in first on a few flights will mean an upgrade or two more for me. 

Part D in 2011 - Time to Fill the Donuts!

If you're familiar with Medicare Part D (either a beneficiary with a Part D plan, a family member of a Part D beneficiary, or someone involved in providing Part D services to beneficiaries) you know how the Part D benefit can be confusing.  Well, 2011 will offer a whole new set of changes to the program as a result of some healthcare reform provisions.  I don't have enough finger strength to type them all, but here's one most people with or involved in Part D should be aware of:

"Filling" the Coverage Gap

The infamous donut-hole... Since inception in 2006, the Coverage Gap has been a part of the standard Part D benefit.  In short, after an small initial deductible and then a coverage period, beneficiaries reach a certain drug spend and then are responsible for 100% of their drug costs (no payment from Part D) until they reach a "catastrophic" level.  The coverage gap is in fact basically a "delayed" deductible.  Most are familiar with deductibles at the beginning of a coverage year, but in order to allow access to coverage sooner for Part D beneficiaries, most of the deductible was placed in the middle of the benefit.  The gap also made the benefit a lot less expensive for the government, and, equally as important, gave seniors a GREAT reason to convert to less expensive generic medications when they were footing the bill during this part of the plan.

In 2011 the coverage gap changes dramatically, especially for brand-name drug products.  Due to a "deal" brokered between PhRMA, the drug manufacturers' powerful association and lobbying group, and the Obama administration during the battle for healthcare reform legislation, the brand drug manufacturers agreed to an $80 Billion concession, basically in exchange for being pretty much left out of the rest of healthcare reform.  In fact, PhRMA was one of the first stakeholders to the table. (smart in my opinion)

Beginning in the 2011 Part D plan year, eligible brand drug products will experience a 50% discount for beneficiaries in the coverage gap.  Well, it will be pretty close to 50%...  Unfortunately, the official definition of the cost to be discounted did not include common "dispensing fees" negotiated between pharmacies and Part D plans (or their claims processors).  In many cases these fees are not very large (a few dollars) but this amount will not be discounted.  So, beneficiaries will receive a discount of 50% on the "ingredient cost" but will still have to pay 100% of the dispensing fee on top of that.  This new discount will continue on from 2011 forward, assuming this portion of health reform is not, at some point in the future, repealed or adjusted.  (seems unlikely to me, given the popularity of an increase in benefit like this)

For the generic side of the house, there is also a discount in the gap, though not as large at first.  Beginning in 2011, generics will experience a discount in the gap of 7%, and this discount will increase annually by 7% until the discount reaches 75%. (yeah, I know the math doesn't work - it jumps more than 7% the last year)  It will take 10 years total for the discount to reach 75%.  Again, the dispensing fee is not included in the discount.  This discount is not funded by manufacturers, however, and is actually a change to the benefit, with Part D (shared between the feds and Part D plan sponsors) picking up the tab on this one.

The unfortunate thing for the overall healthcare system (but a good thing for brand manufacturers) is that in the next few years there will be a negative incentive to switch to newly available generics during the coverage gap.  It is common for new generics to come on the market with only 1 (actually 2 with authorized generics, but that's a different post) generic manufacturer permitted to sell the product for a 6 month period.  During this time, historically, generic manufacturers who have this exclusivity will price their product very close to the innovator (brand).  A discount of 10-20% is not uncommon.  If the brand experiences a 50% discount, and the generic a 7-21% discount (2011-2013), and the generic is priced only 10-20% below the brand, the brand will be less expensive to the Part D beneficiary during the gap. 

Granted this is likely only to occur on products where a generic manufacturer has the 6 month generic exclusivity, and assumes that the generic manufacturer does not alter the logic on pricing during that period.  Once more competition enters the market (more generic manufacturers) prices quickly drop.  Nice how market forces work... However, given that the 1st generic manufacturer makes a TON of $$ during the exclusivity period, I would expect this initial pricing trend to continue.

Generics, in general, save the healthcare system (patients and third-party payers) a lot of money over brand products, so anything that undermines the swtich to generics will, in the end, cost the system more money in drug cost. 

But, if you own some stock in a brand manufacturer, it's a good thing.

Obama on Mythbusters

On Sunday, Adam Savage was tweeting about the Mythbusters traveling to an undisclosed location, which was revealed this morning to be Washington DC.  Both Adam and Jamie appeared at the White House for the White House Science Fair, along with middle and high school students from across the country, showcasing their award-winning science experiments.  Other science-focused individuals in attendance included Bill Nye and Dean Kamen, inventor of Adam's sometimes seen-on-TV Segway. (if you watch the show, you've seen him ride it - especially with they're at the abandoned air base on the runway)

Another little announcment was made today - If you're a Mythbusters fan, you've likely already heard...  On December 8, President Obama will make a cameo appearance on the popular Discovery Channel show.  Apparently taping already ocurred back in July (based on a plixi post from Adam that indicated as such). 

To answer an immediate question from anyone who watches the show, No, the President didn't get to blow anything up.  He apparently taped the appearance to assist Adam and Jamie re-test the Archimedes solar ray.  The Mythbusters have tested this one before...  However, it is not unusual for them to revisit previous myths when the viewers express their displeasure with an outcome, or have opinions that the mythbusters didn't consider important points.

This will not be the first appearence for Obama on popular television, but here are some other Presidential appearences you may or may not recall:

George W Bush - Deal or No Deal - 2008
George W Bush - Fishing with Roland Martin - 2004
Bill Clinton - MTV - 1994
Gerald Ford - SNL - 1976

The President indicated he was disspointed that he didn't get to blow anything up on the show.  Not sure how it will come out yet, but perhaps there'll be a big Democratic explosion to watch on November 2...

Botox for Chronic Migraines

On Friday, The US Food and Drug Administration (FDA) approved Allergan's product Botox for a new indication - prophylactic prevention of chronic migraine.  Those who suffer from chronic migraine have headaches most days of the month.  It's estimated that more than 3 million Americans suffer from chronic migraines.

Women are three times as likely as men to suffer from chronic migraine.  Additionally, it's estimated that 80% of the sufferers have not received an accurate diagnosis.

I would expect that Allergan will begin a massive direct-to-consumer campaign.  If it follows other direct-to-consumer campaigns, they will likely focus on the appropriate diagnosis of chronic migraine, and direct consumers to a non-Botox branded site, referring them to their physician.  I'd doubt that they will focus on that fact that their treatment involves 31 different injections in 7 different head and neck locations.

I wonder how many of the 3.2 million chronic migraine sufferers have the condition due to self-induced stress related to their wrinkles?  For them, treatment with Botox could be a two-fer...  Dull the headaches AND look years younger!  Come to think of it, that could be an effective campaign as well!  AND Allergan has both indications, so hopefully they wouldn't be facing another $600 million settlement related to their marketing practices...

Or, this could be a huge conspiracy to lure Allergan to market Botox in the way I've suggested, so the feds can charge them again, and get another $600million settlement...  Maybe through a series of settlements companies like Allergan can finance all the administration's spending initiatives...

Homemade Spacecraft

Homemade Spacecraft from Luke Geissbuhler on Vimeo.

Golden Pot

California is poised to potentially legalize marijuana for recreational use.  There are strong feelings on both sides, and I am fortunate to be in a position to simply consider how I would vote, not living in California myself.  I can see arguments on both sides of the debate. 

But my interest is less about how California residents' snacking habits will change (potentially an investment in Frito Lay is wise, thinking that purchases of chips will go through the roof in the Golden State) and more in the showdown developing between the residents of California and the US Attorney General.  On Friday US Attorney General  Eric Holder released a letter, addressed to concerned former DEA officials, making the statement that no matter the outcome of the ballot initiative in CA, federal officials would continue to prosecute those who are involved in marijuana production, sale or use as they have to date.  Holder makes the assertion that the Obama Administration "strongly opposes" Proposition 19.

A strongly worded letter from the US AG is certainly a sign that CA residents who attempt to take actions if the proposition passes are at risk for federal prosecution, but the lack of a position up to this point is potentially telling to me. Is it possible that Holder's "late-to-the-party" stance is a sign that there is more bark than bite?  Looking to how federal officials currently handle medical marijuana should also be considered.  At this point, after an initial strong push, prosecution of medical marijuana cases has reportedly dried up.  Could this be foreshadowing for how the game will play out with recreational marijuana?

Something I would love to better understand is the strength of the federal position in this case.  If CA passes this, does the federal law REALLY trump a state's wishes in this scenario.  I'm sure there's someone out there who can enlighten me.

In any event, I would say this is just the beginning.  The "legalize" marijuana movement will likely not weaken.  I would liken the situation to alcohol prohibition.  Trying to maintain it as illegal, and prosecuting those who are involved its commerce will not work.  Sometimes you have to pick your battles. 

How about we just be thankful for our Golden Pot and move on to bigger and better things.  Like some Fritos...  I'm hungry... 

Focus on Health Care

Ostensibly, the Affordable Care Act (health care reform) had several different stated and hidden goals, including but not limited to:

1. Increase the % of the populate protected by health insurance
2. Increase controls on private companies that offer health plans
3. Slow the increase of health care costs as percent of GDP

The first goal of increasing the coverage of the public by health insurance is one that would, in theory, have a positive impact on the country in general.  Currently the cost of those who utilize health care services and cannot pay for these services leads to financial ruin for those individuals involved, and ultimately write-off of those costs by those who are due payment for the services (doctors, hospitals, clinics, etc). 

Adding health care coverage for this group of people doesn't really fix the issue, though.  Those individuals without coverage either can't afford such coverage or they have chosen not to protect themselves.

For those without the financial resources to purchase insurance today, coverage is really just transferring the cost of their care from provider write-offs to premiums for insurance that will be paid by taxpayers.  The costs of care are still there - and potentially will grow as those having this new coverage will have greater access to care and may utilize more services.

For those who choose (word used here to represent a risk-benefit decision) not to obtain coverage, selecting to spend those $ elsewhere (either wisely or foolishly, depending on your personal comfort level for risk) are really just rolling the dice, and some of those individuals will have a medical event that will be catastrophic if not ruinous, while many will not.  The costs of those who have major medical expenses will often end up having those costs handled similarly to the group that could not afford health insurance. 

Coverage of the above groups can only be complete if there is a mandate of coverage, as many are actively choosing to not select coverage today.  A mandate not only ensures coverage (or a stiff penalty if a person continues to decide not to purchase) but also mitigates some of the negative selection that is attempted today.  By that, I mean the situation where someone "holds out" and "rolls the dice" by not purchasing coverage, and then only decides that they need coverage after they are sick. 

So, the Affordable Care Act attempted to deal with the two groups of uncovered individuals (those who choose and those who do not) with a mandate and through private insurance company controls.  Throughout the campaign process for the legislation, health insurance companies were continuously villanized for their decisions and policies around coverage.  Admittedly, some health insurance companies maintained unpopular positions around preexisting coverage and policy denials or cancellations.  Objectively, from a business perspective, these were mostly motivated by good business sense, not social responsibility, as the majority of large companies in the health insurance industry are in business to make money.  Obviously this was unpopular with the general public (though I hazard to say most can understand the motivations, and as stockholders would likely support such actions), so the legislation included additional controls on health insurance plans.  Mission accomplished there...

The final goal I've outlined is the kicker.  The driving force of increases in insurance premiums in the commercial coverage market is the risk associated with covering medical costs.  So, if medical costs go up, through inflation, new covered treatments, or increased utilization, then the price charged by a company to take on that risk logically increases.  So, as costs go up, so do premiums, and this has been the mantra of the health insurance industry as premiums of coverage have increased double digits for years. 

So, to impact the growth of medical costs, you have to find ways to either control the inflation of costs, control the costs associated with new covered services, or impact utilization. 

To control inflation of costs, you have to control the prices for services.  Medicare basically already does this, by simply establishing the amount that Medicare will pay for services.  There is little negotiation, and many providers are just forced to accept Medicare rates because of the purchase power wielded by Medicare.

Controlling the costs associated with new covered services is tougher.  It's politically tough to block payment for new, exciting, or potentially game changing therapies, despite the fact that they are often much more expensive than existing options and are also often relatively unproven.  People want the latest and greatest.  So, while placing exclusions on new therapies is logical, it's harder to accomplish in practice, especially if the group covered is politically active and it is a governmental program.

Finally, you can impact utilization.  Here is where the real savings can come.  First, you can set realistic requirements or safeguards to ensure that those who get certain expensive services are truly good candidates for them.  For those with commercial (private) insurance, you see this done through precertifications or preauthorizations.

But bigger than utilization controls is preventing Fraud, Waste and Abuse (FWA).   This week the FBI announced the arrest of 73 individuals in a $163 million organized Medicare fraud ring.  Likely the FBI, OIG and private insurance investigations are merely catching a small portion of the overall fraud schemes being perpetrated against payers.  The National Health Care Anti-Fraud Association estimates conservatively that 3% of annual health care spend is lost to fraud - which puts it at $68 BILLION annually.

So, in the end, much of the focus during the "sale" of the Affordable Care Act was placed on the "ill gotten" profits of insurance companies, when conservative estimates of the annual cost of fraud (true ill gotten profits) place it higher than the combined profits of the top 14 insurance companies.  Perhaps we should focus more on ensuring the proper payment of claims, and focus less on the ethics of insurance company profits.

US v France - They Win

Alright - so generally I'll complain about the American public's perpetual sense of entitlement.  I even today posted about Social Security.  But, despite the best efforts to capture the crown, we have been overcome, I believe, by a group of people who are currently demonstrating a level of entitlement-think even beyond our own...  and it's happening in France.

For 3 straight days this week, the French have been in the street protesting French President Nicolas Sarkozy's plan to increase the retirement age from 60 to 62.  Apparently this has induced many in France, including HIGH SCHOOL STUDENTS to protest in the streets. 

Interesting to note, is that these are HIGH SCHOOL STUDENTS!  It would stand to reason that they are the farthest from retirement age, and have yet to really meaningfully contribute to the country's financial and social systems, but apparently they still feel as though they are entitled to a retirement at age 60.  That's 40 years away...  What's another 2 years?

I'm not even sure I'll be done paying for weddings and college for my three daughters by the time I'm in my 60's, and, as I posted earlier today, I'm not even planning on having ANY $ coming from Social Security.

Sorry - having a really hard time feeling sorry for you, my little French friends.  Buck up.  Get a job.  Contribute.  Take a few less holidays, and then maybe we can talk.  Until then, go sit down in your geometry class and shut up.

B737 - 45 years young

Perhaps I'm just plain ignorant about the details of Boeing's business, but I find it amazing that the Boeing 737 jetliner has been around for more than 45 years. 

According to Boeing's website, the first order for a 737 was placed on 2/15/1965.  The first delivery was to Lufthansa on 12/28/1967 and it went into service on 2/10/1968.  The 737-100 was manufactured until July 1973, when the last one was delivered to NASA.

Today Boeing is still manufacturing 4 different 737 models, including the 600, 700, 800 and 900, with rollout underway of the 900ER.  Since launch, more than 6,000 B737 have been ordered, which to me is just simply astounding.

Even more astounding is the number of people and airlines salivating over the much anticipated (and unfortunately much delayed) B787 Dreamliner.  Orders have been placed for more than 840 B787s from all over the world.  To date, Boeing has only produced 6, all test aircraft.  Unfortunately, the first delivery of a B787 has been pushed to mid Q1 2011, due to a combination of supplier issues and engine availability.  Hopefully for Boeing, by the time they get this baby in production, they can have their supplier issues ironed out, though realistically, given how they have structured their dependence on suppliers as part of the 787 program, it's likely we'll see sporadic supplier issues ongoing.

Despite all the delays, the added efficiencies and comfort promised in the B787 are still eagerly awaited.  Things like LED lighting, large tint-adjustable passenger windows, large overhead bins, and better cabin pressurization with cabin air that is cleaner and humidified are all things that will hopefully make the air passenger experience a little more enjoyable for those who get the pleasure of a flight aboard one.

And, on top of all that, it's just a pretty airplane.

Social Security Rears Its Head as Election Approaches

The Social Security Administration announced today that due to a low inflation rate, Social Security benefits will not experience a Cost of Living Adjustment (COLA) in the year 2011.  This is due to federal law that links Social Security COLA to the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). The CPI-W did not increase between third-quarter 2008 and the same time in 2010.  Since the COLA is linked, there will be no corresponding positive adjustment to Social Security benefits.

In contrast, overall consumer prices rose 1.1% from a year ago (2009), with core prices up 0.8% over the past 12 months.

US House Speaker Nancy Pelosi on Thursday announced a plan pay out a one-time payment of $250 to Social Security recipients and veterans, claiming the House will vote on the measure after the November 2 election.  The White House apparently supports the measure.

It is widely viewed that Social Security faces a dire future, and is currently predicted to become insolvent in the year 2037. At that time the program will no longer be able to pay out projected full benefits.

Despite the near-universal view that Social Security cannot continue to exist the way it does today, instead of viewing the lack of a COLA as a positive (because it keeps more money in the trust fund, versus depleting it further), Pelosi’s stand is to apparently “compensate” with a one-time payment to beneficiaries.  It is yet unclear how this payment would be funded.

Rep Dave Camp, the top Republican on the House Ways and Means Committee said this:

"It will be difficult for many seniors to deal with the lack of a COLA for a second year in a row, but that will pale in comparison to the actual hardships future Social Security recipients will experience if Congress continues to ignore the program's underlying financial problems."

Interestingly, the White House added another twist to the conversation.  Obama said on Thursday that increasing the amount of wages subject to Social Security tax would be the best approach to prolong the solvency of the program.

Pelosi’s and Obama’s statements/announcements appear to be well-timed moves as we near the November 2nd elections.  It doesn’t take a political geniuos to make the obvious connection that appealing to Social Security beneficiaries with promises of $$, funded (potentially now or in the future) through higher payroll taxes (notably taking from those not yet benefiting from the system), is a great way to garner support for your candidates from those who do stand to benefit in the short term.  Of course I would never go so far as to say anyone is attempting to buy votes… 

Personally, I am not planning my retirement assuming ANY funds coming from Social Security, even though I do plan and expect to contribute to the program my entire career. (and apparently my contribution should be higher than it is today). I feel for those who have been led to believe, over the course of their careers, that Social Security would continue to support them indefinitely.  I have a hard time stomaching, however, the obvious use of this popular but inherently flawed program as a political lever.

Painful sacrifices on BOTH SIDES of the aisle (those paying in and those getting paid out) will be necessary in order to save this program, and sustain it, in some form, into the future.  The Democratic election-season approach doesn’t appear to contemplate anything but sacrifices on the contribution side.

Have comments?  Post them here.

Love My Skymiles Dining

Despite the title, this is not a love note about airline food. 

Anyone with a frequent flyer account with an airline gets a barrage of ongoing emails on both how to both earn and spend miles/points. 50% of the time, they're trying to get you to sign up for their branded credit card, which can be pretty lucrative for earning miles/points, IF you use it enough to be able to swallow the annual fee.

I'm not a road warrior like some I know.  Despite my wife's disdain for my travel, it's relatively reasonable.  I will, however, this year earn Gold Medallion Status on Delta, so I guess I travel more than most Americans.

I have to admit, though, that I AM one to try to earn as many miles as I can in the Skymiles program.  Sure, most of the time it doesn't earn you Medallion Qualifying Miles (MQM) if you're not earning them flying with Delta (or a Delta partner), but when dreaming of flying first class to Europe on miles, it just can't hurt to put as many miles in that account as possible.

I saw the other day that I reached what I think is a pretty impressive milestone - I have earned, in 2010 YTD, just shy of 11,000 Skymiles through the Skymiles Dining Program.  All I did was register my credit and debit cards with the program, and then eat out, paying with a registered card.  Easy Peasy (as my daughters would say).

Whenever I visit a city, traveling for business or leisure, I look up (using their handy-dandy iPhone/iPod app) local participating restaurants, and try to visit at least one.  There are also several in the local area around my home that I convince the fam to visit with me on occassion as well.

In general, these aren't 5-Star establishments, but often small, individually-owned places with good food and decent value.  Yes, I've visited some that I probably would not return to, but have also visited others that I can't wait to go back.  The experiences are usually unique, and seeking out these places is both rewarding from a Skymiles perspective as well as from a "get you off the beaten path" perspective.

The program is administered by Rewards Network, and they have other branded programs as well, like Upromise (for college savings), Hilton and Southwest Airlines, depending on where you want your rewards to go.

If you eat out, you should consider finding a dining program that pays you back.  It's worth the time.

Dad's Nail Salon

It may be interesting to some that we have developed a unique division of roles in the Wehneman household.

Mom -

• Make most meals
• Pay Bills
• Laundry
• Clean (as possible)

Dad -

• Go to the office
• Drive whenever we go anywhere as a family
• Play bad guy when it comes to discipline (so Mom can play less-bad guy)
• Paint nails

In the event you didn't catch that one, it is DAD'S job to paint little girl finger nails...  How, exactly, I came to own this little piece of life, I'm not totally certain.  But, it's mine, and I guess I'm starting to get the hang of it.

Here's a sample of my work:

I guess at least I don't have to do the laundry...

MiFiPad

While a Verizon iPad with broadband onboard would have been the best news for many this Holiday season, Verizon (VZ) and Apple (APPL) got close… An iPad bundled with a Verizon MiFi 2200 Mobile Hotspot, going on sale October 28. The retail pricing looks a lot like the AT&T version:

iPad 16GB + MiFi = $630
iPad 32GB + MiFi = $730
iPad 64GB + MiFi = $830

Upside –
• Can connect multiple devices to the MiFi wireless, which could be very beneficial for those who travel as a couple or family and/or those who need to connect multiple devices.
• Verizon has (in my opinion) a superior broadband network than AT&T

Downside –
• The data package could be more expensive in the end, since you’re paying $60 a month for the MiFi access, and if you aren’t a huge power user, it’s possible you could overspend on data unnecessarily.

Overall, this will undoubtedly increase the uptake on the iPad this Holiday season.
(Hopefully in our house too… hint, hint)

UPDATE

Need to clarify data package options -

• 1GB = $20
• 3GB = $35
• 5GB = $50

Also, on the $20/1GB plan, each additional GB costs $20.  For the 3GB ad 5GB, each additional GB costs only $10.

Sugar Pills a Cheap Female Viagra

German drug manufacturer Boehringer Ingelheim (BI) has announced that it has halted research and development of the investigational drug flibanserin.  This announcement comes after rejection of the drug, submitted for approval, by the FDA in June of this year.  Apparently BI failed to sufficiently show that the use of the drug increased the libidos of the women in the studies.
A few thoughts come to mind -

1. Female libido, in my mind, is dramatically different from male libido.  Male libido is "stimulated" easily in comparison to female in my experience.  Realistically, a stiff breeze can get a man going...  However, a woman's libido is usually much more directly connected to emotional state and attachment.  Simply increasing bloodflow for a woman just doesn't seem like the answer to me - but for a man, little else is required.  Drugs, in general, just don't seem to be a good fit.  Fix her man, and maybe you have a different outcome.  Or even better, if the man could be on something that increases his ability to emotionally connect, and maybe you've got a blockbuster.
2. Others have tried and failed at this before...  Pfizer, who launched Viagra which opened up the Erective Dysfunction market in 1998 with their blockbuster drug dropped their search for a female version in 2004. 
3. Placebo (also known as "sugar pills") were actually almost as effective as BI's drug in increasing the number of "sexually satisfying events" (SSE) for women in the studies.  Flibanserin-treated women reported 4.5 SSEs per month, compared to 2.7 SSEs per month for those taking nothing.  Interestingly, women taking a placebo reported 3.7 SSEs per month; more than nothing, but less than flibanserin.

The placebo effect is quite powerful, and often almost (if not sometimes more) effective than traditional treatments.  The human mind is a powerful tool, and its direct or indirect impact on the body is still something we do not yet very well understand. 

However, I think there is a practical lesson for all men in the failure of BI's drug.

You can spend many many $$ on alternative methods to...  um... well, "Git R Done."  However, before spending millions on a super, female libido increasing med, why not try a box of chocolates.  Even if it doesn't work, maybe she'll be thankful enough to let you have a piece.  Of chocolate, that is. 

SCOTUS, NCVIA & Other Interesting Acronyms

A controversial (and by extension interesting) case is currently being heard by the Supreme Court of the US (SCOTUS).  This case (click here) is questioning the protections afforded vaccine manufacturers by the National Childhood Vaccine Injury Act of 1986 (NCVIA).

For those unfamiliar, the NCVIA was enacted to offer some significant liability protection to vaccine manufacturers. The fear then (and now) was that our "litigation-happy" culture (no offense to my brother, or any other members of the nobel profession of arguers) would offer too much risk for manufacturers to continue to stay in the vaccine marketplace.  In the interest of public health, which would, it was/is argued, be harmed by unavailability of vaccines, the act established a compensation program for injuries from some specific vaccines, and in conjunction limited the liability of manufacturers to be sued for those injuries.

The case in question involves a family that claimed injury of their daughter following administration of a diptheria, tetanus and pertussis vaccine manufactured by Wyeth.  The parents files for compensation under the federal injury program, but were turned down.  They have attempted to bring a lawsuit against Wyeth.

In my opinion, vaccinations are one of the true success stories of modern medicine.  When was the last time you heard of a local neighborhood child contracting polio or smallpox?  The long-lasting negative impacts of the diseases to the general population are incredibly larger than the negative impacts supposedly connected with current vaccines.  Adverse events do occur from vaccine administration but on an incredibly infrequent basis.  When they do occur, the national compensation program is available.  I'm in support of the law preventing lawsuits related to vaccine injury - if anything, in this particular case (and I have not researched it fully) there should be an assurance that appropriate grievance and appeals have been considered by the panel responsible for compensation awards.

The other side of the argument says that by preventing lawsuits being brought against vaccine manufacturers, we remove an incentive to develop new, safer vaccines.  Unfortunately, no company will be interested in developing, testing or manufacturing newer (supposedly safer) vaccines if the liability exposure is so great.  For those who DO stay in the manufacturing space for vaccines, the prices charged will be much greater than they are today - market forces there - supply and demand - and so the pricing of vaccines will also rise.

I will disclose that my opinion on this topic is in line with the current administration's.  This admittedly forced me to consider if I could be wrong - but have come to the conclusion that even a blind squirrel finds a nut once in a while.  Oh, and I'm not blind, nor a rodent...