healthcare costs

Your Questions About the Affordable Care Act

I can’t take it anymore. I just can’t take the lies and misinformation out there about the Affordable Care Act (ACA) and healthcare reform. Nearly ever  time I tell someone something about the Act, or answer a question, they are surprised at how the truth differs from what they’ve heard.

To that end, I put out the word to friends and others to send me their questions about the ACA. Here’s the first batch. If you have any questions, send them on. I’ll keep answering them until we run out.

Question: Are the insurers currently participating in the system locked in on Jan 1st? Can they decide to pull out during the year?

Answer: If they decide to participate in the exchanges they must provide coverage for the year so no, they can’t pull out during the year. The only reason they can cancel your coverage is if you lie on the application.

Question: How will income be calculated?

Answer: Based on adjusted gross income (AGI), which includes certain deductions. Note that income is based on your household income, not individual, and that it is based on estimated income for the following year. If you estimate wrong and received a … Continue Reading

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Affordable Care Act health insurance health insurance exchanges healthcare costs healthcare reform healthcare system; Obamacare

Step Away From that Test

My best friend turned 57 in October (but you’d never know it by looking at her; she doesn’t look a day over 45). Like most of us of a certain age, she has a few medical issues. Years of working as an editor has left her with carpal tunnel syndrome. Years of living with cats has left her with asthma. Years of sun worshiping behavior has left her with basal cell skin cancer. Years of good eating have left her with a borderline high LDL level. And, as a result of being, well, 58, she has a pain in her left shoulder. Sound familiar?

My friend recently switched doctors and found a new primary care physician who, upon hearing her medical history and current concerns, performed and ordered several tests, including:

— A pelvic exam/Pap

— A routine physical

— A baseline EKG

— A complete fasting blood panel, including a special test that measures LDL-particles (LDL-P)

— A mammogram and an ultrasound on her right breast, because the doctor felt a suspicious tissue mass (my friend has a family history of breast cancer)

— A right carotid artery ultrasound based on a bruit,  the swooshing sound the doctor said could … Continue Reading

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healthcare costs healthcare system; high-deductible health plan ineffective procedure waste

Elective Deliveries: A Sign of a Healthcare System Out of Control

My husband is always getting on me about the number of tabs I have open in my browser at any one time. I think one time I had more than 100 open.

Within the past few days, at least 10 of those tabs dealt with the same topic: medical tests and procedures that we either don’t need or that don’t work. There are simply too many for a single blog, so I’m focusing on one here and will write more about others in the coming days.

The lucky winner? Births.

Seems like an obvious medical procedure, doesn’t it? Baby is delivered when mom goes into labor or, if problems develop or mom goes over her due date, labor is induced. So why, as  Kaiser Health News recently reported, are 10 to 15 percent of U.S. babies  delivered early without medical cause, up to 40 percent in some hospitals?

Early delivery increases the risk that the baby will have feeding and breathing problems, infections, and developmental problems, requiring a stay in costly neonatal intensive care units. It also increases the risk that mothers will need caesarian sections (indeed, many of these births are scheduled c-sections).

Why the early deliveries? Convenience for … Continue Reading

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fraud get better health healthcare costs healthcare reform healthcare system; ineffective procedure payment Uncategorized waste

Healthcare Reform 2.0: Five things you need to know to grow your business in 2013

How much do you know about healthcare reform — and I don’t mean just the Affordable Care Act (aka “Obamacare”). I mean the coming tsunami of change that has the potential to completely revamp one of the most dysfunction systems in our country (as you know from reading my blog).

Do you know. . .

Why we need healthcare reform? What healthcare reform means for your employees and employer? How healthcare reform will change your interactions with the healthcare system? How healthcare reform may make it safer for you to get sick? Why healthcare reform will save you money?

If you can’t tell me the answers to these questions, then you need to block off 1-2 p.m. (eastern) February 5 for my webinar: Healthcare Reform 2.0: Five things you need to know to grow your business in 2013. You can also view it on demand.

And, as a “thank you” for reading this blog, I’ll give you half off the registration fee. Just use code GS12713 when you register.

 

Labels:
Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; managed care Obamacare patient-centered healthcare payment

Preparing for a (Gulp!) Colonoscopy: What It Says About Our Healthcare System

As of November 30, I am now, as my gastroenterologist puts it, 39 + 11 years old. You know what that means! So, a couple of weeks ago I called his office to make an appointment.

I would have preferred to simply make the appointment online or even e-mailed the office, but since the practice didn’t offer this, I fought my phonaphobia and punched in the numbers. Of course, I went through five prompts before getting a live person and was put on hold for a few minutes. About 10 minutes later, I finally had my appointment.

I was told to arrive at 2:30 p.m., which I dutifully did. Then the receptionist gave me a stack of paperwork to complete. And a pen. Among the information I had to provide:

• My husband’s Social Security number, since our insurance comes courtesy of his job. Not sure why this was needed, since the receptionist made a copy of my insurance card, which has all pertinent information on it. Not to mention that in this day and age of identity theft, I don’t like giving out Social Security numbers to anyone. But the last time I refused to provide a Social Security number … Continue Reading

Labels:
Affordable Care Act customer service doctor offices get better health good health health insurance healthcare costs healthcare reform healthcare system; patient-centered healthcare prevention

Rational Rationing

Full disclosure: I stole that headline from an article on Pharmalot that triggered this blog. It reported on a New York Times op-ed piece by doctors at Memorial Sloan-Kettering Cancer Center in New York City about why the hospital won’t use the newly approved drug for metastatic colorectal cancer, Zaltrap.

Their reason? The drug is not any better than the currently used treatment, Avastin, and it costs more than twice as much, about $11,000 for a month of treatment.

Rational? Yes. Rationing? No.

It’s not rationing because patients can always go to another hospital and get the drug, which I know they’ll do because in this country we believe “new” is always better in medicine.

I saw this in action when I was a newspaper reporter (remember newspapers? You held them in your hands and got ink on your fingers?). Back in the day, I covered the “bone marrow transplant” story. This was when women with breast cancer demanded  bone marrow transplants even though there was no evidence that this highly toxic, highly dangerous, extremely expensive approach worked. Since the procedure was considered investigative, their insurance companies refused to pay for it. The women sued insurance companies, went to the … Continue Reading

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cancer drug healthcare costs Memorial Sloan Kettering rationing Zaltrap

Avastin and Breast Cancer

Time to get back up on my soap box.

Next month, the FDA is supposed to consider taking the unique, first-time-ever step of revoking a drug’s indication not because it’s dangerous, but because it doesn’t work well enough to offset its risks. Never mind that it costs about $8,000 a month.

The drug is Avastin (bevacizumab), a targeted monoclonal antibody that  prevents tumors from creating and maintaining their own blood supply, a process called angiogenesis. Without oxygen and nutrients from blood, tumors can’t keep growing.

Avastin is the world’s best-selling cancer drug, approved for use with chemotherapy to treat lung cancer and metastatic colorectal and breast cancer. It is also being investigated (and, likely, being prescribed off label) for numerous other cancers.

The problem comes with breast cancer. Avastin was approved for breast cancer under an FDA program called “accelerated approval” in which the agency provides “conditional” approval for a life-saving drug that appears effective so as to get it to patients quickly while requiring that the manufacturer conduct more studies demonstrating its long-term effectiveness. About 90 drugs have been approved under the accelerated approval program in the past 20 years and none has ever had its approval revoked (one … Continue Reading

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cancer clinical trials cost healthcare costs healthcare reform

Check, Please!

CheckA couple of recent news stories reminded me of the dirty little secret about healthcare that no one wants to talk about, the proverbial elephant in the room. All those pills, surgeries, x-rays, medical care? It costs money! 

Yes, Virginia, quality medical is not a right, not guaranteed in the Constitution, not something good-hearted corporations and companies, whether for-profit or not, are obliged to hand out like candy corn at Halloween. It costs money. Billions of dollars a day.

This appears to be something we all forgot in the warm fuzzy moments of watching military transport planes fly critically ill people out of Haiti to Florida hospitals. Who was going to pay for all this medical care? For the months of hospitalizations and rehabilitation these people were going to require? When the state of Florida, rightly so, asked the same question, prompting the halting of those military convoys, it ended up on the receiving end of a world-wide outpouring of boos and hisses.

Hey guys, back off. How would you feel if we sent thousands of Haitians to your house … Continue Reading

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federal budget Haiti healthcare costs healthcare reform