Summary: Memories are short, but consequences live a long time. Here’s a Bill Moyers video from the deep dark past (2009) reminding us of how the public option — a potential competitor to for-profit big, existing insurers — got squeezed out of the bill. And let us not forget how Senator Joe Lieberman of Connecticut withdrew his support at the last possible second.
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Cash or self-pay prices. Our metro areas: NYC, SF, LA, Dallas-Fort Worth, Houston,
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Summary: “Health care is the fourth largest share of household expense for the typical family in this country, behind housing, food, and transportation,” write Reshma Gupta, MD, MSHPM; Cynthia Tsay, MPhil; and Robert L. Fogerty, MD, MPH, in the AMA Journal of Ethics. “More than three-quarters of polled Americans with health insurance in 2005 reported being concerned about their ability to pay medical bills for routine care, and, … Recently, it has been reported that more than half (52.1 percent) of all debts in the US are due to medical expenses. These debts may in part be incurred because of a lack of price transparency and communication between patients and physicians concerning medical prices. … Why has cost control only recently become a rallying cry among clinicians? … Major reasons include a lack of information about costs among both physicians and patients and gaps in physician training about financial harms. … We suggest that medical centers take the following steps to promote cost transparency and to train physicians and patients how to have open discussions about costs and the risks of financial harm:
- Provide medical professionals and patients with local cost information about tests, procedures, and medications.
- Publicize data on costs and quality made available by the federal government through Hospital Compare.
- Increase monitoring of patients who are at high risk for financial harms.
- Increase access to community resources to assist patients at high risk for financial harms, including financial coaching, vocational training, and housing and food security programs.
- Promote institutional discussions about system-level changes to improve care coordination, population health, and preventative care.
“Patients and physicians have a joint ethical responsibility to discuss medical costs and to avoid financial harms for patients and society at large. Simply put, the United States cannot withstand the escalating cost of health care indefinitely. However, we believe that the recommendations outlined above, in combination with national policies and incentives, can improve cost transparency, help avoid financial harms, and promote ethical medical practice.” Reshma Gupta, MD, MSHPM, Cynthia Tsay, MPhil, and Robert L. Fogerty, MD, MPH, Promoting Cost Transparency to Reduce Financial Harm to Patients,” AMA Journal of Ethics.
Summary: “The odds are pretty high … that Mom would not still be counted among the living had she not switched from an MA plan to traditional Medicare,” Wendell Potter writes in a piece titled “Why Mom went back to traditional Medicare” for MedicareResources.org. He describes his mother’s experience, and concludes: “Only in original Medicare can a patient count on getting ‘unfettered access’ to doctors and facilities of their choice – and, in many cases, to life-saving care. The Kaiser Health News article that reported the result of those 2013 studies quoted Judith Stein, executive director of the Connecticut-based Center for Medicare Advocacy, a patient advocacy group, as confirming the disparity in access to needed care. ‘Private Medicare Advantage plans work for people when they are relatively well, but fall short of traditional Medicare when they are sick or disabled,’ she said. ‘This is particularly true for our clients with long-term and chronic conditions, many of whom also have low incomes. They are often denied coverage for necessary skilled care, or it is terminated before it should be, while the same coverage would be available in traditional Medicare.” Wendell Potter,“Why Mom went back to traditional Medicare.”
Summary: Direct primary care practices seem to be gaining popularity. In direct care, patients pay the provider directly, instead of paying through an insurer, though some DPC practices do also take insurance. This map shows a range of DPC practices; I see a few we know. On the site, we are told: “Website readers should note that these practices met our three part definition of DPC, although they may not always self-describe as DPC. Both ‘Pure’ DPC practices and DPC hybrids are included in the mapper. If you are aware of a DPC practice that has been omitted from the mapper, please email us at (firstname.lastname@example.org) and we will make every effort to include it in the next revised version of the mapper.” The site is founded by an osteopath who is launching a DPC practice in Cheyenne, Wyo., according to the “about us” page.
Summary: Do people really “shop” for health care? And if they do, do they do it well or poorly? It’s both complicated and pretty simple; let’s discuss.
Summary: “In 2010, the cost of treating breast cancer was about $16.5 billion in the United States — higher than any other type of cancer. This is expected to increase to $20.5 billion by 2020,” Shane Ryan writes in “The Cost of Breast Cancer in the U.S.” at costsofcare.org. “Individual costs vary, depending on the stage of the malignancy and treatment options selected. In the midst of the distress of receiving a cancer diagnosis, many patients feel unsure about discussing money when a treatment plan is being created. That’s why it’s essential that the entire team be involved to understand each patient’s individual situation, the cost of recommended treatments for that specific patient, and what the financial impact will be. A recent study from the University of North Carolina shed light on this issue. Researchers found that uninsured cancer patients often pay anywhere from two to 43 times what Medicare would pay for chemotherapy, as well as higher rates for physician visits.” Shane Ryan, “The Costs of Breast Cancer in the U.S.” Costs of Care.
Summary: Drug coupon programs and patient assistance programs are frequently cited by big drug companies as a good way for patients to escape the skyrocketing out-of-pocket costs of medications. But are these programs universally good, or are they cleverly disguised marketing, sales and public relations programs that cost the companies little compared to what they reap?
Summary: A surprising number of providers are listing cash prices publicly. Why? Because of the growing unhappiness over high deductibles, high co-insurance, and generally high out-of-pocket costs. Among the most recent: St. Luke’s University Health Network, in the Lehigh Valley, which says it’s listing prices to take the surprise out of hospital costs. Others are jumping in as well, in Pennsylvania and elsewhere.
Summary: So my insurance co-op is closing, leaving me suddenly uninsured or nearly so. What should I do? I get my health insurance through Health Republic Insurance of New York. I am not a licensed insurance broker, and I do not want to give anybody any advice about what they should do, but I’ll talk a bit here about what I am doing.
Summary: Free flu shots! Are they really free? Who pays, and how much? Walk into any big-box store, and you’re invited to get a free flu shot today, right now, no waiting! While shots are supposed to be covered if you’re insured under the Affordable Care Act, we’re hearing that people are finding that’s not always true. Big chain stores post cash price lists for vaccines ranging from the flu to shingles. Those prices are the same in locations nationwide.