Yesterday I had what I believe was the scariest experiences of my life. Now, I've not seen what some have, but I'm pretty well rounded. I've rushed my bleeding children for medical care, I've had moments when I thought I had driven my beautiful now-wife away from me for good, and I've had to sign commitment papers for someone I love against their will. However, yesterday I experienced something that still today, after the adrenaline is gone, and I've had a night's sleep, is continuing to make my hands shake and my eyes tear (involuntarily) when I think about it.
The whole clan was over at another family's house. They have 3 kids as well, and they have a pool. We had swam a couple of hours earlier, and then had dinner. All the kids wanted to go swimming again after dinner, and I went out with them. (they range in ages from 2 to 7)
Another neighbor kid also ran over, so there were 7 kids total. Now, my kids do pretty well in the water. Spawn 1 (7) can swim without any assistance, and she loves the water. Spawn 2 (6) can swim as well, but she still often prefers a set of water wings. Spawn 3 (3) wears a vest. Friends' kids can't swim; the older 2 wear swim vests, with their youngest sitting in a float raft.
Friends' kid 2 didn't really want to swim after dinner, so he went to the swings. Friends' kid 3 was floating in his raft, but wanted out of the pool. He floated to the edge, and I proceed to pull him out and extricate him from his raft.
While I did this, friends' kid 2 apparently came over to the pool and, without me seeing him, fell in. He was not wearing his floatie vest, as he (and I) had not planned on him swimming.
My kids are screachers (girls...), so sometimes its hard to tell if they're happy, upset, hurt, etc. (as all the screaches sound pretty similar). Also, Spawn 3 is just really starting to talk well, and so our Spawn 1's name and their kid 2's names are "similar".
I heard Spawn 3 yelling what sounded like Spawn 1's name. I didn't think much of it, as Spawn 1 may have been splashing her, or something of that nature. However, being the father I am, I looked over to see what "torture" was befalling my youngest at the hands of my oldest, so I could yell at Spawn 1... (I do it more than I should)
What I saw was not what I expected. Spawn 3 was reaching into the water, holding onto friends' kid 2, who was struggling underwater - completely underwater - head and all. My heart stopped.
I jumped in (shoes, phone, wallet and all) and pulled him up. I delivered him to the side, where he crawled away from the pool.
He must have not been under long, as he was alert, breathing and just cried. I pulled myself from the water just as the other adults began filing outside. They looked at my oddly.
I think it was all more of an ordeal for me, as friends' kid 2 got back in the pool (with his vest) 30 minutes later.
So, my wallet is drying, and my phone is in rice (it's a company phone - so I'm hoping it isn't damaged). I was okay yesterday, once my heart stopped pounding. But today, my hands are shaky, and I can't stop thinking about it.
And so, even though everything turned out okay, we are NEVER gettting a pool.
Sunday, June 5, 2011
Wednesday, January 19, 2011
Health Care Reform Treating Symptoms But Repeal Unlikely
Today the Republican-controlled House of Representatives passed a measure, widely considered symbolic, repealing the health care reform bill enacted by the previous Congress and signed into law by President Obama. There is little chance the Democratic-controlled Senate will bring the measure to the floor for debate, let alone a vote. Beyond that, there is even less chance that President Obama would sign a repeal of his signature domestic achievement. He would almost certainly veto such an effort if it would reach his desk.
There was much public debate regarding the bill which will not soon be forgotten. The main focus of the proponents of the healthcare reform bill was to attempt to build public support through the demonizing of the insurance industry, mostly with a focus on pre-existing condition exclusions. It was an interesting situation, where on one hand Democrats told of the "evils" of the insurance industry, while on the other hand pushed for the expansion of insurance to more Americans. Secondary to expanded coverage was the idea of cost controls, though much more muted than the outspoken attacks upon commercial insurers.
The Obama Administration and Congressional Democrats continue to extole the virtues of the law. Even yesterday, in advance of the House vote on repeal, Health and Human Services (HHS) released a report that claims up to 129 million Americans are threatened by repeal of the health care reform law's protections against denials of coverage for pre-existing conditions. It's an interesting report, but is clearly partisan in its authors' bias and should be considered thinly veiled propaganda.
What has unfortunately been lost in all the hoopla is the really necessary change to the health care landscape in America. (Yes, I DO mean health care, not health insurance) Health insurance and the associated socially distasteful practices that Democrats "fixed" are merely symptoms, and the fixes leave the root issue (the underlying pre-existing condition) untreated.
The root issue in health care in the United States today is cost. Overall cost, driven by a great many things, including increased utilization of new and continuously improving technology (which is *shock* expensive when new and novel), increases in the diagnosis of previously not understood or rarely recognized conditions, impacts of social/cultural choices (super size my fries please...), and the embedded cost of care for those without means to pay (which is spread across the remaining payers in the system), includes to rise, and eat up more and more of the country's GDP. It's unsustainable to continue to grow health care expense faster than the growth of GDP.
But the health care reform law did little to curb the overall growing expense. In fact, the expansion of coverage (especially Medicaid-like coverage which is generous in comparison to most private coverage) will potentially grow health care costs, by encouraging utilization. And the American taxpayer will foot the bill.
Insurance practices such as pre-existing condition exclusions (there are many less well known approaches) are a reaction by insurers as well as employer clients to the incredible, and unsustainable increases in overall medical expenses related to care. It's actually a natural, business-based reaction. It's not friendly, but it is good business.
Insurance companies make money by insuring people. If you fix the underlying issue of cost escalation, and prices/premiums are allowed to normalize, you would likely see the insurance industry focus on efforts to further increase enrollments, covering more people, not less. In the end, addressing costs (disease) versus industry practices (symptoms) would likely be much more efficient, allowing the symptoms to improve or resolve on their own.
There was much public debate regarding the bill which will not soon be forgotten. The main focus of the proponents of the healthcare reform bill was to attempt to build public support through the demonizing of the insurance industry, mostly with a focus on pre-existing condition exclusions. It was an interesting situation, where on one hand Democrats told of the "evils" of the insurance industry, while on the other hand pushed for the expansion of insurance to more Americans. Secondary to expanded coverage was the idea of cost controls, though much more muted than the outspoken attacks upon commercial insurers.
The Obama Administration and Congressional Democrats continue to extole the virtues of the law. Even yesterday, in advance of the House vote on repeal, Health and Human Services (HHS) released a report that claims up to 129 million Americans are threatened by repeal of the health care reform law's protections against denials of coverage for pre-existing conditions. It's an interesting report, but is clearly partisan in its authors' bias and should be considered thinly veiled propaganda.
What has unfortunately been lost in all the hoopla is the really necessary change to the health care landscape in America. (Yes, I DO mean health care, not health insurance) Health insurance and the associated socially distasteful practices that Democrats "fixed" are merely symptoms, and the fixes leave the root issue (the underlying pre-existing condition) untreated.
The root issue in health care in the United States today is cost. Overall cost, driven by a great many things, including increased utilization of new and continuously improving technology (which is *shock* expensive when new and novel), increases in the diagnosis of previously not understood or rarely recognized conditions, impacts of social/cultural choices (super size my fries please...), and the embedded cost of care for those without means to pay (which is spread across the remaining payers in the system), includes to rise, and eat up more and more of the country's GDP. It's unsustainable to continue to grow health care expense faster than the growth of GDP.
But the health care reform law did little to curb the overall growing expense. In fact, the expansion of coverage (especially Medicaid-like coverage which is generous in comparison to most private coverage) will potentially grow health care costs, by encouraging utilization. And the American taxpayer will foot the bill.
Insurance practices such as pre-existing condition exclusions (there are many less well known approaches) are a reaction by insurers as well as employer clients to the incredible, and unsustainable increases in overall medical expenses related to care. It's actually a natural, business-based reaction. It's not friendly, but it is good business.
Insurance companies make money by insuring people. If you fix the underlying issue of cost escalation, and prices/premiums are allowed to normalize, you would likely see the insurance industry focus on efforts to further increase enrollments, covering more people, not less. In the end, addressing costs (disease) versus industry practices (symptoms) would likely be much more efficient, allowing the symptoms to improve or resolve on their own.
Saturday, January 8, 2011
Verizon iSomething
The Wall Street Journal has predicted that a Verizon iPhone will be announced Tuesday Jan 11th. Invitations have been distributed to the media for an event to be held in New York, with no specific information divulging the specifics of what will be announced. Additionally, there have been reports of vacation bans at both Verizon and Apple retail stores that overlap. Hmmm...
The idea of a Verizon iPhone is new to no-one, and many have for years dreamed of the day of holding an iPhone free of chains from the AT&T network. That day may be at hand.
However, there's also been lots of recent talk and rumors about the release of a second generation iPad, which is also expected in the very near future. Some have predicted a release in April 2011, fitting with Apple's tendency to refresh products with annual timing (iPad originally went on sale in April 2010).
So, while WSJ reporting is likely accurate, I've got a more selfish hope for Tuesday. Perhaps Verizon will, instead of announcing an iPhone (which will undoubtedly happen at some point) on the Verizon network, will instead announce the second generation iPad, with exclusive US wireless broadband service on the Verizon network.
Personally, I never invested in the original iPad - timing of excess available cash mostly. But, with the impending release of iPad 2, I'm getting close. Additionally, I'd rather put my monthly $$ into data for an iPad than service for an iPhone.
So, WSJ's reporting may be absolutely accurate, but I'm still hoping for a Verizon-exclusive iPad 2. Even if I'm wrong, it sure will be fun to watch the mass exodus from AT&T once Verizon has the iPhone.
The idea of a Verizon iPhone is new to no-one, and many have for years dreamed of the day of holding an iPhone free of chains from the AT&T network. That day may be at hand.
However, there's also been lots of recent talk and rumors about the release of a second generation iPad, which is also expected in the very near future. Some have predicted a release in April 2011, fitting with Apple's tendency to refresh products with annual timing (iPad originally went on sale in April 2010).
So, while WSJ reporting is likely accurate, I've got a more selfish hope for Tuesday. Perhaps Verizon will, instead of announcing an iPhone (which will undoubtedly happen at some point) on the Verizon network, will instead announce the second generation iPad, with exclusive US wireless broadband service on the Verizon network.
Personally, I never invested in the original iPad - timing of excess available cash mostly. But, with the impending release of iPad 2, I'm getting close. Additionally, I'd rather put my monthly $$ into data for an iPad than service for an iPhone.
So, WSJ's reporting may be absolutely accurate, but I'm still hoping for a Verizon-exclusive iPad 2. Even if I'm wrong, it sure will be fun to watch the mass exodus from AT&T once Verizon has the iPhone.
Wednesday, January 5, 2011
Could Andrew Wakefield Lose Any More Credibility?
Anti-vaccine activists have been dealt another blow. Reported worldwide today is the news that the 1998 study, published by a group of authors led by Andrew Wakefield, originally published and last year retracted by the British medical journal Lancet, was based upon falsified data. It seems some of the subjects of the study, reported to be normal prior to their dose of MMR vaccine, had in fact shown signs of developmental problems prior to the vaccine.
Scores of other studies have found no link between vaccines and autism, though the outcome of those studies and the complete discrediting of the Wakefield study will likely not sway those that strongly believe autism and vaccinations are linked. Most of these people are driven to and keep their position out of fear. Fear is an extremely strong emotion, and fear for the safety of one's child is especially strong, in many cases stronger than a parent's own self-preservation instincts. Undoubtedly some parents already on the anti-vaccine path will not be moved to change their perspective, even when all potential evidence to support their fears is gone.
The fact is that vaccinations, after clean water, are one of the most impactful cultural and/or scientific developments to decrease mortality. Vaccines can ERADICATE diseases that would otherwise kill or maim scores of people, many of which are children. To deprive a child of potentially life SAVING preventative treatment is more scary in my mind than any vaccine.
Kids get vaccinations. Some kids (for some reason yet to be explained and incredibly unlikely to be vaccinations) are stricken with autism. Vaccines don't cause autism, just like high school doesn't cause pimples. Just because they happen at the same point in life, doesn't mean there is a causal relationship.
Monday, January 3, 2011
CVS to buy UAM - Good for Investors - Bad for RPh
Universal American (UAM) has announced that it will sell it's Medicare Part D business to CVS/Caremark (CVS) for $1.25 billion. It was just a few short years ago (2007) that UAM announced the acquisition of MemberHealth, a PBM that experienced significant success with the launch of Medicare Part D in 2006 with a retail-only Part D plan (CCRx). UAM paid only $630 million for MemberHealth on 2007, so it will turn a nice profit on a short 3 year investment.
Private equity firms actually helped finance the purchase of MemberHealth in 2007, so the return here for them is pretty quick, and substantial. Stock holders of UAM will receive about $13 a share in cash (stock was trading at just north of this amount before the announcement) plus 1 share of a new UAM stock, which will represent the remainder of the business (Medicare Advantage and traditional insurance). So, investors get to "cash out" on the stock, and get another set of shares, which will be in a company with no debt.
There are a few things to consider. The sale comes almost exactly a month after a CMS mandated suspension of marketing for UAM. Not a good thing to say the least. In fact, UAM was prevented from enrolling new members for almost half the Part D selling season for the 2011 plan year. There are undoubtedly major things wrong with the management of the Part C and D businesses for this to occur - likely compliance in nature. So, with compliance issues apparent and ongoing, CVS is buying damaged goods of sorts, paying a little more than $650 a head for the membership. I don't know what the annual "value" of a Part D member/life is on average, so hard to say if it's a discounted buy or not, but this added membership more than doubles CVS/Caremark's Part D business (currently about 1.2 million lives - UAM represents about 1.9 million lives), which they have struggled to grow like I'm sure they wanted to. In the end, good for both parties. CVS grows (taking eyes off, momentarily, the lack of synergies shown in the CVS/Caremark merger of a few years ago) and UAM gets rid of some of their CMS compliance issues.
But, don't forget UAM has the Medicare Advantage (MA) business as well. In fact, they have somewhere in the neighborhood of 240,000 MA members, and this business is also under the shadow of a "do not sell" restriction from CMS. What will become of this part of UAM? According to the news releases, this business will be part of the new UAM. More likely? I'd guess UAM will sell this business as well, once it finds the right buyer. The MA space is being squeezed by premium cuts mandated by healthcare reform, and consolidation is inevitable, expected to accelerate considerably in 2011. With plans flush with cash likely looking to buy membership (scale will help ensure profitability), and UAM management struggling under CMS scrutiny, a sale seems a likely outcome.
While UAM had other Part D plans, the majority of the membership on it's way to CVS is in the CCRx plan. This plan is unique (and popular with community pharmacists) due to the fact that is contains no mail-order benefit. CCRx was arguably successful due to the understandable, yet not quite allowable preference community pharmacist have for the CCRx plans. Community pharmacists have for years been fighting the growth of mail-order pharmacies, and the CCRx plan capitalized on this embedded marketing of sorts. Though pharmacists are not technically supposed to "steer" patients to one plan or another, it's easy to see that pharmacists would like the idea of not fighting mail order to keep their patients... and thus the success of CCRx. Combine that with the fact that CCRx also leveraged their pharmacist network for Medication Therapy Management (MTM) services, where other plans may use call centers of company-employed nurses or pharmacists, and you get a double-whammy of preference.
The 2011 Part D plan year benefits are not really modifiable at this point, and the CVS/UAM management will likely keep the ship steady-as-she-goes for 2011. However, I can see major changes on the horizon for 2012 - or at least whatever changes CVS thinks they can get away with and not piss-off the membership directly. What will be changed is obviously a guess at this point, but I would suspect a close review and possible modification to the CCRx stances on mail-order and MTM, both of which are counter to CVS/Caremark culture. This will be bad for community pharmacists, and in the short term, it will be hard for pharmacists to "suggest" other plans and have a huge impact (membership in CCRx was built over 5 years - it won't disappear in one Part D selling season, no matter how upset pharmacists are about the changes). It's also hard to say there are really any viable "pharmacist-friendly" options left. That is, unless someone else partners a plan with community pharmacists for 2012.
So, if you bought stock in UAM as late as last week, you could really make out - especially if UAM sells the MA business and cashes out further. If you're a community pharmacist, that previously quietly (or not so quietly) supported the CCRx Medicare Part D plan, you're likely not going to make out quite as well, and in fact should be looking for a new partner in the Part D space. Based on the National Community Pharmacist Association's (NCPA) feeling about the Humana/Walmart plan for 2011 (here's another blog that I often read that speaks about it), I'm pretty sure who I would bet it won't be...
Private equity firms actually helped finance the purchase of MemberHealth in 2007, so the return here for them is pretty quick, and substantial. Stock holders of UAM will receive about $13 a share in cash (stock was trading at just north of this amount before the announcement) plus 1 share of a new UAM stock, which will represent the remainder of the business (Medicare Advantage and traditional insurance). So, investors get to "cash out" on the stock, and get another set of shares, which will be in a company with no debt.
There are a few things to consider. The sale comes almost exactly a month after a CMS mandated suspension of marketing for UAM. Not a good thing to say the least. In fact, UAM was prevented from enrolling new members for almost half the Part D selling season for the 2011 plan year. There are undoubtedly major things wrong with the management of the Part C and D businesses for this to occur - likely compliance in nature. So, with compliance issues apparent and ongoing, CVS is buying damaged goods of sorts, paying a little more than $650 a head for the membership. I don't know what the annual "value" of a Part D member/life is on average, so hard to say if it's a discounted buy or not, but this added membership more than doubles CVS/Caremark's Part D business (currently about 1.2 million lives - UAM represents about 1.9 million lives), which they have struggled to grow like I'm sure they wanted to. In the end, good for both parties. CVS grows (taking eyes off, momentarily, the lack of synergies shown in the CVS/Caremark merger of a few years ago) and UAM gets rid of some of their CMS compliance issues.
But, don't forget UAM has the Medicare Advantage (MA) business as well. In fact, they have somewhere in the neighborhood of 240,000 MA members, and this business is also under the shadow of a "do not sell" restriction from CMS. What will become of this part of UAM? According to the news releases, this business will be part of the new UAM. More likely? I'd guess UAM will sell this business as well, once it finds the right buyer. The MA space is being squeezed by premium cuts mandated by healthcare reform, and consolidation is inevitable, expected to accelerate considerably in 2011. With plans flush with cash likely looking to buy membership (scale will help ensure profitability), and UAM management struggling under CMS scrutiny, a sale seems a likely outcome.
While UAM had other Part D plans, the majority of the membership on it's way to CVS is in the CCRx plan. This plan is unique (and popular with community pharmacists) due to the fact that is contains no mail-order benefit. CCRx was arguably successful due to the understandable, yet not quite allowable preference community pharmacist have for the CCRx plans. Community pharmacists have for years been fighting the growth of mail-order pharmacies, and the CCRx plan capitalized on this embedded marketing of sorts. Though pharmacists are not technically supposed to "steer" patients to one plan or another, it's easy to see that pharmacists would like the idea of not fighting mail order to keep their patients... and thus the success of CCRx. Combine that with the fact that CCRx also leveraged their pharmacist network for Medication Therapy Management (MTM) services, where other plans may use call centers of company-employed nurses or pharmacists, and you get a double-whammy of preference.
The 2011 Part D plan year benefits are not really modifiable at this point, and the CVS/UAM management will likely keep the ship steady-as-she-goes for 2011. However, I can see major changes on the horizon for 2012 - or at least whatever changes CVS thinks they can get away with and not piss-off the membership directly. What will be changed is obviously a guess at this point, but I would suspect a close review and possible modification to the CCRx stances on mail-order and MTM, both of which are counter to CVS/Caremark culture. This will be bad for community pharmacists, and in the short term, it will be hard for pharmacists to "suggest" other plans and have a huge impact (membership in CCRx was built over 5 years - it won't disappear in one Part D selling season, no matter how upset pharmacists are about the changes). It's also hard to say there are really any viable "pharmacist-friendly" options left. That is, unless someone else partners a plan with community pharmacists for 2012.
So, if you bought stock in UAM as late as last week, you could really make out - especially if UAM sells the MA business and cashes out further. If you're a community pharmacist, that previously quietly (or not so quietly) supported the CCRx Medicare Part D plan, you're likely not going to make out quite as well, and in fact should be looking for a new partner in the Part D space. Based on the National Community Pharmacist Association's (NCPA) feeling about the Humana/Walmart plan for 2011 (here's another blog that I often read that speaks about it), I'm pretty sure who I would bet it won't be...
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