What's your health worth?

A few weeks back I went to the doctor and in the waiting room I overheard a patient ask the front office staff how much his colonoscopy would cost him. The reply - “I don’t know, ask your insurance company.” But what if instead the answer was, “How much is it worth to you?”

That’s exactly what some doctors in California tried, just for a day.

These primary care doctors didn’t accept insured patients or those on Medicare and Medicaid for one day – only the uninsured. Patients were asked to give whatever they could afford or whatever they thought the care was worth.

While the docs felt great helping the uninsured community - patients didn’t come near covering what the services actually cost and the doctors ate the costs for the day – so this experiment turned into something unsustainable. The patients didn’t really know how much the health care really costs.

So this got me thinking… what if health care worked that way – offering what you could, and not worrying about the real cost? Unfortunately that’s not reality in any sector of our economy. Otherwise we would all live in nice homes, drive nice cars, and enjoy great restaurants, among other things.

But how much should we pay for health care? Well, unfortunately we have to pay what it really costs, and this experiment also demonstrated that no one really KNEW what it costs, which is part of the problem fueling rising health care costs.

None of us really know what it costs because “someone else” is covering it. In reality, we’re all covering it though – through rising premiums and higher doctor and hospital bills. Because when one person fails to pay the whole bill, the money has to come from somewhere, and everyone pays the rest.

Read more about physicians asking patients to pay for their care. And maybe you’ll think about it during your next treatment. I know I will.

Speed Dating: The New Way to Shop for Health Care

Last night I was chatting with a good friend of mine who is single and dating. She’s tried it all – online, blind dates, meeting guys at work, charity events – you name it, she’s been there looking. Some end nicely, others in disaster. But next week she’s going to try something different: Speed dating.

For those of you unfamiliar, groups of men and women attend and meet for 5 to 10 minutes with one another to get a general feel for the other. I must confess, I wish her all of the happiness in the world, but can’t wait to hear about this next installment in her dating diary.

So how does this relate to health care? Well, there’s a hospital in Texas that takes this same theme – speed dating – and puts it to good use in health care. The hospital invites physicians by specialty and patients in need of specific care to an event where they “speed date” to determine if they are a good match.

Patients love it because they don’t have to schedule various appointments with numerous doctors to find the best doctor for their pregnancy, or to care for their children, or whatever other service they are seeking. Physicians looking for patients love it. And the hospital uses it as a recruiting tool. Basically, it’s a win-win for everyone.

Think about the possibilities – shopping for health care – meeting with doctors to ask about their quality standards, practices and costs… something we should all be doing more of in health care.

Want to learn more about speed dating with docs? Read more on the Bedford Hospital on the cutting edge.

New Trend Emerges in Reducing Health Care Costs

A few weeks back I visited family in New Orleans, and the massive oil spill in the Gulf came up at a family party. My uncle works for a large oil company (I won’t say who, but it’s not BP), and since he is related in the oil industry, he was bombarded with questions about causes, clean up and costs. Suddenly, he was the oil spill “expert” at the party (despite the fact that he works in an entirely unrelated department of the company).

As a health insurance company employee, I am often peppered with questions at parties and family gatherings – everyone wants to know my position on the latest health care reform legislation. As if I’m suddenly an expert!

So when I was asked questions about health care at a function I attended last night with my husband, I was armed with an interesting perspective, after reading a great article about a new trend in reducing health care costs. Not only did I find this concept innovative, but so did the other party guests.

The premise is simple: pay doctors based on good care, instead of the number of patients they see. It’s quality versus quantity. Through this system it’s believed the sickest patients will get more coordinated care and attention. Not only are health insurers behind it, but so are a good number of physicians as well.

I’ve known about Regence’s support for this concept, and that our members can access nurse managers that will help guide them to stay on treatment plans and get health coaching - but in the midst of the doom and gloom of the economic news lately, and the persistent rise of health care costs (that will never seem to go down) – I was pleased to see someone else taking the initiative, and excited that doctors were on board.

Tackling rising health care costs will only benefit all of us. Are you a trendsetter? How will you bring down health care costs?

When Free Isn't Free

About two months ago I took my six month old to the pediatrician because she is allergic to every single brand of formula we had tried (and we tried every kind on the market). No matter the brand or base, her body’s reaction was terrible.

The doctor gave me a free sample of a new special type of formula – available only online, not in retail stores. So we tried it. The results weren’t perfect (let’s be honest, no formula is perfect), but bearable for our family.

So I went online to order some and the prices made me gasp – over $200 for one case! That’s eight cans! And one can goes in less than a week. You do the math.

Sound familiar? Maybe you haven’t ordered formula, but certainly you’ve tried a new prescription sample at your doctor’s recommendation – and once you’re hooked you find out the true cost of the medication. Apparently we aren’t the only ones. Check out this post on KevinMD.com.
I’m not faulting the doctor – he solved a major problem for our family. But maybe we should understand the high costs of everything, including medications, before we order them. This time the money came out of my pocket so I found out the real cost pretty quickly, but had my insurance been billed, would I have known what that cost my health care community pot? Probably not.

With costs on medications and special treatments as high as they are, no wonder health care costs are out of control.

Share your experiences. I want to hear what you think.

"Free" Health Care and Other Myths of the New Health Care Bill

The Patient Protection and Affordability Act (commonly referred to as PPACA – pronounced “P – Paca”) passed Congress and the President signed it into law. Being that this was the largest reform since Medicare and Medicaid in the 60’s, this was big news to me, but what made it even more important was my status as an employee of a health insurer.

Living and breathing the various components of the law daily, it shocked me when I was in my local grocery store and overheard the couple behind me discussing purposely dropping their employer-sponsored health insurance coverage because now they didn’t need to pay for it “the government would provide it instead.”

After the shock wore off, I thought about it – why wouldn’t average Americans think this? For months all we heard about was how “everyone would be covered” and it would even be cheaper. The new law was compared to Medicare and Medicaid – and all in rhetoric that was hard to decipher.

But this is a myth. No health insurance is free, no matter how you slice it. Somehow, you’ll pay for it – whether it’s in taxes or in raised premiums or health costs elsewhere – it’s just like my mom always says, “Nothing in life is free except love, and you even have to pay for that sometimes.”

So what are some other common myths? Check out this opinion in Portland’s newspaper, the Oregonian. This guy has some interesting takeaways.

To learn more about PPACA and what’s really in the bill, there are resources available to help.

MRI for $3000 or $350 -- Price matters

If you think there’s no reason to shop for health care, check out this doctor’s blog post – her patients were skipping needed care because of high costs, even her own mother. http://www.kevinmd.com/blog/2010/04/price-transparency-improve-patient-care.html

Affordable care was available, as the examples here point out, but it’s hard to find prices and comparison shop for health care.

Dr. Leslie Ramirez decided to help out, at least if you live in the Chicago area. She’s compiling her own list of affordable care providers. Wouldn’t it be great if every town had a list like this: http://www.leslieslist.org/index.php

Skip that $3000 MRI and get one for $350, as long as your doctor says it will do the job. It takes a little legwork, but for somebody like me with a high-deductible health plan, there’s an immediate payoff.

Even for those who have only a $20 co-pay for unlimited MRIs, CTs etc., if we all did this, we would be shrinking the number of our health dollars needed, bringing down the cost overall. That’s the power we have as consumers.

It’s like that saying, “When the going gets tough, the tough go shopping! And believe me, shopping for health care prices can be tough, but I dug up a few more places to get started. -- Susan at Regence

MRI: http://www.comparemricost.com/
Common health screenings: http://www.costhelper.com/cost/health/

See if your hospital has information like this:
http://www.cnn.com/2009/HEALTH/09/10/health.care.price.comparison/index.html
Find a low-cost clinic: http://findahealthcenter.hrsa.gov/
Check local community and information referral services: http://www.airs.org/i4a/pages/index.cfm?pageid=1

Compare quality too: HHS.-- www.hospitalcompare.hhs.gov
Medication – comparative effectiveness and cost: RegenceRx

Some states and regions are helping consumers find good health care:
Puget Sound (Wash.) Health Alliance – community check-up
http://www.wacommunitycheckup.org/?p=home
Oregon hospital costs: http://www.oregon.gov/OHPPR/RSCH/comparehospitalcosts.shtml
Provider quality: http://www.partnerforqualitycare.org/

Confessions of a Health Care Use-aholic

Last night I received some “Explanation of Benefits” forms in the mail from my primary health insurer (Regence). And what I found surprised me. Of the last five doctor’s appointments my daughter has been to, only one has yielded any diagnosis worth following up on.

Each office visit was at least $200 plus, and two appointments called for tests that ranged in price from $500 to $7,000. The result of each? Normal diagnosis.

I work for Regence and I’m constantly researching and writing about the increasing cost of health care, so you would think I would be a bit more sensitive to “unnecessary care” or “overuse.”

Instead, I have not once questioned my daughter’s doctors or their orders for tests. When it comes to her, in all honesty, I don’t really care what it costs the health care pool that I (and my co-workers) pay into. But isn’t that the attitude of most Americans? When it comes to our health, or the health of our family, we just use it –necessary or not.

Just the other day I read an article about “The Power of No” – how much economic sense does that make in medicine? I encourage you to read it. Like his opinion or not, the writer has an interesting take on how to reduce costs, something that I have long said has been missing from the health care debate.

Coming from a fellow health care “useaholic,” I admit that we must find ways to save money in our health care system – whether it’s “The Power of No” – or some other way that we feel comfortable with.

Our culture of use needs to change. We need to question more, research more, and treat the health care system “bank” as our own. Otherwise, rising costs will never get better. In the long run, I want my daughter to have a functional health care system in her future. And if we don’t really address costs, and fix it now, I’m afraid that won’t be possible.

Wellness for Less?

In this economy everyone is focusing on how to cut costs. Commercials on TV are a great example of that. Have you noticed WalMart’s campaign? They started advertising living better while spending less. Car dealers offer years with no interest. And just yesterday I went shopping and found that every store was having a great sale.

That’s why it didn’t surprise me when I read about another group – doctors – speaking out about how to cut costs -- health care costs.

These doctors in a recent article in the New York Times had some great ideas to offer. My favorites are nutrition counseling and stop overtreatment (see recent post about my hypochondriac cousin). What do you think of their ideas? And I’d love to hear some of yours.

Can we get off this treadmill?

Here's one of my pet peeves.

A news story says the FDA is about to vastly expand the market for statins (which control cholesterol) so healthy people can take them as "prevention" against heart attacks.

But, research says statins can cause diabetes. Experts say it's worth the risk because statins reduce heart attack risk.

However, diabetes is KNOWN to increase heart disease risk.

Is it just me, or does this sound like a crazy treadmill?
--Take statins to prevent heart attack (keep in mind, you’re taking medication even before you get high cholesterol).
--Risk the statins elevating your blood sugar, and if they do, take another medication (metformin for “pre-diabetes” before you have the disease)
--Risk getting heart disease anyway, because you got diabetes from the statins elevating your blood sugar -- and take medication for heart disease.

Maybe I’m connecting the dots wrong – if I am, please straighten me out.

To my mind, REAL prevention would be a public health program (like those against smoking and drunk driving, or promoting seat belts) to get people to eat veggies and exercise – both known to reduce the risk factors of heart disease, diabetes, cancer and other chronic disease.

Health care reform could help because it has pilot projects to pay/reward doctors for intensively coaching people about the underlying issues of nutrition and weight.

We make a lot of choices in life and here’s another – get on the medication-as-prevention treadmill or stick with the exercise-and-veggies. Genetics have their influence. But I still have choices.

I think I’ll take a walk to the farmer’s market.

Susan@Regence

Paying More Out Means Putting More In

Last week my hypochondriac cousin told me about her latest ailments – all of which to me sounded like a sinus headache. However, she wasn’t convinced. So she sought out and visited a neurologist, and an MRI later, it was determined that it was just that – a sinus infection.

Her concern is well-founded in many ways (our family has all sorts of strange disorders) but this time, a lot of money was spent for a diagnosis that a family doc could have easily given without the extras. Which got me thinking – if we expect the health care system to pay for any treatment we want, shouldn’t we expect to put more money into it?

Any other time we want extras, we pay: extra computer memory, higher price tag; silk instead of polyester, higher price tag; leather interior on that car, higher price tag. This is true for almost any consumer good or service you can imagine. So why would we expect it to be any different for health care?

It’s simple –if we want more on the front, we’ll have to pay more on the back end.

As we know, last week Congress passed historic legislation regarding health care. Many components of the legislation should be applauded, but there is still one area that I think falls short – addressing the rising cost of health care.

Doctors in this New York Times article come right out and say the health care reform bill gives them no reason to say “No” to people like my cousin who insist on a needless MRI – multiplied millions of times, that drives up health costs for all of us.

Until the system gives them that reason, it’s up to each of us – what can we do about the rising cost of health care? Here’s some ideas in these Five Questions.

Why does my premium cost so much?

Health insurance was born on the concept of neighbors ‘pooling’ their money together to take care of one another. It was this idea - formed in the early 1900s – that brought communities together to help each other pay for medical treatments they couldn’t afford otherwise.

As is today, usage of this pooled money varied among members – some were sicker than others and needed more care. But everyone supported each other.

Like you, I budget to pay my bills – mortgage, food, utilities, child care, and even health insurance. So when my premium goes up (yes even though I work for a health insurer that even happens to me!) I want to know why.

So I did some research. Here’s a great summary that helped me understand it in a few easy steps:

START with the average amount of claims paid out in the previous year,
ADD doctor, hospital and facility rates, medical trend costs (such as an aging population), then
SUBTRACT adjustments for shock events like pandemic flu or hurricanes and that number
EQUALS the average claim costs expected for the upcoming year. Now,
ADD insurer administrative costs (like how much it costs to run Customer Service lines), and
DIVIDE BY the number of members the health insurer has, which
EQUALS the premium amount to be paid by members

Want to learn more? Visit WhatsTheRealCost.org and be connected to Policy Pricing 101.

Health Care Reform 101: So what is it? And what's it mean for me?

Check out your local or national news sources, open your Facebook and Twitter accounts, and walk into your nearest coffee shop – the talk is on the House’s historic health reform package passage last night.

In fact, nothing of this magnitude has touched our health care system since Medicare and Medicaid in the 60’s. And while it is the talk of the town… many don’t really know what the current legislation means for them, their families, or their country.

So what’s in the bill? Here are some of the “Cliff Notes”:
•Extends coverage to another 32 million Americans over the next 10 years. How? By making it easier to qualify for Medicaid; and providing subsidies (money the government gives you without any promise of paying it back) for low income individuals and families to buy insurance.

•Requires all Americans to buy health insurance or face a yearly penalty. The initial penalty (starting in 2014) will be $95. By 2016, the penalty would be either: a flat fee of $695 or 2.5 percent of your income.

•Employers not offering coverage could pay up to $2,000 per worker as a penalty.

•Bans insurers from denying coverage to people with preexisting medical conditions (begins in 2014) and a requirement that adult children be permitted to stay on their parents' policies until age 26 (begins this year).

•Taxes on high-cost insurance plans (often referred to as “Cadillac” plans) beginning in 2018. Applies to health plans that cost more than $10,200 a year for individuals and $23,000 a year for families.

•Any individual making above $200,000 or couples making above $250,000, pay increased taxes on their income.

•Insurers face more federal regulation and a new premium tax starting in 2014.

•$250 million has been allotted to fight waste, fraud and abuse.

So what’s NOT in the bill?
The elephant in the room is cost containment. The bill does not fully address how to slow the inherent, rising cost of health care.

Technology is more expensive; we’re using services at an increasing rate; Americans have chronic conditions that require not only prevention by physicians but lifestyle changes by patients; and the cost of pharmaceuticals like biologics (like the medicines used to treat cancer) keep increasing – just to name a few.

You can learn more about the bill and hear other Americans’ opinions on it by visiting the following sources:
MSNBC- what Americans really think about health care reform
Health Care Reform – What it is and isn’t
So it passed. What happens now?

In short,a new era in America’s health care system is underway. While many effects of the bill won’t be felt for a few years, the transition is beginning.

Learn more about rising health care costs and what you can do as a consumer to contain them. Visit www.WhatsTheRealCost.org.

The Kind of Reform Americans Want

Turn on any news channel this week and you’ll hear predictions about how many votes the Democrats have – or don’t have - to pass Obama’s health care reform bill.

Interestingly, if the bill passes, history will write that this Congress passed a historic health care package, marking this a time in history to remember – and it’s likely no one will remember how it came to pass. The debate on the process will be forgotten. Similar to former President Clinton’s economic legislation – thought to be passed by a landslide – when actually it was Vice President Al Gore who was the one to cast the deciding vote.

It’s during these times in America’s history that we learn more about the legislative process than we ever cared to – which is why we don’t remember it later.

But for me, this time seems more important than others. Maybe it’s because more Americans than I care to think about are out of work. Or maybe it’s because I work for an insurance company. Honestly, I think for me it’s a combination of both.

Regardless, it’s got me thinking… and I’m sure it’s got you thinking too. About what the heart of the issue is. About why we care so much. And about what’s at stake. In these times, I believe it’s not just our health that’s at stake. It’s our economic well-being, and the kind of problems we could pass on to our kids, and their kids, and their kids, and so on.

The stakes are high this time – and maybe we won’t remember the process, but we’ll sure remember the result. So I hope this Congress gets it right. I hope they understand what is really driving health care costs up for all of us, and making health coverage so unaffordable… rising medical costs.

In my opinion, current legislation isn’t going to bring down rising medical costs, or address it in the way that it needs to be. Y

You can say that I’m jaded by the industry, but I don’t think so. Even news media have released stories recently indicating that insurers aren’t raking in the cash. Like CNBC – stating that for every $1 the U.S. spends on health care, less than 1 penny goes to health insurer profits. And recently Warren Buffett indicated that he wouldn’t consider investing in a health insurance company… it’s because the profits aren’t there.

So why do medical costs rise? According to Kaiser Health News, the increased use of medical services, hospital stays, new technologies and doctor visits are to blame. Does current legislation account for that?

Regardless, history is in the making, and I believe we should all get involved. Write your Congressperson and tell them what you think. If you need help finding them, you can contact them via Regence’s Issues and Action Center.

Are We Losing Sight of the Goal?

Health care reformers are passionate on all sides. Each side commissions studies that support their point, and another side fires back with their own study conflicting the first. The message is lost, and average Americans are struggling to make sense of it all. There’s finger-pointing, placing the blame on someone else, when instead we shouldn’t be worried about who is right, but rather what is right.

Blaming opposing political parties, government, or single industries isn’t going to address what’s really bringing down health care costs. So yesterday both parties came together to address Obama’s health care plan at a White House health care summit.

After watching the coverage last night, my mom called and went off about the health care debate. She said she just felt confused and didn’t understand who was right and who she should believe. She was hearing from Republicans, Democrats, even her health insurance company - all with differing messages on what reform should look like. And she wondered who to believe.

I told her – what does it matter? What matters is, were in this mess together. So let’s fix it together. Stop the blame game, and let’s come up with a real solution to address rising health care costs. I think we’re all for the same thing: a sustainable system that Americans can afford.

If you want to talk to your Congressperson about curbing health care costs you can send them a message through Regence’s Issues and Action center. Or if you just want to learn more, here are some resources you can visit:

http://americanhealthsolution.org/fact-check-what-causes-premiums-to-increase/
Top 10 Health Care Cost Drivers
More on health insurer competition
http://www.aarpmagazine.org/health/health_care_costs.html

The Reimbursement Riddle

Do you pay the same for your McDonald’s meal as the guy behind you in line at the drive thru? Or better yet, should you? That’s the type of question the Massachusetts Attorney General (AG) is asking after a statewide investigation of health care costs.

The results of the investigation indicate that various insurers and consumers were paying different rates for the same care in the same hospitals. It turns out that the hospitals negotiated different paying agreements with each party. And this drove up health care prices – for one major insurer in Mass., provider price increases accounted for 80 percent of total medical growth – according to a recent article in the Boston Globe.

Don’t get me wrong, I like it that my insurer (and employer) Regence, negotiates good discounts for me. That’s part of the advantage of belonging to a group. But negotiating is a two-way proposition. Like in Massachusetts where the AG found that some providers negotiated higher prices for themselves, even though their outcomes (the outcome of the treatment or procedure) weren’t any better.

This all reminds me of the time my daughter was in the hospital. Every single day the case manager visited us and asked when we were leaving. Turns out my insurance coverage paid one flat fee for service, regardless of the time we spent there. In turn, the hospital wanted us out of there to open the bed to someone else.
Meanwhile, there was a child in the same room as my baby, with the same condition – and no one hassled those parents about discharge – they had different insurance coverage. So was that provider treating my daughter differently because of the way the reimbursement model was structured?

Which opens us up to ask – should negotiating these prices be allowed? Or should providers just post their prices, and insurers just set the prices they will pay – and let consumers sort out the difference with the providers? Are any of us ready for a system that operates this way? I’m not faulting the hospitals – they have staff to pay, technologies to keep up, and more. And I’m not faulting Regence or Tricare for their position, but I am faulting the system for allowing this type of reimbursement model to exist.

Maybe we should focus on other ways to curb costs – like incentives that make us stop and think about the resources we’re using, and that others are sharing the cost of. Incentives like discounts on coverage for extreme weight loss, or smoking cessation. I’m sure there are numerous ideas out there t hat would work, and I would like to hear yours.

They don't know the cost, but ask anyway

Last week I took my daughter in for a pediatrician’s office visit. One of those many last minute, scary appointments you make when you have an infant screaming with a fever and you don’t know why.

After her examination the diagnosis was apparent: ear infection, and something else -- abnormal test results on her kidneys. It sounds much worse than it is (I think something like 70% of kids come back with these findings), but I was told that I did need to follow up with another test sample (you don’t want the details).
I learned from the staff that no matter what the results are, there is nothing they can do for her anyway until she’s older.

So I asked how much the tests were going to cost, and the lab techs looked at me, stunned. They didn’t know. And neither did the lady that worked the front desk. This baffled me – wouldn’t you know the prices if you worked at the lab?
After going home and thinking about it, I called the doctor’s office and asked when I would find out the results, and if they came back abnormal, would they do anything? I was told no, but they would send my baby to a specialist.

I was ok with that, but if her last results already came back abnormal, why am I repeating them – so that I can be sent to a specialist, have the test out of date again and then have to do it all over again?

The nurse acted as though I was speaking Russian in Spain, but somewhat agreed with me. But the deed was done. Just for kicks, I asked how much this test was going to cost. No one in the doctor’s office seemed to know – I was told they don’t bill for it, so they weren’t sure.

I’m not criticizing the doctor for taking care of my daughter – if she needs a test, then run it. But why do it over and over again, with no new action in between? And why isn’t anyone clear on the costs of these procedures?

The whole thing reminded me of something this doctor wrote in the Seattle Times. http://seattletimes.nwsource.com/html/opinion/2010867306_guest24stitham.html

Maybe something like this has happened to you?

Isabella's story

October 14, 2009 I woke up at 5:30a.m.frantically shaking my husband and shrieking, “I think it’s time!” He was as surprised as I was – I wasn’t due for our first child for another month, and I was scheduled for a c-section in November. We had no idea that my water would just BREAK in the middle of the night. So with no bag packed or baby “essentials” put together in our home, we left for the hospital.

In the midst of the hustle and bustle of delivery preparations that followed over the next few hours, I asked several medical personnel for assurances that although the baby was early, she would be healthy. They all told me not to worry, she would be fine.

And four hours later our beautiful Isabella joined our family! I can’t remember the details following delivery (the pain meds make it a bit of a blur), but Isabella had some breathing issues from the start. Within two hours she was taken to the Neonatal Intensive Care Unit (NICU) for pneumonia. Several breathing tubes and IVs later, she was in treatment.

About a week later, the breathing tubes came out and a week after that, the IVs – Isabella was on the mend! But as any parent will tell you, just when you think you’re cruising along, your kids throw another curve ball at you. That was when Isabella decided to start “forgetting” to breathe sometimes. Medications were administered and time passed, and nothing was working. She just seemed to get worse every day, not better.

After consults and many treatments, and time for her to “grow out of it,” she was sent home a month later on a breathing monitor. We couldn’t be happier to get our little girl home.

All this time, medical bills didn’t even cross our minds. We would willingly be in debt for the rest of our lives if it meant that she had what she needed to get better. But should we have been more responsible in at least asking, “How much is this going to cost?” If for no reason than assuming that someone else was picking up the tab? Maybe, but we didn’t.

After we were home for one week, medical statements started showing up in our mailbox. The bills for Isabella alone were $80k! That didn’t include the extra $10k for my c-section, hospital stay, and meds. Or the $1k per week home breathing monitor rental (which she is still using).

Thankfully, I work for Regence and my husband is in the military – so as for insurance, we’re covered. I wonder if others who share my insurance carrier have seen premium increases even though they didn’t visit the doctor more than once or twice last year. The same pot of money they paid into was tapped to care for my family and others with medical difficulties. Thank you—I will be here for you, too.

But coverage has its limits, especially in the world of high-dollar, high-tech health care, and many people still end up owing thousands out of pocket. (Read more - http://www.boston.com/business/personalfinance/articles/2009/02/18/pleading_your_case_on_medical_bills_is_a_sound_policy).

And none of this begins to address the hardship faced by those without coverage at all.

As we watch how health care changes shape up in our country, I wonder if some of the fundamental issues are being addressed in our reformed system? For example, when will the actual costs of medical services be addressed, and more importantly, when as consumers will we collectively become more informed, and ask “how much does it cost?”

And I’m not the only one wondering (Read more - http://www.nytimes.com/2010/01/11/health/policy/11health.html).