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The growth seen in the use of coupons in the past decade or so has made this one of the more exciting marketing strategies that we have seen. The idea is simple. A central marketing agency promotes the named businesses by offering discount vouchers. Go to this restaurant, eat a magnificent meal, and enjoy a discount of 50%. This is a great promotion for the restaurant and the statistics show the majority of people who come to try out the meals return and pay the full price later on. Now let the pharmaceutical industry play with this idea. Suppose the drug manufacturers were to offer coupons to their loyal customers, how would the marketing plan work? Well, for a moment, consider the problem of the generic market. When the patent runs out on a brand, others may copy the chemistry and sell a generic version of the drug for a significantly lower price. From the customer’s point of view, this is wonderful news. The same drug is available. It has been approved by the FDA as an exact match for the original branded drug. And it comes at a heavily discounted price. Not surprisingly, this knocks a big hole in the profits of the branded manufacturer, so this manufacturer will search for a way to keep the generic manufacturer out of the market.

This is where copayment coupons come in, with copayments having been used in the insurance industry for a number of years. This requires the patient to pay a proportion of the medical costs. It is actually self-insurance of that part of the costs. The justification advanced by insurance companies is that it reduces moral hazard, i.e. it is an encouragement to people only to seek treatment when it is genuinely necessary.

By copaying on branded drugs, patients are able to benefit from a form of subsidy from the manufacturers through the use of these coupons. This makes the branded drugs more affordable and maintains more of their profit margin. Obviously, if the brands were losing too much of their market share, the manufacturers would have to reduce their prices to compete with the generics. In theory, the coupons represent a compromise. The patients pay less for the brand, but more than for the generic. The manufacturers give away a part of their profits, but less than through a price reduction to complete with the generic directly.

There is now a class action effectively accusing the manufacturers of fraud through their use of these coupons. As it stands, the insurance companies pay the manufacturer a fixed price for every branded pill or tablet prescribed. The manufacturers and pharmacists have been forgetting to tell the insurers about the coupons. It is highly relevant that the patients have been paying less at the drugstore counters. Because there are no savings to the insurance companies in paying for the generics, the premium rates stay high. This makes cheap health insurance even less likely to appear. In reality everyone is losing. Customers are still paying more than they should. Both individual and group health insurance plans cost more than they should. All this being purely for the benefit of the pharmaceutical industry. The class action describes these coupons as part of a bait and switch scam. If the courts agree, heavy damages will be awarded and there will be compensation available to some consumers.

As you are almost certainly aware, a number of GOP-controlled states have been introducing pro-life bills to deter women from going through abortions. As federal law stands, states cannot simply ban abortions. That would require the repeal of Roe v Wade, a decision of the Supreme Court in 1973. So ingenious law-makers have been coming up with ever more barriers to put in the path of women who want to terminate a pregnancy. The latest proposals require an ultrasound test. In the early stages of pregnancy, this can be external. But, as the pregnancy advances, the probe must be inserted into the vagina to take precise readings. Thus, not only are the law-makers requiring doctors to carry out a procedure that’s medically unnecessary, but they are also insisting the procedure be the most invasive possible. Not only women but a significant number of men think this is an abuse of law-making powers.

In Pennsylvania, State Senator Larry Farnese is proposing a bill to change the procedure men will have to go through to get a prescription for one of the erectile dysfunction drugs. The first step will be a full cardiac stress test to ensure you are fit enough to attempt sexual activity. This will be followed by a physical examination to see whether there are any signs of prostate cancer. The man will also have to produce an affidavit from his partner confirming the reality of sexual difficulties and, if there are no obvious physical causes, psychological counseling will be required.

All this is magnificently absurd but it has had the required effect. For better or worse, men are now seriously asking why anyone should have to go through unnecessary medical tests as a condition of obtaining a routine medical treatment. It does not matter whether you are male or female, the practice of medicine is for doctors and law-makers without medical expertise should stay out of the way. Unfortunately, this kind of stunt is unlikely to sway the GOP law-makers who are not interested in individual freedom of choice. All they want is to impose their own views on others. So the next time you go online to buy your cialis, be grateful this bill is unlikely to pass. Even if something remarkable were to happen and enough votes were found, cialis is still available online without a prescription.

We have now finished the oral arguments on health insurance before the Supreme Court. So where are we now? What are the prospects for health insurance?

Well, history was made as the Supreme Court took oral arguments over three days on the fate of the Affordable Care Act. Now all we have to do is wait for the decision in June. As we do so, it’s worth quickly reviewing what’s at stake and how everyone might react following the Court’s decision. Let’s start with a statement of the obvious. This Act is a complicated set of provisions, but one has been singled out for particular “hate”. Even though the original source of the proposed mandate was right-wing, the Republican party now suggests any requirement an individual buys an insurance plan is unconstitutional. It then goes further and argues that if the mandate is struck down by the Court, the whole Act must fail.

There’s no doubt the form of the Act is unfortunate. It’s a patchwork for what has become an incoherent healthcare system. But it’s an important step towards making health care available to all Americans – something that ought to be uncontroversial. If the mandate was held unconstitutional, it should not affect the other important reforms. The Act would just cover fewer people at a higher cost. One important hint given by the Justices was that a single-payer approach would probably be constitutional, i.e. using tax revenue to treat everyone. That’s why Medicare is constitutional. So let’s say the Supreme Court hold the Act valid and President Obama wins the November election. Now we just sit back and wait for 2014 when all the provisions are to come into force. But if the Court holds some or all of the Act invalid, we come to the vote in November with a political hot potato.

If the Court splits along political lines with a 5/4 verdict, President Obama will run on the basis of activist Republican judges improperly interfering with the powers of the law-makers. The mandate was a right-wing idea and it was not suggested it was unconstitutional when it went through the legislative process. For five unelected Republican judges to throw it out would be dynamite. Being honest about all this, health insurance has been in a mess for some time. It needs reform. If the Republicans break the law, it will be for them to suggest how reform should be made. Without reform, health insurance will be unaffordable to all but the 1%.

The ability to buy big ticket items even if you don’t have the cash available is an idea that everyone has now got used to. This may involve a loan or some other credit arrangement, or you can rent. We have moved from a society in which people used to save until they could afford to buy, to one where you can satisfy your wishes instantly with a good credit score and proof of your identity. When it comes to vehicles, it’s either been a case of talking nicely to neighbors to borrow their car in an emergency or go to a rental agency. Now we have moved beyond the carpooling arrangements into car-sharing. This is both good news and bad. At a community level, there are an increasing number of self-help groups who are making their vehicles available to each other. At the top end of the market, established renters like Hertz are making vehicles available on demand. New organizations like Zipcar also leave vehicles in designated places and anyone with a card can get in and drive them away.

The established renters are simply using the existing fleet in a more flexible way to generate money. Satisfactory insurance cover is already in place. But problems have been emerging in the less formal market. What happens to your own insurance cover if you place your own vehicle into a pool that anyone can drive? The answer is simple. If you do this on a regular basis and you are paid, this is a commercial use. As a private owner, this invalidates your policy.

To clarify the insurance situation states like California, Oregon and Washington are now producing laws. In Washington, for example, we now have HB 2384 which requires all organizations offering car-sharing services to carry a minimum of $180,000 liability cover, and at least enough comprehensive and collision cover to pay fair market value should the shared vehicle be a total loss. This protects vehicle owners who can make additional money during tough times without losing their own auto insurance cover. It also imposes tough new requirements on the sharing organizations to ensure the vehicles are properly maintained and safe to drive. The public not only need auto insurance cover, they need to know the vehicles they drive away are safe.

You may be wondering what to do now that you were cited for speeding. It is not necessary to immediately contact your car insurance company although it is not a bad idea to give them a heads up if you have a decent relationship with them. The ticket alone may not impact your coverage, but when it is combined with other factors it can lead to higher rates.

Type of Car

Sports cars are often targeted by police who are on the lookout for speeders. For this and other reasons, drivers of these cars probably already have higher than average premiums. Adding speeding tickets to the mix is guaranteed to result in increased rates.

Speed

How much you were driving over the speed limit is important. If your ticket is for a speed that exceeds the limit by a small amount, it is possible that your insurance provider may view it as a minor infraction and not penalize you for it. This is particularly true as long as it is a random occurrence. However, speeds in excessive of 20mph over the limit cannot be overlooked. Speeding in school or construction zones will be viewed as especially reckless.

Accidents

Speeding that contributes to the cause of an accident will result in higher rates and possible loss of coverage. Drivers who speed in poor driving conditions and are then involved in an accident, with or without another vehicle, are seen as high-risk drivers by insurance companies and are rated accordingly.

Other Tickets

If you have more than one speeding ticket, you raise your chances of receiving an increase in your premiums. The documented speed on each ticket contributes to the insurance company’s decision. Not only do you lose any safe driving discount you may have received, you are now rated as a high-risk driver. The more tickets you receive in a short amount of time, the more likely your insurance provider will simply cancel your coverage because of the risk you pose to them.

Rate Increases

Rates do not increase overnight. Just because you do not see an immediate change in your premiums, do not assume you are scot-free. It may just take a few months for the ticket to catch up with you or your insurance company may wait until your annual renewal. Your insurance provider will have a policy in place that details how this is handled. Rate increases that result from speeding tickets stay in affect for up to three years, which is the amount of time the ticket stays flagged on your driving record.

The greatest potential impact of a speeding ticket is that your car insurance coverage is dropped entirely. And if you are dropped by one carrier, it may be difficult to get another one to accept you as a customer. When you do get a new policy, you should expect to pay substantially higher premiums.