Huge overcharges we all pay for

CNN just reported that Medicare pays 4 times more for wheelchairs than suppliers.  This is annoying, but what’s even more annoying is that the issue of competitive bidding for this type of thing isn’t a no-brainer and a done-deal in Washington.  Industry likes the gravy train that is the US taxpayer and lobbies congress hard to bar government agencies from negotiating on behalf of the taxpayer.  They are barred from competitive bidding!  I know the pharmaceutical industry won big in this area too.  Why aren’t we as taxpayers more upset about this?  I would think this would be an area where we could get bipartisan support for reform, but then again, I could be wrong.

Healthcare heats up!

One week on vacation and whoa!  The healthcare debate got more feisty.  I was enjoying the mountains of Colorado while Sarah Palin was starting the whole “death panel” conversation.  The media loves extremes and controversy so I’m not surprised that this one very false comment could generate so much press.

I’ll bet the industry players in this game are relieved to have the Republicans drawing interest away from the really hard problems that need to be solved.  The status quo benefits a lot of special interests.  They have thrown big bucks into lobbying to make sure things go their way.  What’s interesting is how they have done a good job of making everyday people think their way benefits them as well.  Can the big guys and little guys win at the same time?

Consider the following:

1. Government involved in healthcare is used like a dirty word.  Now, I’m not saying that government is flawless or anything like that (this doctor’s blog post on the hassles of Medicare is outrageous) but is the corporate world so great?  These businesses have to make a profit or they are punished by Wall Street.  For-profit insurers have very real incentives to deny care, drop expensive policy holders, etc. to enhance their bottom line.  If they don’t, their stock price drops.
2. Is the health insurance industry really a good example of a free market?  I don’t think it is.  They don’t want the people who need them most.  They profit when you don’t use their services.  And, if you find their service sucks when you get sick, you are trapped and can’t shop around and take your business elsewhere.  People who use the system are often confused by it and find out the holes in their plan after they are sick.  I don’t see “reputable” insurers rallying against the junk plans being offered in the “free market” that essentially bankrupt people who honestly thought they were covered.
3. You are just a lay-off away from losing your insurance if you have it.  Not a good thought especially if you have any kind of condition that would make it really hard to be insured in the private sector.  I don’t think insurance should be tied to employment.  It just doesn’t make good sense.
4. At the same time government healthcare is being called inferior, the private insurers are whining they couldn’t compete with it.  Well which is it?  If the private groups can do it better and cheaper, than why should they care about a public plan?  Private schools exist alongside public ones.

I don’t have millions of dollars to lobby Congress.  I just have to write my letters and hope they have it in their character to work out reform for their constituents and not just the big industries of healthcare.

A Pedicure plus!

I managed to get out of the house to get a pedicure for the first time this summer.  I went to a local beauty school I like.  It was just me in the room except for another girl who was a student there.  She had her feet in a basin of water with a machine attached.  She warned me that I shouldn’t look over there because what she was doing would be pretty disgusting.  Ironically, this was moments before my infant son blew out his diaper on my lap, but I digress.

I asked the student doing my pedicure what was going on over there.  She explained that it was a special ionic foot bath designed to pull toxins out of the feet.  I’m suspicious of the general word toxins and pressed a little more.  What toxins, from where, how, etc?  She said the toxins were coming from places like the gall bladder and liver.  She said the water looked very gross after the procedure and even worm-like stuff appeared in there.  She said she was told it could get at tape worm.

There’s a lot of talk about this kind of stuff in the medical blogosphere (especially as CAM practitioners try to get included in healthcare reform) so it was kind of amusing to see it in action.  Somebody must have had to believe this nonsense to spend money on a machine and teach it to beauty students.  I’m amazed that someone would even consider it possible to extract anything more than sweat and skin cells from the bottom of the foot.  The logic just doesn’t hold.  If all it took to cleanse the liver and gall bladder was a fancy foot bath, wouldn’t liver failure and gall bladder disease be things of the past?  Even if it were possible, would you want someone at a beauty school messing with your internal organs?

If you’re curious as I was about this procedure, check out the explanation of it at Quackwatch.  Turns out the water will turn gross looking even if no feet are in the water.  I wouldn’t part with a dime for any of these types of procedures.  I hope our federal government doesn’t either.

Paging Dr. No

Celebrity deaths like Michael Jackson’s prove that even the richest and most well-connected aren’t always guaranteed the best results.  A lot of the speculation about his death surrounds the possibility of a bad combination or overdose of prescription drugs that caused his heart to stop.

Michael Jackson had the money to buy the best care or at least the care he thought was best.  Maybe what he was paying for in a private physician was someone who was very amenable to his wishes.  If this is the case, he would have been better served by a doctor (or years earlier, plastic surgeons) that would tell him no.  If celebrities are used to getting what they want, they probably don’t hear no in the same way an average patient would and shop for a doctor willing to go along with their wishes.

Sometimes less is more and no treatment is the best treatment.  That’s something worth thinking about at the doctor’s office.

Healthcare Reform for Dummies

I’ve got the Primetime interview with President Obama on the DVR to watch as soon as I can.  There’s lots of talk about healthcare reform right now and barring any really big story, the issue should stay in the limelight for quite a while.

As a patient, here’s one of my big hopes for reform.  I want whatever the end result to adhere to the KISS principle.  Keep It Simple Stupid.  Any reform to the system needs to be simple enough that people can understand how it works.  There are a lot of interests elbowing for a place at the table and a piece of the enormous healthcare pie, but for the everyday Joes and Janes, I hope the end result of reform is something that can be easily described and understood.

As it is now, figuring out the system is hard.  Group insurance vs. individual insurance, deductibles, copays, various government programs with rules and donut holes, etc., etc.  It is maddening to try and figure out if you have “good” insurance and are covered in a health crisis.  Everyday people with health insurance go bankrupt because they are overwhelmed by unexpected out-of-pocked costs.   It can even be worth it to lie to your doctor so insurance companies don’t have an excuse not to cover you later or rescind your policy.  This is a game with complicated rules.  Messing up is dangerous.

Costs for everything related to healthcare aren’t usually that easy to find either.  Try to read some of the bills and explanation of benefits statements.  Not fun.  My sister just got an itemized bill for childbirth.  She said she might as well not have even seen it because it was just a bunch of codes and she had no idea what anything meant.  As she is a nurse who has worked in hospitals, that doesn’t bode well for the rest of us.

So I hope whatever we wind up with in the end, people will have a very clear understanding of what they are covered for and what they may need to consider extra insurance for or save for out-of-pocket.  I hope that we can have insurance policies (public or private) that don’t read like stereo instructions and bills that don’t make you give up understanding them when you open them up.  Is that too much to ask?

Back from Baby

I’m trying to get back into the swing of things after delivering my baby boy on June 3^rd.  We are all doing well, but ah, newborns!

Since I think about healthcare quite a bit, I paid attention to the details and I’ve got to say I had a very good experience at Nebraska Methodist Hosptial.  I could not have asked for a kinder, more considerate staff.  They had careful procedures for medications including barcode bands for patients that were scanned before meds were dispensed.  I was also discharged with very specific and detailed instructions.  Even the food was pretty good.

So when I hear horror stories about hospitals letting patients die waiting in the ER, I have a hard time imagining that happening here.  In fact when a family member of mine visited this hospital’s ER, he had the same kind of experience.  Super care.  I don’t know what goes on behind the scenes at this hospital in terms of administration, billing, etc., but I can tell you they put on an excellent front for patients.

Hidden Costs to Cheaper Generics

With the economy in the midst of a recession, it’s no surprise that people are looking to save money more than ever.  On the healthcare front, a big way to do that is by using generic drugs.  However, this isn’t as much of a no-brainer as I thought.   Bad Bargains, an article in this month’s Self magazine investigates whether generic drugs are always as safe and effective as their brand name counterparts.  I hadn’t even considered this possibility since they are both approved and regulated by the FDA, but after reading this article, if I needed a medication (particularly long-term), I would ask my doctor if s/he knew of any possible differences between a generic and brand-name medication.  I would also explicitly ask my pharmacist if I had been switched from a brand-name to a generic or if I had been switched between manufacturers of my generic.

The article is very worth reading in its entirety, but if you don’t get a chance, here are some of the highlights.

1. Generics are a big part of the US market.  Many are fine, but some are not.  The article gives several examples of patients taking meds for conditions like depression and epilepsy who suffered relapses and serious problems when switched to generic versions of medications that had controlled their symptoms.  Even small differences that were deemed insignificant by the FDA made a big difference to these people.  See examples here.
2. Generics may have the same ingredients as their brand-name counterparts, but the release formulas may be different as those patents are separate.  That means you could get the same drug either too fast or too slow and thus change its effectiveness.  The difference can exist between the different manufacturers of the same generic drug too.
3. The FDA is swamped and regulation can be slow and lax.  Medications are often manufactured overseas where it’s even harder for the FDA to monitor.  They often rely on company-provided data to vouch for the safety of the drug.  The manufacturer, Ranbaxy, was cited in the article as seriously violating safety standards, but the drugs in question were not pulled and an alert took three years to be issued.  (Note:  You can use EmilysProject to find all the manufacturers of a particular medication.  Click on “more info” next to the drug name to see a list.)

The FDA was too understaffed to prevent toxic peanut butter from sickening people with salmonella, and it’s not encouraging hearing once again that those same government regulators we count on seem to be struggling to keep up with monitoring medications.  I wouldn’t avoid generics or panic that all medications are a big risk, but I would be aware that changes between brand-names and generics and between generic manufacturers can make a difference.

Prescription for Porn?

Did that get your attention?  A May 20th Newsweek article about this titled Rx vs. XXX got mine.  To summarize briefly, men with low testosterone levels can boost them by, eh, hand or with a testosterone foam called AndroGel.

Did that get your attention?  A May 20th Newsweek article titled Rx vs. XXX got mine.  To summarize briefly, men with low testosterone levels can boost them by, eh, hand or with a testosterone foam called AndroGel.

 Morality and sensationalism aside, Solvay Pharmaceuticals is trying to raise awareness of low testosterone levels in conjunction with awareness of its foam cure.  So it would seem they have to nurture a “problem” (that the article points out can be a sign of normal aging) to sell a cure.  If this gets even a tiny bit of the attention and money that Viagra gets, this could be big money.

I’m sure this medication can help fix legitimate problems, but one of them shouldn’t be a pharmaceutical company’s bottom line.  With medications come side effects, sometimes serious ones.  You can bet if you are seeing an advertisement for a medication in a magazine or on television, it’s a medication that makes a big profit for drug companies.  

But a costly drug is for a patient isn’t always best.  It’s interesting that even after comparative effectiveness research found that cheaper diuretics work as well for blood pressure as more expensive brand drugs, doctors still continued to prescribe the more expensive meds.  How much of this is related to good advertising by the drug companies?   Chances are they wouldn’t do it if it wasn’t working for them.  So, good idea to be extra inquisitive to make sure it works for you.      Did that get your attention?  A May 20th Newsweek article titled Rx vs. XXX got mine.  To summarize briefly, men with low testosterone levels can boost them by, eh, hand or with a testosterone foam called AndroGel.Did that get your attention?  A May 20th Newsweek article titled Rx vs. XXX got mine.  To summarize briefly, men with low testosterone levels can boost them by, eh, hand or with a testosterone foam called AndroGel.

 Morality and sensationalism aside, Solvay Pharmaceuticals is trying to raise awareness of low testosterone levels in conjunction with awareness of its foam cure.  So it would seem they have to nurture a “problem” (that the article points out can be a sign of normal aging) to sell a cure.  If this gets even a tiny bit of the attention and money that Viagra gets, this could be big money.

I’m sure this medication can help fix legitimate problems, but one of them shouldn’t be a pharmaceutical company’s bottom line.  With medications come side effects, sometimes serious ones.  You can bet if you are seeing an advertisement for a medication in a magazine or on television, it’s a medication that makes a big profit for drug companies.  

But a costly drug is for a patient isn’t always best.  It’s interesting that even after comparative effectiveness research found that cheaper diuretics work as well for blood pressure as more expensive brand drugs (see here), doctors still continued to prescribe the more expensive meds.  How much of this is related to good advertising by the drug companies?   Chances are they wouldn’t do it if it wasn’t working for them.  So, good idea to be extra inquisitive to make sure it works for you too.

How 60 Seconds Could Save You $60

Okay, so it was a few more than 60 seconds, but not much.  Last week when my husband had to see an ophthalmologist, she prescribed an antibiotic/steroid.  He went to fill the prescription and found that the copayment for the medicine (a tier 3 medicine, grrrr…) was $60.   Because of our experiences with EmilysProject, he declined to pick it up until he did some legwork at home.  He wanted to find out if the cash price fell below the deductible price anywhere.  Unfortunately though, without insurance, he found that the medicine was $109 at one store and $96 at another.  However, he found that choosing a suspension over the ointment brought the price down significantly because there was a generic available.  He called the ophthalmologist to ask if that would work for him.  She said it wouldn’t, but offered free samples of the ointment to use.  $60 saved and everything’s fine!  

See more resources about saving money on meds here.

When the Best Lose

Hospitals make money on sick people.  That isn’t a surprise at all, but think for a minute about the implications of that when you are the sick person.  I’ve been reading about how hospitals that have set up programs to help people avoid being re-admitted to the hospital are backing off of the programs because they are losing money.  (See short blog here and longer NY Times article here). These programs involve hiring nurses to call patients and check on them and give them advice on what to do if they are having trouble.  This often prevents an expensive re-admission which benefits both the patient and the payer (in the cases cited Medicare).  However, money saved by the payer is money lost by the hospital.  We have a built a financial disincentive for hospitals to keep patients from getting sick enough that they have to be re-admitted.  This is obviously not good.

Most doctors are also paid based on the testing that they do and services they provide.  Once again, this doesn’t sound like a bad thing, but think again.  A doctor who tests for everything under the sun gets more money than the doctor who does not subject his/her patients to questionable (possibly invasive) testing.  A doctor who helps you out over the phone or internet is not paid whereas the doctor who makes you miss work to see you in the office is.  There is talk of paying doctors a flat salary, but this has incentives to do less than more and that makes people nervous too.  I like this idea of paying doctors a salary and giving bonuses for best practices or positive outcomes for patients, but this has challenges too (similar to paying teachers).  Someone who takes sicker, less compliant patients might not look as good as someone who has healthier and more compliant patients.  

I don’t think most hospitals or doctors are working to keep us sick or over test (they would lose a lot of patients and reputation), but I don’t like a system that doesn’t reward the best practices of institutions designed to keep us healthy.  They should not lose money by doing what’s best for the patient.  Talk about a frustration and burn out risk for people I don’t particularly want frustrated and burned out.  So however healthcare reform comes, we need to make sure that the financial incentives for our providers are in line with the best outcomes for patients.