health care Archives - ChangingMedia

Sep 16

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A Guide to Shopping for Health Exchange Insurance Plans

In just two short weeks the online exchanges or health insurance marketplaces will open and millions of people will have the opportunity to begin shopping for various health insurance plans. Coverage won’t begin until January 1, 2014, but it is super important to know what you are getting into before choosing a plan.

The online exchanges are intended for small business owners and people who don’t receive health insurance through their job. If you are unsatisfied with your employer’s health insurance, you probably won’t be able to get a different plan through an exchange unless it costs you more than 9.5 percent of your income or if it doesn’t cover the required essential health benefits.

The first thing to consider when shopping for a plan is that all health insurance plans in the exchanges will be categorized into four tiers: bronze, silver, gold and platinum. Although all plans are required to cover essential health benefits, they differ in how you pay for them. The bronze plans have the lowest premiums but the highest out-of-pocket costs whereas the platinum plans are the opposite with the highest premiums and lowest out-of-pocket costs. In the bronze plans, the individual is expected to pay about 40% of health service costs with each tiered plan covering about 10% more ( so, silver: 30%; gold: 20%; platinum: 10%). The idea behind this is that if you are a generally healthy person who rarely needs more than preventative care, a bronze plan may work best for you. If you are someone who gets sick a lot and seems to need a lot of health services, a platinum plan may work best for you.

It may be easy to choose between a bronze and platinum plan, but maybe not between bronze and silver or silver and gold. One consideration is that the out-of-pocket costs for the bronze plans will be capped at $6,350. If you think the bronze plan monthly premiums are still too expensive for you, you may be able to apply for a Catastrophic Health Plan if you are under 30 or get a “hardship exemption.” In this type of plan, your monthly premium will be a lot lower but you’re only covered for 3 yearly primary care visits. If you’re have a medal plan however, you may be able to add benefits to your coverage.

Another huge consideration is the subsidies on your premiums for which you may qualify. The Advance Premium Tax Credit will be applied directly to your premiums, so you save immediately. Incomes up to 400 percent of the Federal Poverty Level will qualify for these tax credits with the lowest incomes receiving the largest credit. A general range for individual households receiving credits is an annual income between $11,490 – $45,960. If you want more specifics, you can try out the Kaiser Family Foundation’s Subsidy Calculator until October 1^st.

So if you have an idea by now of what plan you’d like to go with, the last thing to do is pick an insurance company. Here is a list of estimated premiums for plans in the Baltimore area (many other states/areas can be found here). Each company will differ in the specifics on how much you pay for certain services. For example, one plan may cover completely your prescription drugs but charge you a little more for dental services. Besides price, you may want to consider how the health insurance company is run. I encourage people to check out the CO-OP insurance plans since they are non-profit and will probably put you, the patient, first.

Still confused? Don’t worry, once the exchanges open, many clinics and online/telephone support services will provide trained “Navigators” who will help you decide which plan is the best for you.

IMAGE CREDIT. [www.protocol.gov.hk].

Aug 21

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To Be Young and Invincible

By Leanne Demery | Health | No Comments

After a year of AmeriCorps, living in poverty while dealing with Hopkins staff and students and Baltimore city youth (all intimidating in their own way), I do feel quite powerful and invincible. I’m moving to Africa and the world is mine for the taking! According to Joel Stein’s The Me Generation such narcissism and self-confidence is beneficial since it causes myself and others born between 1980 and 2000 to think that we can change the world for the better. At the same time, such traits are becoming a barrier to the success of the Affordable Care Act.

The Department of Health and Human Service recently announced a video contest, pioneered by the non-profit The Young Invincibles, that will give up to $30,000 in prizes to winners who convince the millennials to sign up for health insurance. A little bit of peer education – smart idea. Getting people ages 18-30 is an integral part of making Obamacare work and keeping critics at bay. Having healthy people to pay for insurance (or medical care of the poor) is a sacrifice that all other countries with national health care consider a no-brainer. And it should be. Getting young healthy people to pay for insurance means keeping insurance costs lower for everyone else (ideally).

Most critics have already been complaining about higher premiums costs under the ACA. But all premium increases (whether it’s an increase to an already existing plan or a comparison of the new plans in the exchanges) will have to be approved and out-of-pocket costs will be capped, eventually (unfortunately this requirement will also be delayed another year). Another consideration is that all health insurance plans will have to have minimum benefits so even if you’re paying more, you may be receiving more too. Slowly but surely states are releasing estimates of health insurance rates from the exchanges, and depending where you live it could be more or less. Plus people up to 400% of Federal Poverty Level will be receiving subsidies for health insurance.

So if you’re young and invincible and will very soon need to start thinking about purchasing health insurance, the government has given over $67 million to organizations that will help people navigate the exchanges. United Way and Planned Parenthood are two of the most popular organization to receive grants while University of South Florida Association of Community Health Centers and United Way of Metropolitan Tarrant County (Texas) were among those to receive the highest amounts. Or if you want to start taking things into your own hands (feeding into those self-reliant stereotypes) these pointers from Kaiser Health News will serve you well. And if you’re still hesitant about even considering health insurance, this article from New York Magazine describing how vulnerable we truly are might change your mind.

Jul 22

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Obamacare Mash-up Model

By Leanne Demery | Health | No Comments

If an alien came to America today and asked you to describe our health care system, could you?

I certainly doubt you would be able to fit it into one sentence. It’s a smorgasbord of private insurance, government programs (Medicare and Medicaid), non-profits and a lot of things in between. Lucky for some other countries, they don’t have this problem. And two in particular, Germany and Britain, are seen by experts as two of the best models for health care.

The Bismarck Model

For 130 years the Germans have been using this model of health care. Adopted by the French and many other countries, including the U.S. to some extent, this system uses insurance or “sickness funds” to pay for medical care. Employers and employees contribute to the funds through payroll and the government sets budgets and prices. This model works really well for a lot of countries despite the doctors who often exercise their right to strike and protest for higher wages.

The Beveridge Model

This is the epitome of the single-payer system. The government, through taxes, is the sole payer of medical care in Britain and other countries such as Spain and Cuba who’ve adopted the model. The government keeps costs low and patients never see a bill.

The Obamacare Model?

The other week I had the privilege of seeing Wes Moore speak (author of The Other Wes Moore, a true story about two boys from Baltimore with the same name who grew up to have very different lives — a must read). He said one of the smartest things I’ve heard in a while. His definition of a good politician was someone who sees what’s already working and helps to make it work bigger and better. To me, I think that is what the Obama administration tried to do when it came to health care reform.

For example — and Obama has said this many times — they looked at Mayo Clinic and Kaiser Permeante for inspiration on the Accountable Care Organizations that have been popping up in Medicaid. In these organizations, multi-disciplinary groups of health care providers are accountable for the quality and cost of care to the patient. This could be a shift from the old fee-for-service model of payment and is one of the few cost-control initiatives in the affordable care act.

On a less popular note, what had been working (or more like had created a market so big that it couldn’t be shut down, cough, cough Blue Cross Blue Shield) were private insurance and employer-based insurance. Since the turn of the 20^th century this is what has been “working” and is most popular in the country, for better or for worse.

In this way and many others, Obamacare tried to improve on our current mash-up health care system. But will Obamacare be known as a model for health care? It certainly is the first reform and health care system that advocates for the market-based approach. Even though the Affordable Care Act itself isn’t popular, most of the provisions on their own are.

IMAGE CREDIT. [www.transatlanticacademy.org].

Jul 09

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Obamacare’s Delayed But Not a Disaster

By Leanne Demery | Health | No Comments

It’s been a rough week for Obamacare. Last Tuesday the White House announced it would delay the employer mandate of the Affordable Care Act until 2015, giving businesses with 50 or more employees an extra year to figure out how to provide health insurance. Because of this the law has been under major scrutiny since many critics believe this is proof of failure. Though this delay is definitely a huge setback for morale, there could be some good that comes out of it.

But first, the cons.

Besides all the remarks about how Obamacare is now a disaster and will never work, the delay will probably make the law more expensive next year. Those who don’t receive health insurance from their employer will now have to turn to the exchanges to find it. Plus these people are more likely to be lower-income workers meaning that many of them will be eligible for subsidies (incomes up to 400 percent of the Federal Poverty Level) which cost the government (and us) a lot more. And it gets a little worse than that too. When you apply for an exchange, the government is no longer requiring proof of income to qualify for the subsidies (I guess just try to keep that on the down-low). Paying for subsidies is one of the biggest expenses for Obamacare. And to help pay for them, businesses were going to help out, not just by providing insurance, but from fees for not following the employer mandate.

And there’s more. The national health insurance exchanges are falling behind schedule which are supposed to be ready by October 1^st. The law requires at least two insurance companies for the exchange and at least one that’s not-for-profit. This is supposed to create more competition in order to lower premiums. So far, only the Blues (Blue Cross Blue Shield) have applied for the national exchange. But they already dominate the country without much competition.

Okay, deep breath — now the pros. I like to find the light in any negative situation.

First, this delay is a relief to many businesses and mostly those who are right on that 50 employee border. A lot of businesses revealed plans to cut workers or workers’ hours to offset costs of buying more insurance. Now they have extra time to figure out how to make the law work efficiently for them. Yes, you can argue that the Obama administration is once again being swayed by big business, but like it or not, businesses are made up of people too.

Second, the employer mandate doesn’t really affect that many people (relatively speaking). Most large businesses already provide health insurance (about 95 percent of them in fact) — it’s pretty much the backbone of the American health insurance system. And of the companies that do not provide insurance, about 10,000 out of six million, they employ only 1 percent of American workers.

Third, delaying a somewhat significant part of the law shows that there is room to adapt and reflect on what is working and what does not. Taking a year to reconsider and revise the employer mandate, in my opinion, leaves room to consider other options that may work better — reconsidering a livable wage (to make health insurance more affordable)? Reconsidering a public option? Reconsidering more comprehensive plans for medical cost control? Hey, a girl can dream.

All-in-all, the employer mandate delay is an eye sore for the image of Obamacare. Is it a complete disaster and train wreck? I don’t think so. If you look at it this way, the main goal of Obamacare is to expand coverage and non-insured employees at large companies will still be able to purchase insurance through the exchanges. Cost control was never a priority but maybe now the Obama administration will see that it should be.

IMAGE CREDIT. [www.golocalworcester.com].

Jun 24

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Burkina Bound

By Leanne Demery | Health | No Comments

I was bitten by the travel bug a long time ago, but ever since I found out I’ll be leaving for Burkina Faso in October with the Peace Corps, I haven’t really been able to hide my excitement. So I wanted to dedicate this post to my future home.

Burkina Faso is a landlocked country in West Africa about the size of Colorado. Despite all the turmoil that affects nearby countries, Burkina Faso is relatively peaceful as they don’t have any coveted natural resources. They grow peanuts and mangoes rather than raw minerals or oil fields. The country has been described as poor even by African standards. A low blow, but nonetheless true — the United Nations ranks it 181 out of 187 on the Human Development Index.

But what the Burkinabe people lack in resources they make up for in personality. It is known as one of the friendliest countries in the world and I hear they live up to their country’s name, meaning “The Land of the Upright People.” They also take fashion, arts and music very seriously. Ouagadougou (pronounced wah-gah-doo-goo, and so much fun to say), the country’s capital, is home to the African equivalent of the Cannes film festival and many other famous music festivals. They also have one of the world’s best soccer teams.

Plus, Burkina Faso actually has somewhat of a structured health care system. In the years following its independence from the French in 1960 their system was managed by the government, but with no support from the local level, meaning there wasn’t really outreach to Burkinabe who still today rely on traditional or folk medicine. Then, about 25 years ago at the African Ministers of Health conference, the Burkina government decided it was time to provide more primary care services to its people. They started the Bamako Initiative which allocated more medical resources and money to the community level and pushed for a bigger emphasis on primary care.

Today, the health care system is organized into three institutional tiers. The first is the Ministry of Health, which has three national hospitals throughout the country and manages all health care policies and public health programs. The second tier is made up regional directors who enforce the policies set by the ministry and provide assistance to the third tier – the local health districts, which contain emergency care centers, dispensaries and clinics. I’ll be working in one of these local clinics as a Peace Corps volunteer. Each health district has a health team that manages the resources and makes sure minimum services are available. The health team is hired by the government but they have to share managerial power with a committee elected by the community. This sharing of power makes the administrative doings of the clinics more transparent, so clinic staff become more accountable and will better allocate funding.

Even though Burkinabe are expected to live until only about 52, I think there’s something very attractive about their health care system. What I love most about the Burkina health care system is that they include the community in the management of the local health districts. If we had something like this with our hospitals, there wouldn’t be all this sneakiness about billing and service fees.

We could also use more community health educators in our hospitals, clinics and doctor’s offices. Somebody could counsel you about insurance (much of what Health Leads does) or talk you more thoroughly about diabetes, high blood pressure, smoking cessation or whatever else instead of getting a little pamphlet about it. If I come in with diabetes, and someone from my community who also has the disease comes in to talk to me about managing it and encourages me to be proactive about my health– that gives so much more motivation than a doctor suggesting you do such and such.

If our clinics and hospitals got this kind input and support from the community level, we would see a lot more people using preventative care and get a lot more out a visit to the doctor.

IMAGE CREDIT. [Wikimedia Commons].

May 27

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A La Sante!

By Leanne Demery | Health | No Comments

It’s no secret that j’aime la France. It’s in my blood. And you know who else loves the French? The French. Besides their wine, cheese and “c’est la vie” attitude, one of their biggest bragging points is their health care system. In 2000 when the World Health Organization ranked health systems, France came out on top. The curious thing is that if you take a closer look, our red, white and blue cousins have health care very similar to ours yet spend about half of what we do.

So how do they do it? The French have coverage in two ways. The first is through the government’s Sécurité Sociale. Each working person pays an income tax to finance universal coverage. If you’re not working, pas de problème, there are taxes on tobacco, alcohol and pharmaceuticals that also help pay for universal coverage. De plus, co-pays were most recently added to the pot. The Sécurité Sociale pays for 70 percent of fees and the customer pays the remaining 30 percent if you’re referred by or seeing a primary care physician. This may sound high to an American, but fees are set each year by the government and they are also made known to the patient so prices stay low even though doctors are paid by fee-for-service. In every doctor’s office and hospital the cost of every service provided is presented in clear view.

Even though 100 percent of the population is covered through Sécurité Sociale, more than 92 percent of the population also buys supplemental insurance. This can help pay for that extra 30 percent and give you coverage for some bonus services. This insurance can be private, but providers are not allowed to compete by lowering health premiums. Instead they can offer different benefits and ways to cover the 30 percent. Supplemental insurance is also provided by employers with about half of the cost split by an employer and employee.

Like ours, France’s health care system is not simple, but everyone has coverage. Even illegal immigrants — after they’ve been in country for three months — receive health insurance. And people can go to any doctor they please, unlike in the U.S. where you must stay within your insurers network. And coverage is cheap too. People pay small co-pays at doctor’s visits but to make it even fairer people with chronic illnesses, low-income people and pregnant mothers get free services.

The most magnifique component of France’s health care system is the little plastic health insurance card. The “carte vitale” or “life card” contain all the information needed for a doctor to not only adequately asses the patient but asses how the patient will pay. All medical records have been digital since the 1990s and tell the doctor every note, exam and service the patient has had. The processing of services is also done digitally by the “carte vitale.” The doctor inputs the services and this alerts the government and the supplemental insurance of payment which must be given to the doctor within three days. It’s fast and cuts down enormously on medical errors, unknowns and administrative costs.

En bref, when it comes to health care, the French get more bang for their buck. They have more freedom of choice, better quality, lower costs and more efficiency. Many French people still complain about the rising costs and doctors complain about their low salaries (a general practitioner in France will make about a third of what one in the U.S. makes). Both countries rely heavily on employer-based insurance, pay doctors by fee-for-service and both countries demand choice. But WHO ranked France’s system number one for many reasons — low infant mortality rates, higher life expectancies, low medical errors and low deaths in preventable illnesses. The French decided that health care for all is more important than free markets and excessive salaries, and it paid off. I think we can learn a thing or two from that.

IMAGE CREDIT. [my.aup.edu].

Apr 29

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What’s in a Name?

By Leanne Demery | Health | No Comments

One of the biggest criticisms of the Affordable Care Act is that health insurance premiums will rise. The cost of premiums has already increased up to 4 percent in the past year. So is the ACA living up to its name? Let’s take a closer look.

Last Tuesday, the Maryland Insurance Administration released rate proposals from insurers for the new exchange in October. In the proposals, from a wide variety of insurers, new plans are the only ones that see a rate increase. This is because insurers are expecting the newly insured people in 2014 to be sicker so they plan to charge more. This also represents one of the major faults of our current health care system — those who are sicker are less likely to have access to care. Fortunately, many of the people who will be buying new plans (about half of the newly eligible in Maryland) will be able to receive subsidies to help pay for care.

Though insurers are saying the additional 12 percent of currently uninsured Marylanders is going to cost them more, the individual mandate was what insurance companies negotiated for in the first place in return for accepting people with pre-existing conditions and giving up recessions of coverage. Plus, the current rate proposals are not just estimates, but they also must be approved by the insurance administration. A major regulatory rule of the ACA (also known as the Medical Loss Ratio) requires 85 percent of group plan costs (80 percent for individual) must be spent on medical coverage or quality improvements instead of administrative cost. If they don’t follow this, they must give customers a rebate.

The newly 32 million people who will be getting health insurance in 2014 may be sicker yes, but that doesn’t mean they won’t be relatively easy to care for. Most of these people don’t have insurance because their job doesn’t provide them with it, not because of deathly pre-existing conditions. Most of these people will most likely be sick with diabetes or cardiovascular disease — two of the most common causes of morbidity and two illnesses that are relatively easy to control with proper medication. This thinking just comes from my experience as an EMT and as a volunteer with Charm City Clinic.

What’s more is that the ACA has provisions that target increases in premiums. For the first three years of the exchanges, the reinsurance program will help pay for the higher cost of newly insured sicker patients and the temporary risk corridors program will help protect inaccurate rate-setting. The law also sets limits on cost-sharing or charging healthy young people more to pay for the sick older people. Previously, the difference had been 6-to-1 but now will be at most 3-to-1. It’s true that some people may start paying more for health insurance, but they are also more likely to receive better insurance too since Obamacare mandates minimum required benefits.

As I’ve said before, Obamacare focuses on access to care rather than cost control, which makes its official name — the “Affordable Care Act” — very misleading. In addition to increasing medical prices, the biggest obstacle so far for Obamacare is getting the word out about eligibility for insurance and subsidies. The exchanges are supposed to ready to go in October, so pretty soon we better start seeing some kind of major outreach. So much of what Obamacare promises is still just speculation; it’s hard to know where it will end up. But we do know one thing is for certain — Obamacare gives the opportunity for millions more of the neediest people to have access to care when they otherwise wouldn’t.

IMAGE CREDIT. www.business2community.com.

Apr 15

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The Perils of Step-by-Step Healthcare

By Leanne Demery | Health | One Comment

Medicare represents some of the greatest and worst qualities of our health care system. The positive is that it provides coverage for people over the age of 65 no matter what. After your 65^th birthday you receive a little red, white and blue card in the mail that guarantees you can go see a doctor for little cost. The program serves many of our most vulnerable populations and has helped to bring many elderly people out of poverty.

On the other hand, Medicare is the foremost example of our fractured, piecemeal health care system that attempts to fix problems after they’ve occurred instead of trying to prevent them. Instead of having a simple, unified health care system, we rely on Medicare, Medicaid, non-profits and other charity groups to fill in the pieces when people don’t have employer health insurance. Medicare was built one part at a time, just as our health care system and just as Obamacare are being phased in year by year.

When Medicare was introduced into the Social Security Act by President Johnson in July 1965, the program consisted of two parts – A and B. Part A covers 80 percent of hospital costs. Part B covers 80 percent of inpatient and primary care. This type of payment is referred to as cost-sharing. President Reagan tried to implement catastrophic coverage (Medicare paid for services up to a certain amount, depending on your income). So many protests resulted that he switched back to cost-sharing.

But, as you can imagine, paying for that extra 20 percent can get pretty costly. So Part C was introduced in 1997 to help both the elderly and private insurance. If you decided to enroll in part C, or Medicare Advantage, you would choose to pay a higher monthly premium instead of that 20 percent. During this same time, the Sustainable Growth Rate was implemented, which was intended to limit the increase in cost of doctor’s services, but has been suspended every year since 2002.

This lack of control added to Medicare spending, and so did the last part of the program, Part D, which covers drugs. But even this provision left coverage incomplete, with many people trapped in a “doughnut hole” with high out-of-pocket costs. So even with these four parts in Medicare coverage, you’re still paying quite a bit for your comprehensive coverage. Fortunately, if you’re low-income you can apply for more assistance or even qualify for Medicaid which will pay that 20 percent.

If you’re living with a disability, you also qualify for Medicare, but if you have a work history you may have to wait for up to two years. If you don’t, you will also qualify for Medicaid. Either way, you’ll need to lawyer up.

Yet, one of the greatest parts about Obamacare, is minimizing the out-of-pocket costs for Medicare beneficiaries. The law phases in rebates for drug costs, free primary care services and ways to improve quality of care. The biggest benefit is drug coverage as eventually, it will be 75 percent covered and will save people a lot of money since those pills can add up.

Nonetheless, since the law was enacted, Medicare has still been subject to changes because of sequestration by capping reductions to payments and limiting out-of-pocket expenses. Fortunately in Obama’s plan, the “doughnut hole” will be closed by 2015 instead of 2020 and (unfortunately for hospitals) teaching hospitals and hospital debts will be paid less. Another controversial new provision is having wealthier Medicare beneficiaries pay more. Others have proposed Medicare changes but none offer Obamacare’s biggest addition to the program – the elimination of the “doughnut hole.”

All these changes and back-and-forth make it even harder for Medicare beneficiaries to understand. Drug coverage for this vulnerable population could mean saving an extra few hundred dollars a month, or more importantly an ER scare. I doubt most Medicare beneficiaries follow health reform closely and if they do, I bet they’re still confused about what pieces are going to be implemented that will affect them. Like our health care system, we need a concrete plan that will curb costs and improve quality of care in place of making changes step-by-step as things go wrong. Step-by-step, day-by-day doesn’t work. What we need is a fresh start!

IMAGE CREDIT. seniorjournal.com.

Mar 05

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Bills, Bills, Bills

By Leanne Demery | Health | No Comments

If you have yet to read Steven Brill’s TIME cover story, “Bitter Pill: Why Medical Bills are Killing Us,” you should. It’s long, but it’s worth it. Though the public has been worrying about medical costs since the Great Depression, Brill does a great job illustrating just how expensive medical care is and how Obamacare doesn’t really do much to offset costs. After reading this article I asked myself a few questions. The first was, why are medical bills really so high?

The simple answer is because of the fee-for-service payment system that doctors in the U.S. have fought so long to keep. It’s a method of payment older than our country itself. When doctors would do home visits in colonial times they would charge patients per mile traveled on the horse and buggy. And although doctors don’t directly charge us for the gas to get to work in the morning, we are charged for medical education, administrative costs and other costs that aren’t directly related to one service. Even when you go to a hospital you are charged twice – once from the doctor and once from the hospital. The professional authority of doctors has allowed them to control their own fees for services as separate from the total cost.

This causes the second issue of doctors and hospital administrators dictating prices. Doctors have always charged patients on their ability to pay and not on the quality of service or on effort. For example, surgery costs have steadily increased but the actual effort of a doctor to perform a surgery has decreased. At one time only the doctor would be charged for a surgery because he did most of the work including pre-op care and rehab, now he is still charged at the same rate, but you are now paying technicians, assistants and others who are billed as well. Procedures have been simplified but medical costs remain high and continue to rise.

One of Brill’s main opinions was that an expansion of Medicare could help control costs, yet medical historian Paul Starr argues that it was the third party government programs and private insurers that led to medical inflation in the first place. Because most of the time patients don’t see their bills, the general public is unaware of the true cost. Another reason is that because third-party payers reimburse, hospitals and doctors were encouraged to raise the rates of reimbursement to offset expenses instead of figuring out how to lower costs in the first place.

All of which begs another question: how can non-profit hospitals make so much profit? Hospitals originally started to provide free care for individuals whose families couldn’t take care of them and for a while they served only charitable care. But with the increase of the middle class, patients wanted better rooms and better services so doctors and hospitals began to charge more. Because of surgery and technology, hospitals became institutions with a lot of jobs, people and money floating around. Hospitals are usually governed by an elected board of trustees but when they aren’t affiliated with a university or religious institution, can easily be bought out by a big corporation.

So these hospitals with a non-profit, tax-exempt label get to keep their status even if they are now owned by a corporation and then governed by corporate management. Even many state hospitals have been sold to corporate entities. The other scenario is when a non-profit hospital then buys for-profit entities such as restaurants, rehabs, clinics, nursing homes etc. It seems that the status quo for hospitals is to increase available services and fees, expand buildings and usurp other medical entities, which all drastically raise costs for the patient. At the same time, the hospitals argue this is what patients want — top of the line technology, more services and bigger and nicer buildings. So I guess (certain) patients are getting what they want, and they’re paying for it too.

My last question was, why hasn’t anything been done to stop the medical monstrosity of health care costs? The quick answer is there have been efforts but most have been focused on Medicare and Medicaid, not on the entire system, and none have had an impact. The full explanation is for another time. As Brill notes in his article, Obamacare makes some minor, meager efforts at controlling costs but nothing impressive, mostly because of such strong hospital lobbying.

However much controlling costs is essential to having a more efficient health care system, expanding coverage was always the main priority of Obamacare. But Obamacare is adapting to peoples’ worries, as the administration recently announced they will require insurance companies to report any price increases. With Obamacare we’ve jumped over one hurdle on expanding access to care. Now we can hopefully pave a path to reducing costs.

Image courtesy of: www.helpingyoucare.com

Feb 22

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Disease Prevention is Sexy

By Adam Conway | Health, The Global Is Local | One Comment

Preventative health care is sexy. This is true in politics — as a means of addressing our long-term cost issues — but also to providers and patient advocates in terms of quality. We have heard a lot about preventative care in the last few years, especially with the discussion and passage of the PPACA (the Patient Protection and Affordable Care Act), a.k.a. “Obamacare.” But some argue that preventative care is just as expensive as the alternative.

So, does preventative care actually save money?

Regardless of whether or not it works, lowering costs by increasing preventative care is far from a new idea. A very brief search yielded this 1977 article touting the cost-effectiveness of preventative care. The theory is straightforward, and I will not belabor you with the details. In brief, however, it goes like this:

Some kinds of health care are expensive, and are often tied to chronic physical or psychological conditions. Treating those conditions early and often — improving habits and monitoring various indicators — rather than late and intensively should lower costs overall, since emergency or acute care in hospitals is very, VERY expensive. Oh, and health care expenditures are going up, in case you hadn’t heard. (And although Medicare and Medicaid are part of the problem, they are far from the biggest part of the story…)

US Healthcare Spending as a Percent of GDP

That’s the short and sweet version. Feel free to look out there on that world wide web for far more in-depth discussion and articles, or look into one of the many excellent books on the subject. Also, I recommend the blog post by my colleague, Leanne Demery, who provides analysis of one of the Affordable Care Act’s major provisions, State Insurance Exchanges.

In some form or another, earlier, preventative interventions are the basis for many of our health reform efforts, both current and past. Usually there is some lip service to quality of care, too, but savings sell. They’re sexy.

So what is the problem? Take care of people before they are sick, save money doing it, pat yourself on the back and call it a day!

The problem is simply that preventative care is ALSO expensive. In addition, if preventative care is successful, it may simply delay future costs. This argument is not new either, as Marcia Angell writes in the Journal of the American Medical Association in 1985: “Although preventive care may improve our health, it cannot be assumed to reduce medical costs, since a later death may be as expensive as an earlier one.” There’s also a fantastic study often cited by health economists by Manning et. al. proving that smokers and drinkers who die early based on their unhealthy behaviors actually are a net gain on the health economy.

Let’s circle back to the original question though: Does preventative care lower costs?

To help me answer this question, I had the pleasure of speaking with Doctor Jay Sanders yesterday. Among many other roles, he is a Professor of Medicine at Johns Hopkins University’s School of Medicine. He was quoted in Tuesday’s Kaiser Health News report on health kiosks in Walmart stores. These unmanned kiosks are self-service booths that allow customers to respond to questions about their health, diet, and family health history.

Dr. Sanders argued that the Preventative Care/Cost Reduction situation has been misrepresented. He pointed out that in the short-to-medium term (1-15 years), increased preventative care will almost certainly not decrease costs and instead probably drive them up. This does NOT mean that preventative care will cost more overall. Long term costs will likely come down, but the specifics are yet to be seen, and the time factor has been left out of the discussion.

To be successful, according to Dr. Sanders, health care needs to get smarter, more targeted, and more present for patients. He cites technological innovations, some of which are being developed and implemented here in our region, as potential game-changers. For instance, Under Armour and Zephyr are making items of clothing with embedded technology to monitor vital signs for athletes and gather other information for their coaches. Soon these items will be affordable consumer products that can be tied to our mobile devices, gathering data for us to share with our doctors about heart rhythms, activity levels, and asthma symptoms, among other metrics.

Finally, Dr. Sanders pointed out, the onus is on us as individual patients to generate better outcomes. Smart phones, apps, and wearable technology should make us more aware, at the least.

I agree with him, and I draw a tenuous parallel with democracy. We deserve the health, or government, that we get. If we want something different, we really ought to be more involved. If the Affordable Care Act is successful, we should not necessarily expect that success to be immediate. Instead, a long view is necessary, a chance to allow the experiment to take place.

As a parting thought, keep in mind that our spending as a country has not exactly yielded great results in the past. Quite frankly, a new approach could hardly make things worse:

Life expectancy vs health spending

IMAGE CREDITS, University of California at Santa Cruz Health Atlas;

Organization for Economic Cooperation and Development