"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.