You're the Boss Blog: This Week In Small Business: YOLO!

Dashboard

A weekly roundup of small-business developments.

What’s affecting me, my clients and other small-business owners this week.

The Deal: A Not-So-Grand Bargain

A “fiscal cliff” deal is reached and after all the drama this chart sums up the impact. One provision could head off a doubling of milk prices. Here’s what’s in it for small businesses. Jared Bernstein says the fiscal debate has killed the economic debate. Kevin Drum says we don’t have a spending problem, we have an aging problem. One blogger believes that the biggest beneficiaries of the resolution are puppies. Bruce Bartlett explains when the deficit will be fixed. John Boehner is re-elected House speaker. Hugh Hefner marries. These are the four business gangs that rule the country. Next up: the debt ceiling.

Happy New Year: Small-Business Predictions

This infographic shows what’s in store for small businesses in 2013. The editors at Springwise.com offer 10 business opportunities for the coming year. Here are 12 buzzwords you can expect to hear. Here are 20 quotations you can use to prosper. Here are 21 predictions from social media experts. Both Constant Contact and Marla Tabaka spot marketing trends they think will affect small businesses, including “the rise of MomPopolies.” Here are six e-mail marketing and four hyperlocal trends to watch. Oh, and here are eight major tech predictions and four predictions for your finances. A Pennsylvania psychic counselor predicts an avalanche that “will destroy many lives.” Amanda MacArthur suggests 12 worthwhile small-business resolutions. Here are the top five reasons your employees will quit. This video recaps 2012 in four minutes.

The Economy: Auto Sales Are Strong

Many economic bloggers ended 2012 feeling pessimistic. The Restaurant Performance Index contracted, and SurePayroll’s November small-business scorecard is down. Construction spending also fell, and small-business borrowing slowed. But manufacturing (pdf) picked up in December, and don’t forget that the drilling boom for shale oil is remaking America’s energy picture and has brought net oil imports to a 20-year low. Borrowing rates are as cheap as they have ever been in America, and domestic auto sales were very strong last month. The unemployment rate stays steady, online labor demand (pdf) increased, the private sector added 215,000 jobs, and the Philadelphia Fed’s leading indexes (pdf)  projected growth. A physics teacher imparts real life lessons.

Start-Up: A Well-Known Blogger Tries the Start-Up Life

These are 13 promising East Coast start-ups to watch in 2013. A start-up wants to be the Spotify for e-books. Bruno Aziza shares some advice from his start-up adventure: “Unless you are working on something truly different, or have a compelling story to tell, nobody will pay attention. … Unless you can truly add value, nobody cares.” This 15-year-old thinks he can reinvent how we consume news. A well-known blogger plans his own start-up. Jay Patani says interns are the unsung heroes of start-ups. Or maybe baby boomers are more essential?

Marketing: Content on the Cheap

Can you guess the most annoying and hated words and phrases of the year? (Yes, “whatever” made one list, and so did “YOLO” and “fiscal cliff.”) An influential marketing blog picks the most influential marketing books. Andy Sernovitz offers a few suggestions for rescuing unsubscribers. Michael Stelzner explains why stories attract customers. Mathew Donald has five brochure-designing tips, including: “Do not slack off during the proofreading process.” Marcus Sheridan has eight renegade methods to use content marketing to dominate your industry, including, “Reward your competitors”: “Stop pretending your competitors don’t exist. Your customers already know they exist, so find a way to deal with it, to your advantage.” Ryan Derousseau explains how to introduce a content strategy on the cheap.

Your People: Stupid Things Bosses Say

Cullen Roche examines what makes people successful. Jeff Schmitt says there are seven types of employees you should weed out, including the viruses: “You can’t expect them to be slavishly sunny and loyal to you. But you can expect them to be helpful, respectful and protective toward each other.” Jeff Haden says there are eight stupid things bosses say to employees, including: “Sure, I’ll be happy to talk to your brother about a job.” You won’t believe how many people applied to work at Comcast last year.

Management: The War on Fraud

A 16-year-old maker of motorcycles proves that passion trumps experience. In this economist’s guide to year-end charitable giving, Dean Karlan advises not to divide donations among many charities: “If there is one that is doing the most good for the cause you care the most about, then every dollar you give to the one doing the second best work is a dollar not given to the one doing the best work!” Here’s how to beat “the overwhelm” of entrepreneurship. Adrian Swinscoe says the relationships you have with existing customers are your keys to success. Volvo owners have the best credit scores. Daniel Hood files a dispatch from the war on fraud. Here are five ways to stay healthy at work.

Social Media: Twitter Tools

Here’s how to start your social media year off with a bang. Jeff Bullas lists six social media trends you should not ignore, including: “Facebook will continue to strengthen its grip as the dominating and the de facto social network of choice.” A webinar explains how to leverage social media effectively and efficiently. Did you know there are still a few cool things you can do with your blog post after you hit publish? These are the top 20 Web sites every blogger should know and the six top Twitter tools for business. And if your business is not a big user of social media, don’t worry: you’re in good company.

Around the Country: Honk if You Love Someone

Avis buys Zipcar. Polaroid is creating branded retail stores. Texas was the best place for small-business job growth in 2012. Jeff Jordan wonders if American malls are dying (Russian malls certainly are not). One man goes on a quest to make a city smile: “Honk if you love someone.” Entrepreneur magazine’s Growth Conference is this week in Dallas. Constant Contact and the City of Chicago Treasurer’s Office announce a small-business online marketing contest. Meet the “poshest” entrepreneurs in Silicon Valley (even though they will probably be wiped out by climate change in the next 40 years). This week, 150,000 people are expected to converge on Las Vegas for the Consumer Electronics Show.

Around the World: What’s Up in Iceland?

Indian manufacturing hits a six-month high. Chinese manufacturing expands. Unemployment falls in Spain. And do you ever wonder what’s really going on in Iceland? This may be the best review of “Les Misérables” ever.

Technology: Michael Arrington Is Bored

Here are 10 objects that prove that 3-D printing will change the world, and Dylan Love lists the best 3-D printers. Michael Arrington is bored: “Yeah, yeah, mobile. I get it. … But really a lot of the mobile stuff out there is just radioactive decay from the iPhone launching in 2007. 2007! Old news! Ancient platforms!” Even so, enormous changes are on the horizon for the smartphone. These are the 15 best gadgets of 2012, and here are 13 technologies you won’t see in 2013. Steve Kovach says Windows phone users have one big problem. A bunch of well-known (and not so well-known) companies want us to go paperless in 2013. A mobile messaging app processed 18 billion messages on the last day of 2012.

Tweet of the Week

@AaronCBaker: I’m hoping they release some sweet beepers at CES this year

The Week’s Bests

Eric Barker says there are 10 things you should do every day to improve your life, including laugh: “People who use humor to cope with stress have better immune systems, reduced risk of heart attack and stroke, experience less pain during dental work and live longer. Laughter should be like a daily vitamin.”

Scott Grannis says the fiscal cliff resolution goes a long way toward explaining why this has been the weakest recovery in history: “The burden of our debt binge is already upon us because we have borrowed trillions of dollars to support consumption, rather than new investment. What matters in the future is how productively we spend the proceeds of future bond sales, not how we pay off the bonds we’ve already sold. We can make progress on the margin if we can reduce federal spending relative to the size of the economy, since that in turn will reduce the amount of the economy’s resources we waste. Allowing the private sector to increasingly decide how to spend the fruits of its labors will likely improve the overall productivity and strength of the economy, because the private sector is most likely smarter about how it spends its own money. We’ve got to get the government out of the way if we are to move forward.”

This Week’s Question: Will the fiscal cliff deal help or hurt your business?

Gene Marks owns the Marks Group, a Bala Cynwyd, Pa., consulting firm that helps clients with customer relationship management. You can follow him on Twitter.

Read More..

IHT Rendezvous: Hints of Taiwan Leading the Way on Same-Sex Marriage in Asia

BEIJING — Will Taiwan become the first place in Asia to legalize same-sex marriage in 2013?

Perhaps, judging from recent developments on the island, where the legislature has held its first hearings on the issue, a move that signifies “a major step towards becoming the first Asian territory to approve marriage equality,” the Shanghai-based Web site Shanghaiist reported, citing Gay Star News.

In another sign that change may be on the way for Taiwan, senior judges recently asked for advice from the country’s constitutional court, the Grand Justices, on whether to legalize same-sex marriages after two men from Taiwan, Nelson Chan and his long-term partner, Kao Chih-wei, filed an administrative lawsuit last year following the rejection by a local registration office in Taipei of their application to marry.

As The Taipei Times reported late last month, the Taipei High Administrative Court had been expected to hand down a decision on Mr. Chen and Mr. Kao’s case, “but instead said it was seeking a constitutional interpretation while holding further debates before making a judgment.”

To Mr. Chen, that was a victory. “I think this is a good decision. I’m happy to see it,” he told The Taipei Times. “I am confident and hopeful of the outcome of the constitutional interpretation, because the world is changing. I hope Taiwan would be the first Asian country to recognize same-sex marriages through a judicial ruling.”

The moves come as more states in the United States have legalized gay marriage – Maine and Maryland becoming the latest, with Maryland’s new law taking effect Jan. 1. Same-sex marriage is now legal in nine states and Washington, D.C.

One of the most socially and politically progressive societies in Asia, “Taiwan is moving closer to allowing same-sex marriage,” predicted Gay Star News, though it pointed out that top judges in Taiwan had said that the proposed changes did not go far enough and that legislation needed to be rewritten and expanded before that could happen – and that it would not be a simple matter.

Current proposals for change affect only the articles of the Civil Code that pertain to marriage in gendered language, and propose “altering the words from ‘male’ and ‘female’ to gender-neutral language,” Gay Star News reported.

It quoted a senior judge, Hsu Li-ying, from the Supreme Court’s Juvenile and Family Department (the court is known in Taiwan’s complex political-legal system as the Judicial Yuan) as saying that the new legislation might “need to be more comprehensive.”

The deputy justice minister, Chen Ming-tang, said it was not just the Civil Code that would have to change, but also laws regarding parentage, taxes and health insurance. That means the Justice Ministry could not do it alone, the report said.

Others believed the road ahead will be long and same-sex marriage difficult to achieve, with the decision to seek advice from the constitutional court a way of avoiding making a decision.

Taiwan has a flourishing civil society and a gay community that has long been pressuring the government to legalize gay marriage. Many believe it is a matter of time. Taiwan hosts Asia’s biggest gay pride parade, with the one held last October drawing more than 50,000 participants from across the region.

Taiwan even has its own gay god – the Taoist Rabbit God, to whom homosexuals can pray for love and good fortune (there is a small temple to the Rabbit God near Taipei). As The Taipei Times reports, the rabbit deity is based on the real-life figure of Hu Tianbao, an official in 18th-century Qing dynasty China.

And last year, two women in Taiwan were “married” in a Buddhist ceremony by a Buddhist master, Shih Chao-hwei, who is also a professor at Hsuan Chuang University. Homosexuality is not prohibited in Buddhism, the professor said: “It’s difficult enough to maintain a relationship,” the professor said in a telephone interview with The Taipei Times. “How could you be so stingy as to begrudge a couple for wanting to get married, regardless of their sexual orientation?”

A poll in September by The United Daily News found that 55 percent of those surveyed approved of gay marriage laws, with only 37 percent against. But the poll also found that 61 percent could not accept their children being gay, with only 37 percent saying they could.

Read More..

Crowdfunding for Small Business Is Still an Unclear Path

Joshua Bright for The New York Times

Candace Klein, chief of SoMoLend, in Midtown Manhattan. In starting her crowdfunding site, she sought out institutional investors that don’t face the same limits that individual investors do.

RYAN CALDBECK was stumped. A director at a private equity firm, he was taking part in a panel discussion at a consumer goods conference last summer in New York when an entrepreneur raised his hand with a question: Where could a young company with just a few million dollars in sales go for money to grow?

Librado Romero/The New York Times

Zak Normandin expanded his Little Duck Organics food company with financing found through CircleUp.

Mr. Caldbeck and his peers on the panel fumbled for a response. The fact is, most private equity investors and venture capitalists won’t touch a consumer products company until it has surpassed $10 million in sales — anything else is too small to bother with.

The best advice the panel could offer was for the entrepreneur to tap his credit cards.

“The purpose of the panel was to help entrepreneurs raise money, but we had no answers,” Mr. Caldbeck remembers. “That’s when I knew that there is a big issue here.”

That big issue caused Mr. Caldbeck to leave his job to start CircleUp, a company that aims to connect up-and-coming consumer products companies with investors.

Right now, the people allowed to invest through CircleUp must be accredited, meaning they have a high net worth. CircleUp hopes that soon not just the wealthy few, but the general public — whether friends, family members, customers, Facebook friends, or even total strangers — will be able to invest in deserving companies through a hot new area of finance known as crowdfunding.

To its advocates, crowdfunding is a way for capital-starved entrepreneurs to receive financing that neither big investors nor lenders are willing or able to provide. To others, it represents a potential minefield that could help bad businesses get off the ground before they eventually fail, and in some cases could even ensnare unsophisticated investors in outright fraud.

Those fears are partly why the Securities and Exchange Commission has delayed rules allowing crowdfunding that were supposed to take effect this month as part of the JOBS Act (Jump-Start Our Business Start-Ups), signed by President Obama last April. The S.E.C. is wary of loosening investor protections that have been in place since the 1930s.

Despite the uncertainty, the outlines of a new industry are emerging as a few crowdfunding start-ups have found ways to raise money within current rules. They include companies like CircleUp and SoMoLend, which lends money to small, Main Street-type businesses that typically wouldn’t interest private investors.

By themselves, of course, a few start-ups can’t completely democratize finance. But they begin to illuminate what the future of crowdfunding could look like, as the debate continues over a vast widening of the private investor pool.

Mr. Caldbeck formed CircleUp last fall along with Rory Eakin, a former business school classmate who was working for a philanthropic foundation. Through their start-up, the two men seek to finance food, personal care, apparel and pet-related companies, often with an environmental or social bent.

CircleUp considers applications from companies with $1 million to $10 million in revenue. Companies whose applications are accepted make their pitches to investors behind a firewall on the CircleUp Web site, offering equity stakes in return for capital. CircleUp, which helps companies raise up to $3 million, takes a small cut of the money.

Under current federal regulations, CircleUp wouldn’t be able to arrange such deals on its own. But it struck a partnership with W. R. Hambrecht, a registered broker-dealer that can handle investments from accredited, or high-net-worth, individuals whom the S.E.C. considers sophisticated enough to invest in private companies.

“Living here in Silicon Valley, a lot of people don’t understand the need,” Mr. Caldbeck says. “If you’re a tech company with a good idea, you can raise money. But it’s a different story for food, agriculture, retail and other consumer-oriented businesses.”

Mr. Caldbeck sees a big opportunity. Consumer goods companies account for a sizable portion of the nation’s businesses, yet very little capital — from private equity funds or from accredited investors — flows to them, he says.

What’s more, only a tiny percentage of those who qualify as accredited investors actually invest in private companies, he says. (These are people with a net worth of at least $1 million, not including their primary residence, or who have earned more than $200,000 — $300,000 for couples — in each of the last two years.)

Amy Cortese is the author of “Locavesting: The Revolution in Local Investing and How to Profit From It.”

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Despite New Health Law, Some See Sharp Rise in Premiums

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Bob Chamberlin/Los Angeles Times

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.

Read More..

Despite New Health Law, Some See Sharp Rise in Premiums

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Bob Chamberlin/Los Angeles Times

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.

Read More..

Despite New Health Law, Some See Sharp Rise in Premiums

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Bob Chamberlin/Los Angeles Times

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.

Read More..

India Takes Aim at Poverty With Cash Transfer Program

Manish Swarup/Associated Press

Poor and homeless people waited for food on Tuesday at a New Delhi temple.

NEW DELHI — India has more poor people than any nation on earth, but many of its antipoverty programs end up feeding the rich more than the needy. A new program hopes to change that.

On Jan. 1, India eliminated a raft of bureaucratic middlemen by depositing government pension and scholarship payments directly into the bank accounts of about 245,000 people in 20 of the nation’s hundreds of districts, in a bid to prevent corrupt state and local officials from diverting much of the money to their own pockets. Hundreds of thousands more people will be added to the program in the coming months.

In a country of 1.2 billion, the numbers so far are modest, but some officials and economists see the start of direct payments as revolutionary — a program intended not only to curb corruption but also to serve as a vehicle for lifting countless millions out of poverty altogether.

The nation’s finance minister, Palaniappan Chidambaram, described the cash transfer program to Indian news media as a “pioneering and pathbreaking reform” that is a “game changer for governance.” He acknowledged that the initial rollout had been modest because of “practical difficulties, some quite unforeseen.” He promised that those problems would be resolved before the end of 2013, when the program is to be extended in phases to other parts of the country.

Some critics, however, said the program was intended more to buy votes among the poor than to overcome poverty. And some said that in a country where hundreds of millions have no access to banks, never mind personal bank accounts, direct electronic money transfers are only one aspect of a much broader effort necessary to build a real safety net for India’s vast population.

“An impression has been created that the government is about to launch an ambitious scheme of direct cash transfers to poor families,” Jean Drèze, an honorary professor at the Delhi School of Economics, wrote in an e-mail. “This is quite misleading. What the government is actually planning is an experiment to change the modalities of existing transfers — nothing more, nothing less.”

The program is based on models in Mexico and Brazil in which poor families receive stipends in exchange for meeting certain social goals, like keeping their children in school or getting regular medical checkups. International aid organizations have praised these efforts in several places; in Brazil alone, nearly 50 million people participate.

But one of India’s biggest hurdles is simply figuring out how to distinguish its 1.2 billion citizens. The country is now in the midst of another ambitious project to undertake retinal and fingerprint scans in every village and city in the hope of giving hundreds of millions who have no official identification a card with a 12-digit number that would, among other things, give them access to the modern financial world. After three years of operation, the program has issued unique numbers to 220 million people.

Bindu Ananth, the president of IFMR Trust, a financial charity, said that getting people bank accounts can be surprisingly beneficial because the poor often pay stiff fees to cash checks or get small loans, fees that are substantially reduced for account holders.

“I think this is one of the biggest things to happen to India’s financial system in a decade,” Ms. Ananth said.

Only about a third of Indian households have bank accounts. Getting a significant portion of the remaining households included in the nation’s financial system will take an enormous amount of additional effort and expense, at least part of which will fall on the government to bear, economists said.

“There are two things this cash transfer program is supposed to do: prevent leakage from corruption, and bring everybody into the system,” said Surendra L. Rao, a former director general of the National Council of Applied Economic Research. “And I don’t see either happening anytime soon.”

The great promise of the cash transfer program — as well as its greatest point of contention — would come if it tackled India’s expensive and inefficient system for handing out food and subsidized fuel through nearly 50,000 government shops.

India spends almost $14 billion annually on this system, or nearly 1 percent of its gross domestic product, but the system is poorly managed and woefully inefficient.

Malavika Vyawahare contributed reporting.

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App City: Taking Stock of Mobile Apps

Testing apps from week to week, it’s easy to fill my phone with a seemingly endless number of theoretically helpful programs. But how many of them do I actually use? To start off 2013, I decided to take stock of my apps, with a focus on those that relate to my life as a New Yorker. Here are my favorites, many — but not all — of which I reviewed for App City. — JOSHUA BRUSTEIN

Christoph Hitz

Embark NYC

Free for iOS and Android

For directions, the default is Google Maps. But Embark, which helps you chart a trip on the New York City subway, is the other transportation app I use regularly, largely because it can generate directions without a data connection. After all, plans can change while you are underground. Offline, you can get only directions between stations, not for street addresses, but it’s a start.

Instapaper

$3.99 for iOS; $2.99 for Android

Instapaper is not new, but the idea of setting aside articles that I see online so that I can read them when I get stuck on the subway never gets old.

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Seamless

Free for iOS and Android

This tool for placing orders for delivery or takeout food through a smartphone app has drastically increased the likelihood that I will order in on any given day. I do not know if this is a good thing, but it is certainly a testament to its effectiveness.

Christoph Hitz

Immaculate Infatuation

Free for iOS

Apps for finding restaurants are plentiful, but most of them leave me feeling overwhelmed. I want someone to choose for me, and I trust the authors of this app to do that. Their taste has never led me astray — although unlike them, I have no problem with the immense popularity of brussels sprouts.

Christoph Hitz

Taskrabbit

Free for iOS

One of the neatest things to come from the current generation of tech companies are informal communities where strangers do things for one another, like share a ride or a spare room. Taskrabbit allows people to hire one another for odd jobs. These jobs can be pretty much anything, but for tasks like taking in clothing for donation, I would much rather give $20 to a neighbor with a car than figure it out myself. Getting tasks done may be easy, but becoming someone who does the tasks isn’t: there are 1,500 people on the waiting list in New York City.

Songkick

Free for iOS and Android

It analyzes the music you listen to and tells you when bands you may like are playing nearby. It has successfully kept me away from Seamless on a number of nights. But being constantly reminded of great shows has the potential to be somewhat expensive.

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Nike+ Fuelband

Wristband $149, app free for iOS and Android

This setup serves as a pedometer for the digital age, keeping track of your physical activity 24 hours a day. The app’s graphical representations of miles walked and calories burned are addictive. While the Fuelband does not do a good job of measuring exercise in a gym, it is a great way to keep a tally of all the walking you do. And if I’m going to spend my life wandering around the city, I might as well get credit for it.

Christoph Hitz

Craft Beer New York

$1.99 for iOS

This app is great when deciding which bars to visit. Of course, it works only for beer drinkers; good bars without good beer selections do not make the cut. There is a nice coffee app designed by the same team, and I use it in essentially the same way, although a bit earlier in the day.

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The New Old Age: Murray Span, 1922-2012

One consequence of our elders’ extended lifespans is that we half expect them to keep chugging along forever. My father, a busy yoga practitioner and blackjack player, celebrated his 90th birthday in September in reasonably good health.

So when I had the sad task of letting people know that Murray Span died on Dec. 8, after just a few days’ illness, the primary response was disbelief. “No! I just talked to him Tuesday! He was fine!”

And he was. We’d gone out for lunch on Saturday, our usual routine, and he demolished a whole stack of blueberry pancakes.

But on Wednesday, he called to say he had bad abdominal pain and had hardly slept. The nurses at his facility were on the case; his geriatrician prescribed a clear liquid diet.

Like many in his generation, my dad tended towards stoicism. When he said, the following morning, “the pain is terrible,” that meant agony. I drove over.

His doctor shared our preference for conservative treatment. For patients at advanced ages, hospitals and emergency rooms can become perilous places. My dad had come through a July heart attack in good shape, but he had also signed a do-not-resuscitate order. He saw evidence all around him that eventually the body fails and life can become a torturous series of health crises and hospitalizations from which one never truly rebounds.

So over the next two days we tried to relieve his pain at home. He had abdominal x-rays that showed some kind of obstruction. He tried laxatives and enemas and Tylenol, to no effect. He couldn’t sleep.

On Friday, we agreed to go to the emergency room for a CT scan. Maybe, I thought, there’s a simple fix, even for a 90-year-old with diabetes and heart disease. But I carried his advance directives in my bag, because you never know.

When it is someone else’s narrative, it’s easier to see where things go off the rails, where a loving family authorizes procedures whose risks outweigh their benefits.

But when it’s your father groaning on the gurney, the conveyor belt of contemporary medicine can sweep you along, one incremental decision at a time.

All I wanted was for him to stop hurting, so it seemed reasonable to permit an IV for hydration and pain relief and a thin oxygen tube tucked beneath his nose.

Then, after Dad drank the first of two big containers of contrast liquid needed for his scan, his breathing grew phlegmy and labored. His geriatrician arrived and urged the insertion of a nasogastric tube to suck out all the liquid Dad had just downed.

His blood oxygen levels dropped, so there were soon two doctors and two nurses suctioning his throat until he gagged and fastening an oxygen mask over his nose and mouth.

At one point, I looked at my poor father, still in pain despite all the apparatus, and thought, “This is what suffering looks like.” I despaired, convinced I had failed in my most basic responsibility.

“I’m just so tired,” Dad told me, more than once. “There are too many things going wrong.”

Let me abridge this long story. The scan showed evidence of a perforation of some sort, among other abnormalities. A chest X-ray indicated pneumonia in both lungs. I spoke with Dad’s doctor, with the E.R. doc, with a friend who is a prominent geriatrician.

These are always profound decisions, and I’m sure that, given the number of unknowns, other people might have made other choices. Fortunately, I didn’t have to decide; I could ask my still-lucid father.

I leaned close to his good ear, the one with the hearing aid, and told him about the pneumonia, about the second CT scan the radiologist wanted, about antibiotics. “Or, we can stop all this and go home and call hospice,” I said.

He had seen my daughter earlier that day (and asked her about the hockey strike), and my sister and her son were en route. The important hands had been clasped, or soon would be.

He knew what hospice meant; its nurses and aides helped us care for my mother as she died. “Call hospice,” he said. We tiffed a bit about whether to have hospice care in his apartment or mine. I told his doctors we wanted comfort care only.

As in a film run backwards, the tubes came out, the oxygen mask came off. Then we settled in for a night in a hospital room while I called hospices — and a handyman to move the furniture out of my dining room, so I could install his hospital bed there.

In between, I assured my father that I was there, that we were taking care of him, that he didn’t have to worry. For the first few hours after the morphine began, finally seeming to ease his pain, he could respond, “OK.” Then, he couldn’t.

The next morning, as I awaited the hospital case manager to arrange the hospice transfer, my father stopped breathing.

We held his funeral at the South Jersey synagogue where he’d had his belated bar mitzvah at age 88, and buried him next to my mother in a small Jewish cemetery in the countryside. I’d written a fair amount about him here, so I thought readers might want to know.

We weren’t ready, if anyone ever really is, but in our sorrow, my sister and I recite this mantra: 90 good years, four bad days. That’s a ratio any of us might choose.

---

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

The New Old Age: Murray Span, 1922-2012

One consequence of our elders’ extended lifespans is that we half expect them to keep chugging along forever. My father, a busy yoga practitioner and blackjack player, celebrated his 90th birthday in September in reasonably good health.

So when I had the sad task of letting people know that Murray Span died on Dec. 8, after just a few days’ illness, the primary response was disbelief. “No! I just talked to him Tuesday! He was fine!”

And he was. We’d gone out for lunch on Saturday, our usual routine, and he demolished a whole stack of blueberry pancakes.

But on Wednesday, he called to say he had bad abdominal pain and had hardly slept. The nurses at his facility were on the case; his geriatrician prescribed a clear liquid diet.

Like many in his generation, my dad tended towards stoicism. When he said, the following morning, “the pain is terrible,” that meant agony. I drove over.

His doctor shared our preference for conservative treatment. For patients at advanced ages, hospitals and emergency rooms can become perilous places. My dad had come through a July heart attack in good shape, but he had also signed a do-not-resuscitate order. He saw evidence all around him that eventually the body fails and life can become a torturous series of health crises and hospitalizations from which one never truly rebounds.

So over the next two days we tried to relieve his pain at home. He had abdominal x-rays that showed some kind of obstruction. He tried laxatives and enemas and Tylenol, to no effect. He couldn’t sleep.

On Friday, we agreed to go to the emergency room for a CT scan. Maybe, I thought, there’s a simple fix, even for a 90-year-old with diabetes and heart disease. But I carried his advance directives in my bag, because you never know.

When it is someone else’s narrative, it’s easier to see where things go off the rails, where a loving family authorizes procedures whose risks outweigh their benefits.

But when it’s your father groaning on the gurney, the conveyor belt of contemporary medicine can sweep you along, one incremental decision at a time.

All I wanted was for him to stop hurting, so it seemed reasonable to permit an IV for hydration and pain relief and a thin oxygen tube tucked beneath his nose.

Then, after Dad drank the first of two big containers of contrast liquid needed for his scan, his breathing grew phlegmy and labored. His geriatrician arrived and urged the insertion of a nasogastric tube to suck out all the liquid Dad had just downed.

His blood oxygen levels dropped, so there were soon two doctors and two nurses suctioning his throat until he gagged and fastening an oxygen mask over his nose and mouth.

At one point, I looked at my poor father, still in pain despite all the apparatus, and thought, “This is what suffering looks like.” I despaired, convinced I had failed in my most basic responsibility.

“I’m just so tired,” Dad told me, more than once. “There are too many things going wrong.”

Let me abridge this long story. The scan showed evidence of a perforation of some sort, among other abnormalities. A chest X-ray indicated pneumonia in both lungs. I spoke with Dad’s doctor, with the E.R. doc, with a friend who is a prominent geriatrician.

These are always profound decisions, and I’m sure that, given the number of unknowns, other people might have made other choices. Fortunately, I didn’t have to decide; I could ask my still-lucid father.

I leaned close to his good ear, the one with the hearing aid, and told him about the pneumonia, about the second CT scan the radiologist wanted, about antibiotics. “Or, we can stop all this and go home and call hospice,” I said.

He had seen my daughter earlier that day (and asked her about the hockey strike), and my sister and her son were en route. The important hands had been clasped, or soon would be.

He knew what hospice meant; its nurses and aides helped us care for my mother as she died. “Call hospice,” he said. We tiffed a bit about whether to have hospice care in his apartment or mine. I told his doctors we wanted comfort care only.

As in a film run backwards, the tubes came out, the oxygen mask came off. Then we settled in for a night in a hospital room while I called hospices — and a handyman to move the furniture out of my dining room, so I could install his hospital bed there.

In between, I assured my father that I was there, that we were taking care of him, that he didn’t have to worry. For the first few hours after the morphine began, finally seeming to ease his pain, he could respond, “OK.” Then, he couldn’t.

The next morning, as I awaited the hospital case manager to arrange the hospice transfer, my father stopped breathing.

We held his funeral at the South Jersey synagogue where he’d had his belated bar mitzvah at age 88, and buried him next to my mother in a small Jewish cemetery in the countryside. I’d written a fair amount about him here, so I thought readers might want to know.

We weren’t ready, if anyone ever really is, but in our sorrow, my sister and I recite this mantra: 90 good years, four bad days. That’s a ratio any of us might choose.

---

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..