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;

What I Learned About the Healthcare System From My Aunt’s Shoulder Surgery

I’m here in the cold northeast helping my 80something aunt out for a couple of days as she recovers from shoulder replacement surgery. It’s been a great real-life example of the good and the bad in our  healthcare system.

The good part is that the surgery went well and the hospital arranged for post-discharge physical and occupational therapy, as well as a home health nurse to check on my aunt, all of whom are great.

But the main problems come with the coordination of care for my aunt, as well as the communication. Our changing healthcare system relies on greater patient empowerment and patient-centered care. That, in turn, relies on educating patients about their condition. That so did not happen here. Here’s where I think the failures occurred:

— My aunt’s doctors did not set realistic expectations. She talked to several people who’d had the surgery before who told her what a breeze it would be. So when she experienced swelling, bruising, nausea, pain, etc., she thought something was terribly wrong and she panicked. Her doctors — and the nurses — should have prepared her for what such a major surgery would involve, particularly for someone her age.

— Her … Continue Reading

Labels:
healthcare reform healthcare system; patient-centered care patient-centered healthcare

Would You Buy a Car the Way You Buy Medical Care?

I was at book club the other night, pouring another glass of Chardonnay, when my friend told me that in August she was diagnosed with three blocked arteries, one of which is 100 percent blocked. I could rant about the fact that she’s been walking around like this for three months with only a beta blocker and statin as treatment, but that’s fodder for another blog.

When I talked to her she had an appointment with a cardiologist in our area. “Oh, he’s wonderful,” she said. because that’s what she’d heard from other people. What she didn’t realize, however, is that “wonderful” doesn’t mean good. She didn’t know how often he performed the procedure she might need; how well his patients did with or without surgery; what ties he might have to the pharmaceutical or medical device industry that could bias his recommendations; if he’d had any malpractice suits against him and how they’d turned out.

Choosing a doctor based only on what your friends tell you is like buying a car based on its color, something few of us would do. Instead, we research cars to find out which gets the best gas mileage, its safety record, its cost. … Continue Reading

Labels:
CABG doctor offices healthcare system; patient-centered care patient-centered healthcare quality

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

Labels:
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

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

Wise Words From a Retired Hand Surgeon

Those of you who know me know I like wine. A lot. And food. Even more.

Put the two together and I’m there! So that’s where I was last night, at a wine tasting dinner enjoying the wines from Ferrari-Carano, which, by the way, are excellent and very reasonably priced (we bought a case).

We were sitting across from an older couple and, of course, got to talking. Turns out he’s a retired hand surgeon from New Jersey who retired to Williamsburg. He heard me say that I was giving a talk about healthcare reform.

“I figured out how to fix the healthcare system,” he said.

At this point, I kicked my husband under the table. I was sure I was about to be treated to some diatribe about “Obamacare” and getting the government out of healthcare, and vouchers and moochers (most members of the wine club that hosted the dinner are, ahem, somewhat conservative).

But I’m learning about Buddhism, trying to be more patient and to listen, really listen, rather than always jumping in. So I bit my lip, took a deep swallow of the red, and listened. Then he said the sentence that brought joy to my heart:

… Continue Reading

Labels:
Affordable Care Act healthcare reform healthcare system; Obamacare

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