What's The Real Cost?

What's your health worth?

2010-05-28T09:47:00.000-07:00

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

2010-05-21T09:49:00.000-07:00

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

2010-05-19T15:04:00.000-07:00

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

2010-05-10T15:03:00.000-07:00

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

2010-04-29T12:16:00.000-07:00

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

2010-04-15T16:38:00.000-07:00

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

2010-04-13T12:04:00.000-07:00

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?

2010-04-05T14:42:00.000-07:00

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?

2010-04-02T09:49:00.000-07:00

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

2010-03-30T15:46:00.000-07:00

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?

2010-03-25T10:37:00.000-07:00

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?

2010-03-22T16:47:00.000-07:00

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

2010-03-16T19:52:00.000-07:00

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?

2010-02-26T13:02:00.000-08:00

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

2010-02-04T10:37:00.000-08:00

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

2010-01-27T09:38:00.000-08:00

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

2010-01-14T15:34:00.000-08:00

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).

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

2009-12-23T06:46:00.000-08:00

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

2009-12-11T11:53:00.000-08:00

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

2009-12-02T08:50:00.000-08:00

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

2009-11-18T14:58:00.000-08:00

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?

2009-11-12T13:39:00.000-08:00

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

2009-11-02T11:07:00.000-08:00

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?

2009-10-13T12:11:00.000-07:00

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?

2009-09-27T08:14:00.000-07:00

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

2009-09-14T16:13:00.000-07:00

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

2009-09-09T06:57:00.000-07:00

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

2009-08-28T10:53:00.000-07:00

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

2009-08-19T12:19:00.000-07:00

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

2009-08-12T16:22:00.000-07:00

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?

2009-07-31T09:53:00.000-07:00

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?"

2009-07-22T09:45:00.000-07:00

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

2009-07-09T08:47:00.000-07:00

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