For health care reform, the only way to keep costs low

Have you noticed in the health care debate how some people start talking about car insurance? Specifically the argument goes that all drivers are required to purchase car insurance, so why not mandate health insurance the same way and make everyone buy it?

The comparison is a little shaky, but interesting. As a driver it's reassuring for me to know that other people on the road are insured in case one of them hits me. I won't have to shoulder the price of someone else's mistake. With health care, the "shared responsibility" works a little different, but it comes down to this: Insurance costs can't be controlled without everyone required to buy in.

Here’s another example to help put it into perspective that the Wall Street Journal recently used:

Imagine that parking tickets were only 25 cents. Would drivers have much reason to feed parking meters? The answer, of course, is no. Paying a fine would be cheaper than putting a dollar or more into a meter. A weak coverage mandate would have the same result.

Think about it. If insurers cannot turn away anyone, and yet people are allowed decide not to buy insurance, what would happen? Unhealthy or sick individuals would purchase coverage, while younger, healthier individuals would conclude that they could save money by skipping it. As a result, the overall group of people insured would be less healthy, and thus the costs to each of them would increase.

What would happen next? Responsible people who are currently healthy would be hit with paying a lot more money. Without a doubt, some of them will decide that coverage is too expensive and will drop out. Which increases costs again, as the group loses even more of its healthier — and thus less expensive — participants.

By keeping healthy people in the insurance mix, the individual mandate will help keep average premium costs low. Pure and simple.

The Washington Post's Ezra Klein has a great blog post about the need for an individual mandate. It's worth the read.

Tell us what you think at our Facebook page.

— Susan with Regence

The first word in health care reform is health

There’s a lot of passion in the health reform debate about who should do what. Health plans should take everybody. Premiums should be affordable. The system should be more efficient. I say, "Yes" to all of the above.

But there are some things doctors, hospitals, medicines and health plans just can’t do.

Case in point: My husband Mike was diagnosed as “pre-diabetic” – not to worry, there’s medication for that. I said, “Whoa. Type II diabetes is wakeup call. We gotta make some changes.” What’s the big deal, he says -- one more pill, just a $20 co-pay.

I dared him to ask the doctor, “What would it take to lower blood sugar and not be pre-diabetic?” Answer: lose weight, start exercising. And that would also reduce your high blood pressure. Ha -- two birds, one stone, no meds.

Mike also got the low-down from friends with advanced Type II diabetes. Linda has such bad pain in her legs, “I wish they would just cut them off, some days.” Renee warned: “You do not want this. Stop it now.”

So, we got a stationary bike, adjusted our eating and he dropped 40 pounds in three months. The doctor was impressed: lower blood pressure and blood sugar. No meds—for now. The challenge is to keep it up.

Of course, a pill would be easier -- at first. Those (many) times we just want to watch TV and break out the snack food, it is reeeealy haaaard to remember -- walk, or suffer pain like Linda. Shut the refrigerator, or struggle with yo-yo blood sugar craziness, like Renee.

I realize not every disease is within our control, but these conditions -- high blood pressure and diabetes – usually reflect a lifetime of choices around food and exercise. They are strongly correlated to heart disease, which kills more Americans than all cancers combined.

No doctor can make me do the right thing. Having health coverage does not liberate me from the responsibility to eat right and break a sweat a couple times a week.

An act of Congress can get more people covered but it doesn’t come free. And, I still have to do my own exercise. Darn it.

What are your challenges to staying healthy? Please share what’s helped you stay on track at the What’sTheRealCost Facebook page. .

Susan at Regence

Concerns around cost of reform

Here’s what I want to know: how will health reform being considered by Congress affect what I pay for health insurance?

The Senate bill is estimated to cost around $900 billion; the House bill around $1.2 TRILLION (gulp). That money has to come from somewhere and I can’t shake the feeling that I’m going to feel it one way or another.

A much anticipated budget analysis from the Congressional Budget Office (CBO) released this week attempts to address those concerns. Unfortunately, it does little to clarify the matter, for a regular person like me anyway.

Here’s why: on the one hand, the analysis suggests that the large number of Americans who currently have employer-sponsored medical insurance – like me – would not see much change in their premium costs.

But get this: the New York Times Prescriptions blog says that “calculating the proposed legislation’s effect on premiums is so complicated that the budget office pegged its analysis to a single year, 2016.”

A single year?! How does an estimate for a single year inspire confidence that reform won’t cost me, or the country, a heckuva lot of money?

Here’s another head scratcher: those who buy health insurance on their own would see an increase, but about half would have that increase offset with government subsidies. Subsidies that would artificially lower premiums.

Many in Congress would like me to believe that health insurers are to blame for rising premiums. The hard truth is that premiums go up because medical care is expensive and we use a lot of it. And what happens to premiums is dependent on whether reform can lower health care spending.
Please understand, I support health care reform but I’m concerned that all we’re doing is expanding access to a dysfunctional system. There’s still time though. I’ve been hammering on my elected representatives to give me better answers.

I don’t want a fairy tale, I want accountability because we all deserve a health care system that works for everyone.

–Laura at Regence

Have you noticed you can put "e-" in front of just about anything, and we all know what that means? We do so much online today – (r)e-tail, e-zines, e-trading and e-banking. And now there’s e-patient.

New research says that 61 percent of us go online for health information from trusted websites. We research symptoms to see if we need to a doctor, and then look up the diagnosis and treatment after we go to the doctor. About one in five e-patients interact with each other online, comparing experiences to broaden their understanding at Patients Like Me or e-patients.net

Whether it’s a simple diagnosis or a complex life-changing condition, being an e-patient helps us be effective and educated about what we can do to support our own health. I’ve talked in this blog about my own experience with looking online and replacing prescription meds with over-the-counter remedies – it was really empowering to do that myself because these options weren’t on my doctor’s radar.

People with the most experience in the health care system – those with chronic conditions – are really active e-patients, because they know how hard it is to figure out the treatment routine that works for them. They have a lot of experience challenging the system and asking “why” and “how much.”

As we are all paying more for health care these days, here’s another online resource for the e-patient: our Cost Generator, so we can be prepared with the real price tag of medical procedures.

If you've got an e-patient story, please let us hear about it at our Facebook page: www.facebook.com/TheRealCost.

— Susan with Regence

After House bill passed, more are asking: What's the real cost?

Real health care reform would put a halt to some of the $700 billion wasted each year in treatment and other expenses that do nothing to improve health.

The House bill does adopt new insurance rules and gets nearly everyone covered. But the consensus of news organizations around the country – and across the political spectrum – is that the bill passed by the U.S. House will do little to curb rampant medical spending.

Let’s not lose sight of real reforms that have the potential to reduce costs for everyone.

These people are also asking, "What's the real cost?"

Washington Post: Editorial: Flawed health reform
“As we have said, it does not do enough to control costs, and it is not funded in a sustainable way. Expanding coverage for the uninsured is imperative, but so, too, is getting the country on a credible fiscal path."

The Columbus Dispatch: Editorial: Cooking the Books
“Americans want an improvement in the nation's health-care system, not only for themselves but for their neighbors. But they should not be saddled with an unsustainable, unaffordable overhaul sold to them with accounting gimmicks and rosy projections.”

Huffington Post: Cost containment remains the missing piece
The most important debate - how to slow the inexorable growth of health care costs - has scarcely begun…. The House bill fails to deal seriously with the long-term challenge of reducing the unsustainable pace at which health care costs grow each year. That is what drives premiums up for working Americans, helps to price U.S. businesses out of global competition, and escalates spending on Medicare and Medicaid.

Philadelphia Inquirer: Historic but unaffordable
House plan … is unaffordable despite bearing the title "Affordable Health Care for America Act." Unfortunately, the House measure does little to rein in escalating health-care costs, and that, in the end, would harm the middle class and small businesses alike.

New York Times: How to control rising health costs
With the House’s passage of a health care bill and the Senate legislation possibly moving to the floor for debate next week, many analysts are saying that neither bill goes far enough to slow rising health care costs — an issue that President Obama has made central to his reform agenda.

San Diego Union-Tribune: Fear of health ‘reform’ is warranted
“Consider the…basic promises about…health overhaul: that it actually would save money, that the only new taxes would be on the very wealthy and that individuals would be free to keep their present coverage and doctors. Each of these claims is a myth.”

Denver Post: A long way to go on health reform

Los Angeles Times: Health care’s hurdles

Atlantic: The case for a cost containment commission

The Salt Lake Tribune: Health care reform

Weighing health care treatments: the big question to ask

But does it work?

Even if we don't say that question aloud, we implicitly ask it in our everyday lives. Each time we consider buying a new product or service, we want to be sure that it does what it says it will do. No one wants to throw away money.

But for some reason, when it comes to health care, people do seem willing to undergo treatments without asking: Does it work?

We assume doctors and medical experts are making decisions about our health care based on proven effectiveness. Strangely, that's not always the case. Treatments can be prescribed because they're new (not always better), or accepted (not always proven) even because of where a doctor was trained.

But decisions in health care need to be driven by a main criterion: data. One way to get data is comparative effectiveness research. The first advantage isn't too hard to figure out: Proven results would be better than guesswork.

Medical care is extremely complex: having some 13,000 diagnoses, 6,000 drugs and 4,000 procedures makes it difficult to pick the best course. Comparative research examines all the available medical studies and literature and delivers comparative data so doctors diagnose and treat illnesses based on evidence-based outcomes.

This is already happening on a piecemeal basis. Health care reform could make it more systematic. By combining the best research evidence with a patient's values, treatment would be more effective.

Along with more accurate diagnosis and care, there's a second advantage to evidence-based medicine: costs might just be lower. Why? Currently the health-care system pays for treatment whether it works or not. But just because it’s covered is no reason to waste your time with a treatment that isn’t effective.

When your doctor suggests a medication or other treatment, don’t be afraid to ask: But does it work? Don’t hesitate to do your own research on the Internet to get as much information as possible, and actively participate in decisions about your health.

The goal is for you to be comfortable that the tests or treatments recommended by your doctor are based on broad evidence from the medical literature. That's one way to begin to get health care costs under control — and to get good health care and lifestyle choices in your control. Where they belong.

New video demonstrates system inefficiencies. Has this happened to anyone else?

The other day I got home from work and sorted through the endless amounts of junk mail and bills that I receive day after day. One piece specifically caught my eye this time – what looked like billing from my OB/GYN’s office. When you’re closing in on nine months pregnant, any piece of mail from your OB’s office is of utmost concern.

I immediately ripped open the envelope and scanned the complicated document to read on the final line, “you owe $3,875.89.” I was floored! Yes, I realize I have had what seems like hundreds of ultrasounds due to minor pregnancy complications and monitoring, as well as additional prenatal care, but almost $4k out of my own pocket just didn’t sound right.

See, I work for an insurance company – not only am I self-covered by my work insurance, but I’m also covered by my husband’s. In fact, during my first prenatal appointment, I met with my OB’s billing department to find out exactly what I would need to pay out-of-pocket when this ordeal was over. As most everyone, we live on a budget too. I was quite impressed when they gave me a complete listing of how much each portion of the care costs, why it costs that much, and more. I was also told that because of my pleasant “double- insured” situation, that I would have to pay very little, if anything, out-of-pocket after delivery.

So why the sudden $4k?

The next morning I contacted my doctor’s office and was told to “ignore” the statement – that my situation was the same despite the additional testing I had undergone, and “not to worry about it.” Only problem is, if you read the fine print it also states that if I don’t pay the $4k by X date, I’ll be charged interest. However, after questioning the billing department again, and contacting both insurance companies, I’m still unclear as to what I’m really responsible for when this is over. But what can I do other than just wait for another bill in the mail?

Has this type of thing happened to anyone else out there? I’m sure it has. That’s why I got a kick out of this video called “Checkout.” Watch it, and let me know what you think. Here's a link to it on WhatsTheRealCost.org http://www.whatstherealcost.org/wtrc/toolbox/connect.html?video&site=.

Why aren't we tackling the real problems?

The other day I got an email from the salon where I get my hair cut. They wanted to let me know they're moving to a new location — a much bigger space. Uh-oh, I thought. And indeed, at the very end, the email said just what I suspected — that as a result of the bigger space, the cost of a haircut would increase $5. I’m not happy about the price increase, but I can't really blame them. They're doing what any business does: passing the cost of their higher rent onto the customer. I think health care works the same way.

Last week the Senate Finance Committee released its health care reform proposal. To pay for universal coverage, the committee’s recommendations mainly came down to pushing the cost of change back into the system. The proposal does little to fix why the costs are high to begin with. It offered no remedy for the high costs of prescription drugs (biologics can cost up to $200,000 per year); repeat billings for the same procedures (like having an MRI twice in the same month because your doctor’s don’t all know each other and talk to each other); and other issues that are plaguing health care.

See, the Senate Finance Committee's idea to pay for reform focuses on new fees on insurance companies and drug makers. This is like taxing car insurance because the mechanics and the factories that make car parts have increased the cost of fixing cars. We know who pays for everything in the end: us, the consumers.

Okay, I work for a health plan, but help me understand this: Doesn’t the Senate know that imposing a tax on health plans just makes coverage more expensive for people? Because the health plans have to pass on that cost of doing business. Sixty-one percent of private health plans are nonprofit — they don’t have a way to absorb this cost. And if the Senate thinks for-profit plans will just reduce dividends, they are not being realistic.

Would it be possible for my salon — where I love getting my hair cut — to keep their prices the same even if they're paying more rent? You know the answer.

Taxing the “messenger” of increased costs does nothing to reduce medical spending or fix the real problems with the system, plus it just makes private coverage more expensive for people. The cost problem will just continue to get bigger. That doesn’t sound like real reform to me.

Thinking about the “big picture,” what really matters? What will have a transformational effect?
Get ideas and share your thoughts at our Facebook page.

Keeping the real health reform focus

Did you catch President Obama’s speech to Congress on health care reform last week? He gave an accurate summary of the problems people have in getting, keeping and affording insurance. He even mentioned that medical costs will swamp the federal budget. But he didn’t talk much about how to curb those costs, especially once everybody gets coverage.

And I was disappointed that when he reeled off the list of groups who were on board with reform, he left out health plans. That’s such a bummer because they were the first ones to the table, offering to reform their industry to get rid of the practices that people complain about: pre-existing conditions that prevent coverage or payment of claims.

All the insurer reforms the president mentioned were offered by the industry itself, yet he left the impression these changes are being “done to” the one part of the system that volunteered for reform.

I get it from the letters to the editor that some people think the only reform that matters is offering government insurance and/or getting rid of private insurance. But no matter what kind of coverage method we have, it’s really important to fix the whole system, not just who signs the check.

Here’s the deal: 87 cents of our health care dollar goes to doctors, hospitals, pharmaceuticals and other health care goods and services. That’s $8000 a year for each of us. Experts say maybe a third of that is wasted. That’s scary and reform has to fix that, too. So, where’s it going?
In a system of “disease care” 75 cents of each health care dollar goes to preventable chronic conditions
We use a lot of treatment that may not improve care and may expose us to risk: MRIs, CTs, etc
Quality issues can curb costs but they aren’t widely implemented, even simple ones like checklists, that reduce hospital-borne infections.
Doctors and hospitals are paid based on procedures, not better health; only last year, Medicare quit paying for “never” events like cutting off the wrong limb
Fraud takes tens of billions a year, a low estimate is 3% of all our health care dollars, from a variety of schemes: dummy companies getting Medicare funds for phantom equipment to unnecessary medical treatment.
Dollars wasted by duplication and uncoordinated care could be recovered with wide use of electronic medical records to put patient information in doctors’ hands.

Getting everybody covered is easy. Curbing costs so our country can afford it is hard. I don’t know about you, but I want to see health care reform accomplish both of these.

Medical records: a better way

It's pretty amazing how many aspects there are to the ballooning cost of medical care. As I wrote in my last post, prescriptions are one place where we can be more savvy. Another savings area might be less obvious: the storing of medical information.

The root of the problem here is inefficient communication. Think about a time when you had to repeat the same information over and over again. Maybe you were calling your cell phone or credit card company to ask a question, and you kept getting transferred. It's frustrating, sure, and it wastes time — and we all know time is money.

For health care, the issue is medical records. How many times have you filled out forms for your medical history? We've all seen those floor-to-ceiling files of manila folders in each doctor's office. All that information is on paper, and there's no easy way to share it between different health-care providers. The result can be agonizing delays and costly duplication of tests.

Maybe your 85-year-old grandfather needs surgery. He goes to the hospital, but soon they realize they can't do the surgery because they don't have clearance from his cardiologist saying his heart can survive the strain. A few weeks earlier your grandfather went to a cardiologist, but the surgical team never received the records from that visit.

What to do? Wait? Or repeat the tests with yet another cardiologist? Two very inefficient options.

Maybe you’ve experienced this already. The doctor sends you for a test and follow-up to discuss it, but when you get to the follow-up, the test results aren’t back. So the inefficient system just wasted your time, your doctor’s time, your money and maybe resulted in the unnecessary duplication of tests.

A friend of mine recently moved halfway across the country. In dealing with the million details of her relocation, she never had time to visit all her doctors and get copies of her records. Every once in a while she remembers those files hundreds of miles away and worries that she'll have to repeat many of the same procedures again with new doctors. Another friend actually did send all her doctors the request for files to be transferred to a new doctor, but found out the hard way several years later that the files never showed up. She’s lost about 10 years of her medical history.

One study by a think tank estimated that $81 billion could be saved annually by computerizing patient records. Both the Bush and Obama administrations have pushed for the creation of a system for local hospitals and physicians to electronically share medical records, because it could save lives and money. So why hasn't it happened? True, there are upfront costs. But other perceived barriers, like concerns about privacy, shouldn't really be barriers at all. The banking industry has overcome them, which is why we can use ATMs anywhere. I can e-file my taxes and check my financial history online at a credit agency, so we know issues such as privacy, security, misplaced competition and compatibility across technology can be addressed.

A computerized system would mean doctors could immediately see lab results and read specialists' comments on their patients. It would mean that if you show up in the emergency room, your medical history is already there — your allergies, previous blood work, past Xrays and more. That sounds like a win-win for everybody, doesn't it?

What do you think? Share your ideas at our Facebook page.

— Susan with Regence

Health reform takes attitude

Thinking back on that last post, about how it takes all of us to curb medical spending, reminded me of my personal attitude adjustment on this issue.

My health plan puts claims online so I can track them, and also shows what I paid and what the plan paid. That was an eye-opener. I thought I was pretty low-maintenance, not a drain on the plan. But my two little meds for a skin condition really add up: between co-pay and insurance coverage, they cost $200 a month, more than my premium share.

Working for a health plan has made me conscious of medical costs. So I researched my options at RegenceRx.com. I found that hydrocortisone cream controls the same symptoms as the prescription I used, for only $5 a tube (less for store-brand). After awhile, I didn’t even need it every day, just every few weeks.

Unfortunately, they don’t make a hydrocortisone shampoo (unless you’re a dog). But I got a valuable clue from RegenceRx.com: both my meds were considered “anti-fungal” (ew!). A Google search showed vinegar has anti-fungal properties. I left some vinegar on my scalp for several minutes before shampooing and voila--that works too!

It was fun to find such easy and cheap solutions, but how come I had to find them myself? No doctor in 15 years of taking those meds offered any alternatives. But then, no vinegar salesmen go to my doctor’s office and buy her staff pizza so she will recommend it.

For about $35 a year, I took myself off two meds and saved $450 in co-pays and $1900 for the health plan -- Unbelievable!! I told my doctor to note I was no longer taking those meds, and that she should pass the word to other patients so they could try it. She just looked kind of bemused. “But those meds are covered,” she said.

“Covered” doesn’t mean “free” – somebody still pays. In fact, everybody pays. That’s why reform can’t stop with health insurance. It will take an attitude adjustment.

My little DIY solution cut almost $10,000 in spending by my health plan – that is, me and my co-workers – in just four years. This didn’t take months of research, settling for less or changing my lifestyle. It just took changing my attitude.

If you’ve had one of those attitude adjustments, maybe you could share it at our Facebook page.

One word makes a big difference

Have you noticed the change? I'm talking about the change in the debate over health care reform. Lots of Washington politicians, now on their August break, have started focusing on health insurance reform rather than health care system reform. It might look like just a little shift in wording, but there's a big difference. What should the debate be focused on?

The whole point of reform is to control the costs that have sharply increased over the last decade. Can we really resolve this problem by looking only at insurance?

It would be great if that was the case. And focusing just on health insurance reform might be tempting, because that's the bill we get in the mail, so we're super-aware of it. Actually, health insurance reform will be the easiest thing we could do this year, since all the insurers have already agreed on key reforms that everyone wants.

But health insurance doesn't come close to reflecting the total cost of health care.

Unfortunately, there is no one cause for the skyrocketing costs. Rather, several issues have caused our health care system to become overly expensive. It's true that insurers have played their part. But they have plenty of company! Focusing only on health insurance reform won't get the job done.

Drug companies, the government, doctors, hospitals, and even all of us as consumers have also had a hand in creating this situation. Drug companies charge a lot for certain medicines. Politicians make rules about things like Medicare reimbursements. Hospitals and doctors know they'll earn more money by doing costly interventions, while we as patients have almost no control over the amounts that hospitals and doctors charge.

I know it's a big job, but all of these factors need to be addressed -- and that includes each one of us! We can all make an effort to adopt healthier lifestyles. We can research health issues and treatment options on the internet. We can talk to our doctors about the least expensive yet most effective care. We've got to see ourselves as the central actor in our own health care story. And we can economize on medical care the way that we do with our other expenses.

We're all in this together. Keep checking back here for ideas about how to reform the whole health care system.

-- Susan with Regence

The power of a question, and the answer

This doctor has a couple of great stories about the “medical industrial complex” and why health care reform is hard-- http://tinyurl.com/THCB-lobster-and-lap-choley

After the lobster-salad analogy, he talks about high-tech driving up medical spending, not always for the better. I could relate to his example: gallbladder surgery. Full disclosure–I have gallstones (maybe TMI).

The pain felt like a sword sticking through me right under the rib cage. My doctor said, “Classic gallstone attack, we’ll get CT scan to be sure.” The scan showed a gallbladder that looked like a bag of marbles. The doctor advised removal of the gallbladder: “With laparoscopic surgery, you hardly even have a scar.”

“Doesn’t the gallbladder have a job to do?” I asked. The doctor agreed it did. “Is it necessary to take it out?” She said no, it wasn’t, but I should avoid fats and eating too close to bed time to avert future attacks.

I also went to a licensed naturopathic doctor and he gave me the same dietary advice, plus a pain remedy: peppermint oil pills.

Apparently, peppermint oil soothes spasms, like when a gallstone blocks the bile duct. The pills were about $17 in the grocery store’s health food section. At my next attack: 2 peppermint oil pills, and 10 minutes later – horrendous pain is gone! After 7 years, I’m only on the second bottle of pills. I raved about the peppermint oil -- it helped my friend’s cramps and my brother-in-law’s lower back pain, too.

Guess I could have had the operation, but just I wanted to stop the pain and keep all my working parts. Did you know that gallbladder removal is one of the most common surgeries in the U.S. and the #1 reason is pain. Wonder how many of those people would choose peppermint oil over surgery?

I asked some questions, checked the Internet, got another opinion and found a treatment that worked for me. More disclosure – yes, I had health insurance at the time; no, I did not work for an insurance company then.

It wasn’t about the money, but now I see how each decision impacts the money. We can all ask "Why?" and "How much?", without an act of Congress. You never know what could happen.

Susan with Regence

Can one person really make a difference?

It's an understatement to say a lot of people are involved in pushing for health care reform. Trying to follow the progress can feel overwhelming. Even when we do our best to stay informed, it's hard at times not to wonder where each of us fits in as individuals. Are the decision-makers going pay attention to what one person has to say?

The current health care system lets us get away with being quiet, with being poorly informed and being far removed from decisions.

My mind was wandering over these things as I was doing a few chores around the house, rinsing out some aluminum cans to put in the recycling bin. I put the bin out on the sidewalk and looked down the block and saw all the other blue bins in front of the other houses. I imagined all the blue bins across the neighborhood. And it reminded me: my individual actions do matter and together our actions make a difference that affects others.

Recycling used to be a “fringe” idea, now it’s the norm. Some individuals doing what they believed in came to influence groups of people and whole cities and states and countries. This is why each person's voice is needed and our health care system needs every voice. As more people ask questions of the health care system like, "Tell me more," the more the system is going to change the way it reacts to us, change its assumptions about what we want and the way care should be delivered. It could start with each of us sitting in an examining room, asking the doctor, about a prescription being written, “Is there a generic version?” or what about “Tell me about this new procedure. What’s better about it? Are there alternatives? What is the cost, by the way?”

Speaking up is taking charge. Know the options. Ask why. We’re an equal partner in our health care decisions – it’s about our body, our preferences, our money. And, just like recycling, I do this because I believe in it and because it helps more than me, it helps the community. If I take time and do internet research, maybe avoid a few unnecessary doctor visits and procedures, I'm helping to keep costs down for the group of people that together pay for my medical care, and I for theirs.

When it comes to health care reform, I can email my congressmen, write letters to the editor, blog, and go to meetings. I can also speak up when it matters – in my doctor’s office. This is one more way I can contribute to the well-being of the entire community. I hope you will contribute too – if this speaks to your experience, please share this blog with your friends and family.

– Susan with Regence

Why is it so hard to ask the doctor, "how much?"

Does anybody else feel weird asking the cost of a lab test or a screening or even a check-up? I do. I was looking for a new dentist, one in my neighborhood, and I poked my head in the door of a small clinic and asked the woman at the desk, “How much is a routine cleaning?” Then she asked me, “Don’t you have insurance?” “Yes, but how much is a routine cleaning?” “Well, there’s not really such a thing as routine, you might need something else.” “Yeah, but you must have a baseline, what is it?”

At this point, a guy poked his head out from behind a screen, facemask on, tools in hand, and looked out at me through the doorway, like, “Who IS that?” Okay, now I’m getting weirded out – why should I feel bad for asking?

Eventually, I found a dentist through word of mouth – not that one. But the feeling lingers that if I do have insurance, I’m not supposed to ask the cost of treatment. My doctor asks me to sign a paper saying I’m responsible for costs, just in case, and she doesn’t even know what they are.

But when I buy a car or a computer or take a trip, I look up the prices and see what people say about those products or places. Why shouldn’t I do that with a doctor or hospital or treatment? When it’s not an emergency, at least.

The $10 or $20 co-pay has been the norm my whole adult life until I got one of those high-deductible plans last year. I never thought to ask about cost or necessity. And there’s a couple of generations of people who aren’t used to asking these questions. In that time, medical costs have gone crazy and people can’t afford coverage.

Now, the government is telling us we have to “bend the cost curve” so we can afford health coverage for everybody. These researchers from Dartmouth say maybe one-third of all treatment is unneeded. But how do we know when to say “no”? I guess that’s why we have to ask questions. And look things up on the Internet. And ask around.

Maybe if we start asking questions, we could start bending the cost curve ourselves.

What do you think?

Susan with Regence

Doesn't it feel as if everywhere you look these days, people are talking about health care reform? It's there on the daytime talk shows and the nightly news. Maybe you know someone who's worried about changes in their job's health plan. As the summer gets into full swing, and we're getting together at barbecues and the swimming pool, we're all thinking about these discussions and talking to each other. Health care is such a high priority. It's deeply personal. It touches a nerve.

And yet the main debates about health care reform are taking place in Washington, D.C., which feels so far away from most of us. You might have heard about three bills that are floating around Congress. Two of them include proposals for a government-run insurance plan, known as a public plan. The other one seems to be considering the idea of nonprofit health cooperatives, in which members control and own the co-op.

What's not included in any of these proposals? How to take waste and unnecessary costs out of the system.

We've got to take a good look at the cost of reform for each of us right now. Health care reform is a huge undertaking, and it's vital that we get a handle on the costs involved for everyone — taxpayers, insurers, doctors, and each one of us. In his proposal President Obama gives reforms ten years to pay for themselves. But that's what's going on in Washington. What about closer to home?

Because we're all connected in this undertaking, and we've all got to ask: What can I do right now? How can I contribute? Think about it: the last time you went to get a medical test or see a specialist, did you have any idea what the price tag was for the procedure or visit? We need to make that interaction between patient, doctor, and health insurer more transparent and open. And that's just one aspect of the overall health care reform undertaking.

Despite the big challenges — and the little, nagging fears we quietly share with our friends and family about our health and that of our children — we need health care reform that not only covers the uninsured but is mindful about costs in the here and now, when I walk into my doctor's office. This blog is the place where we try to make sense of the cost of health care reform. Keep checking back to stay informed and be part of the discussion.

~Susan with Regence