Showing posts with label Insurance. Show all posts
Showing posts with label Insurance. Show all posts

March 4, 2010

Declaration of Preauthorized Independence

Inspired by K2's tweet:

When in the Course of human events it becomes necessary for one people to dissolve the preauthorization form which have connected them with another and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all people are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Health Care Systems and Insurance are instituted among us, deriving their just powers from the consent of the insured, — That whenever any Dysfunctional System of Health Care becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Insurance, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Insurances long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Insurance, and to provide new Guards for their future security. — Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Insurance. The history of the present Insurance System is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these People. To prove this, let Facts be submitted to a candid world.
  • It has refused to Assent to Laws, the most wholesome and necessary for the public good.
  • It has forbidden It Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till its Assent should be obtained; and when so suspended, It has utterly neglected to attend to them.
  • It has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.
    It has called together lobbyist to legislative bodies at places unusual, uncomfortable, and distant from the depository of their Public Records, for the sole purpose of fatiguing them into compliance with its measures.
  • It has erected a multitude of New Offices, and sent hither swarms of Officers to harass our people and eat out their substance.
  • It has kept among us, in times of peace, Standing Armies of Cliams Adjusters without the Consent of our legislatures.
  • It has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving its Assent to their Acts of pretended Legislation
  • For quartering large bodies of paper pusher among us:
  • For protecting them, by a mock Trial from punishment for any Murders which they should commit on the Inhabitants of these States:
  • For cutting off our Trade with all parts of the world:
  • For imposing Co-pay on us without our Consent:
  • For depriving us in many cases, of the benefit of Treatment prescribe by out Doctor:
  • For abolishing the free System of Simple English rules, establishing an Arbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these Colonies
  • For taking away our Charters, abolishing our most valuable Laws and altering fundamentally the Forms of our Governments:
  • For suspending our own Legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.
  • It has abdicated Government here, by declaring us out of its Protection and waging War against us.
  • It has plundered our seas, ravaged our coasts, burnt our towns, and destroyed the lives of our people.
  • It is at this time transporting large Armies of form Mercenaries to compleat the works of death, desolation, and tyranny, already begun with circumstances of Cruelty & Perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.
  • It has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Pre-Existing Conditions whose known rule of warfare, is an undistinguished destruction of all ages, sexes and pre-existing conditions.
In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A Prince, whose character is thus marked by every act which may define a Tyrant, is unfit to be the insurer of a free people. Nor have We been wanting in attentions to our Insurance brethren.

We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.

We, therefore, the Representatives of the People With Diabetes, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these united Colonies are, and of Right ought to be Free and Independent States, that they are Absolved from all Allegiance to the Insurance Crown, and that all for  connection between them and the State of Industry Double Talk, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. — And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.

July 8, 2008

Why Buy into Pumping

Not the idea of pumping Better is Better makes that case brilliantly. (5/16 editor note: Better is Better link has gone dead see the book.)

Why buy them?

In the next 4 years there will be a wholesale change in the insulin pump world. We have to be excited that the rate of change is accelerating. (See calculus geeks, we can love that second derivative too.) There is a lot of talk of more pod like products coming down the road. Amy has written about two, the nano pump and the behind the glass (you can't take a picture of it Amy!) MiniMed wearable pump prototype. MM would like us to believe that it is coming by 2010. NIH is sponsoring talks on the closed loop. The CGM market is expected by some to exceed the pump market in the coming years.

OK! OK! I know it isn't all roses, there were those who thought the Bong was a good idea too. Cool as it all may be it isn't Really Cool.

So why do we buy the actual pump? Is ownership the best financial model and if so who is it best for, patients, vendors or insurance companies?

Maybe we should lease them. It works for cars and office equipment.

Maybe we should rent pumps or as in the Omni Pod model throw them out with every set change. In the current buy-for-a-four-year-commitment we get stuck in a technological time-warp for 4 years. Unless we upgrade and upgrades are not typically covered by insurance. Even with insurance diabetes isn't cheap.

Anyone keep a cell phone for four years? I didn't think so. And no matter what any teen says, a cell phone isn't life saving technology.

About that insurance, the insurance company pays a large up front fee for a product it is betting will work for the patient. It may it may not. If the pump doesn’t work in a patients life style, it sits on a shelf un-used for years. The insurance company has already paid for all 4 years.

Renting or leasing would get rid of that big bump up front for the insurance company (OMG I just made a suggestion to save an insurance company money - hell must have frozen over.) If the lease term was less than 4 years pump patients could benefit from advancing technology faster.

The Pod people have an interesting model going. Every time you toss out a pod it is an opportunity to upgrade the functionality of the product. They have a lower up front cost but as I understand it have higher cost of consumables. This lowers the cost of entry that is good for expanding the market even with insurance. (Can you say lower co-pay?)

Lowering the barrier for entry also raises the need for customer service because changing becomes cheaper. If you read their conversations with the financial press (I do - so I must have no life) you will see that the Pod People are very aware of the importance of customer service. I have to think that people with diabetes can only benefit from increasing the priority of service.

Don't get me wrong, I am not saying service is bad in the pump business. Animas has provided great service from day 1. Yet regular YDMV readers know I still beat the heck out of them. We're talking about two of my kids' lives here - no good deed goes unpunished, sorry Audrey.

New business models would give the traditional pump users the opportunity to take advantage of new products faster. I would expect that there would higher consumable cost or possibly recognition (a word that here means benefit to the consumer) of the annuity value of consumables as part of the user / manufacturer relationship.

Hello? Insurance dudes? You can innovate and be creative - life isn't all actuarial calculations and denial letters.You can be part of a brave new world! Step up and create a pump rental payment plan.

If we are moving to more pod-like experiences where the technology is the consumable, why root the traditional pump in a different, traditional 4 year user cycle? In a YDMV world some folks are gonna like traditional pumps. Why can't they benefit from innovative business models as well as innovative technology too? Why do we have to wait for more pod people to land before overhauling the sales and service space?

So my YDMV friends, which is more innovative, the wear the pod pump or the business model that shortens the technology cycle for pump patients?
ps. Amy had a post on renting here. Thanks for pointing that out Amy.