healthcare system;

Why Repealing the Affordable Care Act Won’t Stop Healthcare Reform

So the election is over. The Republicans now control both houses. And several are promising that one of their first jobs is to repeal the Affordable Care Act (ACA). I’m sure there are lots of people jumping up and down with glee.

This reaction reminds me what one doctor told me a couple of weeks ago after I spoke to his group (abdominal surgeons) about healthcare reform (you can read more about the experience here). “This (the ACA) is going to go away and things will return to normal.”

Um, not quite.

Sure, if the ACA goes away we’ll return to more than 40 million uninsured Americans who can’t afford health care. States that have expanded Medicaid will have to pick up the full tab for those expansions (instead of 10% beginning in 2020). Young adults who are still covered on their parents’ policies will now have to buy their own — if they can afford them. Women will once again be discriminated against in terms of premiums and plan designs. People with preexisting conditions will be unable to find affordable health insurance on the individual market. We’ll have no guarantee of a basic set of benefits (for instance, some … Continue Reading

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Affordable Care Act cost health insurance healthcare costs healthcare reform healthcare system;

Doctors Are Angry. I Get That. But . . .

surgeonI knew this would be the toughest audience yet in my three years of teaching/speaking about the US healthcare system and healthcare reform. I even put on a flak jacket at the beginning of my talk as a way of breaking the ice (and protecting myself; I mean, these guys pack scalpels!). And I made it through the two-hour talk and their anger without losing my composure or my sense of humor (thank god for that sense of humor).

Now I’m sitting in the airport waiting for my flight home and find myself tearing up. Not because the doctors were mean or cruel — they weren’t — but because of how much distance there is between  reality and perception, how much anger is out there, how too many people rely only on anecdotes and commentary instead of facts to develop opinions, and how scary it is to look at where we are and where we need to be — and realize that, more and more, it is unlikely we will ever get there given the rhetoric and anger in this country.

The doctors this morning, most of whom have been in practice … Continue Reading

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ACA Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; malpractice insurance Obamacare patient-centered care patient-centered healthcare Uncategorized

Why You Need a Second Opinion

Early in the summer I wrote about a good friend who was diagnosed with ovarian cysts and endometriosis. She saw a gyn oncologist because there was a small chance it was cancer (thankfully, it wasn’t). The doctor drained the cyst and started my friend on  oral contraceptives to control the hormonal shifts that contribute to endometriosis (which contributes to the cysts).

A couple of weeks ago, however, my friend texted me to say that her leg/foot was really hurting. She thought she might have a deep vein problem. I immediately told her to go to urgent care because it might be a blood clot, which can be quite serious. Her own primary care physician had left his practice, so found another that took her insurance.

Here’s her story:

“I went to the primary care physician my insurance company recommended. I specifically asked her if my leg problem could be a blood clot and she said “no” and sent me to a sports medicine doctor who then sent me to physical therapy. My leg still hurts and I thought they were wrong so I decide to go back to the gyn oncologist  who sent … Continue Reading

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healthcare costs healthcare system; ineffective procedure

Should You Listen to Your Doctor?

moneyWhen I speak about the US healthcare system, I always like to tell the story of my mother. A couple of years ago, she emailed my sisters and I. “Good news!” she wrote. “My nuclear stress test was normal!” (The test  involves injecting a radioactive dye into a vein after which a special camera scans the heart to determine if there are any blockages).

At the time, my mother was 70 and, with the exception of very-well-controlled high blood pressure (that she’d had all her life), extremely healthy. No sign of heart disease. No angina. No shortness of breath. In short, no indications for an expensive, invasive, potentially dangerous, test. So why, I asked her, did she have the test? “Because my doctor told me it was time,” she said.

At which point I began banging my head against the wall.

Even regular stress tests (where you run on a treadmill or ride a bike) are only recommended in people with heart disease or symptoms of heart disease, same with an EKG. Yet a survey of nearly 1200 people ages 40 to 60 with neither found that 39 percent had an EKG … Continue Reading

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healthcare costs healthcare reform healthcare system; patient-centered care patient-centered healthcare Unnecessary tests waste

Help! I’ve Lost My Insurance and I Can’t Get Up!

indexThe serendipity of the universe never ceases to amaze me. A couple of days ago I gave the keynote speech on healthcare reform at the Texas Medical Association’s CME Association’s annual meeting in Austin. A physician in the audience brought up an issue that was trumpeted in the press when the health care exchanges rolled out for open enrollment; namely, that people had lost their insurance and couldn’t see their doctors. I knew that a very small minority of people had actually “lost” their insurance, and that, in most cases, that insurance provided pretty bad coverage at fairly high prices. But I didn’t want to get into it with him, so I just agreed that yes, the Affordable Care Act certainly has flaws, then moved on to the next question.

If only I’d checked the news before my talk. I could have told him about a Kaiser Family Foundation survey of non-group enrollees (ie, they don’t have employer-provided insurance and bought their own insurance, most on the Exchanges). Among the findings:

About  two-thirds of those with non-group coverage are now in ACA-compliant plans, while three in 10 have coverage they purchased before … Continue Reading

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

Can We Teach Physicians to Consider Cost?

My best friend’s daughter is pre-med in college. She’s brilliant, and is planning to become a developmental pediatrician (as of now, at least). By the time she enters medical school in two years, I really hope she learns not only anatomy and physiology, diagnosis, and how to insert a breathing tube, but how to consider the cost of the care she provides.

Residents have been required to learn how “incorporate considerations of cost awareness and risk-benefit analysis” in caring for patients since 2007, but how this is done is unclear. In addition, few medical schools provide any such training. Indeed, talking about cost in medical training has traditionally been tantamount to giving voice to “he-who-must-not-be-named.”

That is changing, as it must in a healthcare system that now makes up 18 percent of GDP, with costs typically rising far faster than inflation. As Molly Cooke, MD, wrote in a 2010 editorial in the New England Journal of Medicine, “We must be honest about the choices that we make every day and stop hiding behind the myth that every physician should and does … Continue Reading

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cost healthcare costs healthcare reform healthcare system;

Why I Envy My Sister-in-Law (and Why You Should, Too)

Twenty-three years ago I married an amazing man who just happened to be Scottish. Real Scottish, as in, grew up in Glasgow and attended the university there. In the process, I gained a wonderful sister-in-law and, later, her husband (brother-in-law?).

She and her husband (and my mother-in-law, who is also pretty great!) live in picture-book-pretty idyllic Scottish towns complete with stone walls, sheep, cows, and salmon-filled streams for fly fishing. They also live in a country with nationalized healthcare, which, some would have us believe, is second only to nuclear war in terms of the horrific effects it would have if implemented here.

So when I was teaching a class on the US healthcare system this spring, I asked my sister-in-law for some insider information about the National Health System (or NHS as they fondly call it). Focus on your mother, I said, since she’s had some health problems in recent years. Here’s what she wrote me. . .

“Mum was taken to hospital around seven times in the space of two years. In total, she spent a few weeks in hospital. She didn’t pay anything, not for the ambulances, consultants, accommodation, … Continue Reading

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health insurance healthcare reform healthcare system; Medicare

The CT Scan Cost HOW Much??

So a couple of months ago I saw my doctor about this chronic pain in my lower right abdomen. I’d had it for about a year, sometimes barely noticeable, sometimes more noticeable, and, being a medical writer, I was certain it was ovarian cancer (don’t ask my why, but I’m convinced that this is the cancer lying in wait for me, even though I have no risk factors. Medical writers are only second to med students in terms of hypochondria).

Anyway, my doctor thought it was probably gynecologic and told me to see my gyn. But he also suggested a CT scan to rule out a kidney infection or stone. Sure, I said, and off I went to radiology.

Long story short, we still don’t know why I have this sometimes pain, but it’s not that bad and I’ll just live with it (until it turns out to be something serious and it kills me [see, I told you medical writers were hypochondriacs]).

But the pain got much worse last week when I received a bill from the radiology center for $778.62. Turns out that’s what I owe after my insurance company paid it’s part of the charge. Here’s how … Continue Reading

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Affordable Care Act cost health insurance healthcare costs healthcare reform healthcare system; Obamacare payment

How Much for That Shoulder Replacement?

Forgive the blog silence, I’ve been online trying to sign up for health insurance on www.healthcare.gov (just a little healthcare reform humor there).

So today we’re going to do a bit of math. Don’t worry — I’m not a math person so this will be simple and painless.

We’re going back to my aunt, who was prominently featured in my last post.

She’s doing quite well ( thanks to all who sent good wishes). And she just received the first of what will be many bills.

This one was for the surgery and hospitalization. The hospital billed Medicare $11,851. Keep in mind that’s for the hospital only. Not the radiologist who read her xrays, or the anesthesiologist who made sure she felt no pain, or the surgeon who replaced her shoulder, or the visiting nurse, or the physical therapist, or the outpatient prescription medications. Just the facility charges for the surgery and three days in the hospital.

Medicare and her supplemental insurance paid the hospital $2,016 — about 17 percent of the total charges (don’t worry, I used an online calculator to figure this out). She had no copay thanks to that supplemental insurance.

If she didn’t have insurance, however, … Continue Reading

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Affordable Care Act cost health insurance healthcare costs healthcare reform healthcare system;