Musings on Medicine and the Health Care System

Getting Out of Your Comfort Zone

When is the last time you did something for the first time?

I heard this adage (for the first time) a few days ago just before embarking on my first Tough Mudder—a 10-mile run (OK, walk for me) interrupted by 20 obstacles, most of which involved cold water and mud. One even had electricity. It took my husband and me nearly five hours to finish.

Why, at age 54, was I doing this? Because I never had. Because I still could. Because if I don’t keep challenging myself I will atrophy physically, mentally, and emotionally.

It’s why a very good friend, who is in his 70s, is right now walking 500 miles along the Camino De Santiago in Spain—by himself.

Look, we are all in the healthcare field. We know the myriad ways in which our bodies fail. In just the past two months a friend lost her sister to ovarian cancer; another friend was diagnosed with prostate cancer; a high school friend died of throat cancer; a friend in her 20s had a recurrence of the rare brain tumor that … Continue Reading

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stress work/life balance

Republicans’ Last-Ditch Effort to Destroy the US Healthcare System

I haven’t written a blog in months because, to be honest, I simply don’t know where to start when it comes to what certain people are trying to do to our healthcare system.

But this time they’re going too far. I’m talking, of course, about the Graham-Cassidy-Heller-Johnson healthcare bill Republicans are trying to shove through the Senate before a September 30 deadline. After that date, they need a 2/3 vote to pass it, which means Democrats on board, which means no way in hell.

The New York Times editorial board nailed my feelings about this bill when it wrote: “It is hard to overstate the cruelty of the Graham-Cassidy bill.”

The Washington Post put it another way: “Another execrable health-care bill proves bad ideas never die.” And The Baltimore Sun, bless its heart, calls the proposal “even more draconian than their previous attempts to strip millions of Americans of health insurance coverage.”

Now that’s some good writing!

How This Healthcare Bill Will Destroy Medicaid

This bill is not about repealing and replacing the Affordable Care Act (ie, Obamacare). It is about … Continue Reading

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ACA healthcare reform healthcare system; politics

Health Care and the Terrible, Horrible, No Good, Very Bad Day

Health Care and the Terrible, Horrible, No Good, Very Bad DayWell, they did it. They came up with the worst possible “replacement” for the Affordable Care Act.

The horrific plan that the House Republicans passed on Thursday threatens not only the health insurance of 24 million people, but those of us lucky enough to have employer-provided health insurance, anyone covered under Medicaid, and anyone who ever dreamed of leaving the security of an employer to start their own business or otherwise follow their dream.

Not only did they throw the baby out with the bathwater, but they buried her 10 feet deep in a remote spot in the Amazon.

In passing this appalling bill, the House Republicans: Confirmed, in no uncertain terms, that access to affordable, quality health care is a privilege, not a right. And it appears that the privilege is primarily available to rich white men. Clarified that they could care less about the people who put them in office, given the fact that fewer than 20% of Americans supported the earlier, less onerous version of the American Health Care Act (AHCA). … Continue Reading

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

Why Does an MRI Cost $2,500 Here and $250 in Finland?

Why Does an MRI Cost $2,500 Here and $250 in Finland?Just had dinner last night with an old friend from Finland. He’s a physician so, of course, the talk turned to health care and the differences between our countries. I asked him how much an MRI cost in Finland. With a few clicks on his phone he had the answer: about $250. Not to be outdone, I pulled out my own phone. The average price of an MRI here? About $2,500.

And therein lies the problem. The US spends more per capita on health care than any other industrialized country in the world. And before you say we have the best healthcare system in the world, let me tell you that we don’t.

Our country ranks last or near the bottom on nearly every health-related outcome. Our life expectancy has actually dropped in the past couple of years for the first time in decades, with death rates rising for eight of the top 10 leading causes of death. We also have the highest rate of infant mortality, worse than Cuba, Poland, and Slovakia.

It’s like paying for a new Mercedes and … Continue Reading

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ACA Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; high-deductible health plan

Wave Goodbye to Your Health Insurance

Wave Goodbye to Your Health InsuranceThis is the third in a series of posts examining various components of the Republican replacement plans for the Affordable Care Act (ACA). 

Republicans Plan to Shred the Affordable Care Act

It’s here. The Republican plan to replace the Affordable Care Act. Bottom line assessment? If you like the health insurance you have today you can say goodbye to it tomorrow, particularly if that insurance comes thanks to expanded Medicaid programs or a federal subsidy.

Here are the just a few of the highlights of the two proposed bills:

1. Scraps the individual mandate; adds a penalty.

Currently, all Americans are required to have some kind of health insurance or pay a penalty. This ensures that healthy people buy into the system to help offset the costs of sick people, a requirement if you also mandate that insurers cover those with pre-existing conditions without jacking up the price of the insurance.

Under the new plan, you don’t have to have insurance. But if you don’t, and then you try to buy it, the insurer can charge you a 30 … Continue Reading

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ACA Affordable Care Act health insurance healthcare reform Obamacare politics

Yes, Mr. President, Health Care Is Complicated

Yes, Mr. President, Health Care Is ComplicatedI nearly fell off the couch when I read the President’s statement that “nobody knew health care could be so complicated.”

Um, Mr. President, everyone knew. In fact, health care is considered the most complex industry out there. That would be why, as you and your colleagues are finding, transforming the system is “incredibly complex.” It is also why it will be nearly impossible to repeal-and-replace the Affordable Care Act (ACA) with something better unless you move to a single-payer system.You can, of course, focus on fixing its weaknesses.

I remember a healthcare economics course I took when I was in my 20s. During the first class, the professor told us: “Take every basic economic concept out there, including resource allocation, supply-and-demand pricing, and rational consumer behavior, and toss it aside. Very few apply to health care.”

The past 30 years as a healthcare writer have reaffirmed that statement hundreds of times over.

The Health Care System as a Tube of Toothpaste

I have my own analogy to describe the US healthcare system. I think of it as a tube of toothpaste … Continue Reading

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ACA Affordable Care Act health insurance healthcare reform healthcare system; Medicare Obamacare politics Value-based reimbursement

Replacing the ACA: Selling Across State Lines

Replacing the ACA: Selling Across State Lines

A cornerstone of every Republican plan to replace the Affordable Care Act (ACA), including the president’s plan, is to allow health insurance companies to sell their products across state lines. The Republicans claim this will increase competition and drive down costs.

Health policy experts, including the National Association of Insurance Commissioners and the Center for Insurance Policy and Research, say it will do exactly the opposite: Drive up costs and reduce choice, particularly for those with medical conditions.

State Regulations on Health Insurance

First, a bit of background. States regulate all small group and individual health insurance policies through their insurance commissioner, although the federal government sets certain minimum requirements that plans must offer, like the 10 essential benefits required under the ACA.

States can mandate that their licensed insurers add certain benefits, like infertility coverage. They also determine how much older people can be charged for premiums on the individual market and how much money insurers must have available to pay claims.

Next, the Republicans make it sound like federal law prohibits selling insurance across state lines. Nope. That, … Continue Reading

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ACA Affordable Care Act health insurance health insurance exchanges healthcare reform healthcare system; politics

Replacing the ACA: Will Health Savings Accounts Work?

Replacing the ACA: Will Health Savings Accounts Work?

The problems with high-deductible plans and health savings accounts

Note: I am beginning a series of posts examining various approaches the Republicans are touting as replacements for the ACA. Sorry, but no alternative facts here.

Several years ago (ie, pre-ACA), I needed to buy health insurance on the open market. The cost of an individual policy and the deductible was atmospheric because I had a pre-existing condition. And, of course, the policy didn’t cover costs related to my pre-existing condition.

Luckily, I had just incorporated my business. Since I had two employees (my husband and I) I could get a small business policy. Still expensive but manageable with decent coverage since employer-provided plans can’t discriminate based on pre-existing conditions.

I chose the cheapest plan, which came with a very high deductible. This plan also allowed me to create a health savings account (HSA). Money deposited into an HSA is not subject to federal taxes, grows tax-free, and is not taxed when used for qualified medical expenses (but not premiums).

What a Health Savings Account Can’t Do … Continue Reading

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ACA Affordable Care Act health savings accounts healthcare costs healthcare reform high-deductible health plan politics

Winners and Losers: Assessing the Ramifications of Repealing Obamacare

Winners and Losers: Assessing the Ramifications of Repealing ObamacareAfter voting at least 60 times over the past six years to repeal the Affordable Care Act (ie, Obamacare) only to see their efforts stymied in the Senate, the Republican House is fairly foaming at the mouth at their golden opportunity to reach Nirvana now that they also control the Senate.

Indeed, the Senate passed a budget resolution on January 4 to begin the process, instructing the House to have a repeal bill ready by January 27. You can read how this might work in this excellent article in The New York Times.

There’s just one problem: Despite the six years they’ve spent trying to kill the ACA, the Republicans still have no replacement.

So here’s just a sneak peek at what might happen if they follow through on their threats.

10 Things We Will Lose if We Lose the Affordable Care Act Insurance for more than 20 million Americans. Guaranteed coverage without higher premiums for those with pre-existing conditions. This would affect the 52 million Americans, about a third of all adults, with pre-existing conditions. (There is talk of keeping … Continue Reading

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ACA Affordable Care Act employer mandate health insurance healthcare costs healthcare reform high-deductible health plan Medicare Obamacare politics