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Trudy Lieberman

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Thinking About Health: Taking care of America’s elderly may not be a top priority

During a recent visit to Copenhagen, I squeezed in a visit with city officials to learn more about the Danish health system, particularly the country’s arrangements for long-term care, a topic that draws endless complaints from American families, including many readers of this column. Coincidentally, the day I returned home, I learned the Centers for Medicare and Medicaid Services (CMS), which runs both programs, had just released star ratings for the country’s home care agencies that provide services to nearly 5 million Americans. The home health industry did not shine brightly.

Thinking About Health: Patients want drugs now — But at what risk?

As new drugs and medical devices are developed, it’s understandable that the public, always in love with new technologies, want to use them. They also want them to be safe, and most people think they are. It comes down to a balancing act that will soon be tested in Washington.

Thinking About Health: Supreme Court ruling is factor in health insurance decisions

At the end of its 2014-15 term the Supreme Court decided that the key component of the Affordable Care Act — the tax subsidies available to help people buy health insurance —would continue in all states. Justices addressed a challenge that the subsidies were legal only in the 17 states that ran their own shopping exchanges and not in the rest that chose to use the marketplaces operated by the federal government.

Thinking About Health: If you knew the calories in that sandwich, would you still eat it?

Not long ago my husband showed up with a sandwich for lunch that he bought at a local supermarket. I thought it was going to be our usual: turkey and provolone with lettuce on a hard roll, always plenty for both of us. At $6.50, how could you go wrong?

Thinking About Health: High deductibles vs. lower premiums equals costly trade-off

A few weeks ago I got an e-mail from Judy, a reader who wanted to tell me about trouble she’s had paying her medical bills, particularly those for prescription drugs. Severe daily headaches had just qualified her for Social Security disability benefits. After she satisfies a two-year waiting period, which the law requires, she will qualify for Medicare as all people on Social Security disability will do whether or not they are age 65. Judy couldn’t wait so she looked for other insurance options.

Thinking About Health: Patients grade their local hospitals

The government has just announced its first-ever star ratings of the country’s hospitals based on patients’ assessments of the care they received.

Thinking About Health: Think twice before buying drugs that aren’t effective

Word has just come from Express Scripts, the big pharmacy benefit manager, that per capita drug spending in the U.S. increased more than 6 percent last year. When high prices for specialty drugs like the hepatitis C medicine Sovaldi is factored in, the increase is even greater. There are more expensive specialty drugs in the pipeline, and prices of traditional drugs especially generics are rising too. We know that if we’ve refilled any prescriptions.

Thinking About Health: Long-term care insurance may provide little assurance

The U.S. has no national policy to pay for long-term care — no payment system for nursing home, home care or dozens of other services many people need as they age. And almost as bad, there has been little public discussion about this looming crisis in American healthcare. You’d think it might surface as an election issue in the coming presidential campaign, but it hasn’t so far.

Thinking About Health: Shopping for health care isn’t like buying computers

Imagine a world where you could shop for medical procedures the way you shop for computers. Most likely, price is near the top of your list when you’re looking for a new computer. Not so when the “product” is a hip replacement or an MRI. Generally, what the procedure costs is largely irrelevant. And doctors will make the decision about where the surgery will take place.

Thinking About Health: Hospital mistakes still kill too many

Few people go to the hospital expecting their hospital stay to kill them. But sometimes it does. No one is sure of the precise number of people who die because of mistakes made in hospitals, but it’s not small. Every patient is potentially at risk.

Thinking About Health: Health insurance brings new tax headaches

Choosing an insurance policy either from your state’s shopping exchanges or from an agent selling on the open market is nothing less than daunting, a tough, unwelcome chore most of us could do without. The task for shoppers is about to get even more complicated as tax time approaches. Since most people must carry insurance or face penalties, and more than 80 percent of those buying from a state exchange received tax subsidies, taxes have quickly become linked to medical insurance.

Thinking About Health: Medicare will pay for obesity counseling, really?

It’s amazing how much we talk about making people healthier. Consider all the discussion in America about overweight people who are stigmatized for making poor food choices. Think about the warnings that obesity is a leading cause of preventable death. So, it’s puzzling that Medicare offers an obesity counseling benefit that must be one of the best kept secrets outside of Washington.

Thinking About Health: Cheap insurance premiums may lead to high health care costs

You may tell yourself, “I’m healthy and will have few expenses so why not pick the cheapest plan with a high deductible?” only to learn a few months later you need chemotherapy to treat a melanoma.

Thinking About Health: PBMs horn in on doctors’ decisions about medicines

A few weeks ago Jean, a 64-year-old retiree from Littleton, sent along an e-mail in response to a column I had written. I had told of my friend’s ordeal trying to refill a particular cholesterol-lowering drug that a pharmacy benefit manager, known as a PBM, wanted him to exchange for a new drug. That new medication would have resulted in an out-of-pocket cost increase of more than 1,000 percent.

Thinking About Health: Beware of sales pitches during Medicare’s open enrollment

Once again it’s Medicare open enrollment season, the time for those on Medicare to choose how to cover the gaps in the government health program for seniors and people with disabilities. Once again beneficiaries in many parts of the country face a bewildering number of choices — far more than most of them can reasonably evaluate. It’s no wonder studies show that beneficiaries stick with the same plan year after year even though they may be able to get something cheaper.

Thinking About Health: Insurers shift higher prices for generic drugs to patients

What I like to call The Great Cost Shift in American health care marches on with the approach of this year’s insurance enrollment season. That’s when all of us who get coverage from employers, the new state exchanges, Medicare Advantage plans or from a Medicare prescription drug plan are likely to find that choosing drug coverage just became harder. Not that it was ever easy.

Thinking About Health: When Congress says it’s OK to waste health care dollars

Evidence continues to pile up that Medicare Advantage plans are no advantage for taxpayers. MA plans, as they are called, are one alternative for seniors to receive their Medicare benefits. But in this case, the benefits come from government payments to private insurance carriers, not directly from the federal government.

Thinking About Health: What happens when we get too much health care?

Several years ago the prestigious Institute of Medicine, the health arm of the National Academy of Sciences, revealed something startling about U.S. health care. Many Americans get too much at the same time others get too little.

Thinking About Health: Who wins race for patients — the ER or urgent care?

Tracy Hume, a freelance writer who lives in Greeley, and a reader of Thinking About Health columns, recently sent along this provocative question. “Do ER-affiliated urgent care providers ever try to escalate patients to the ER when it is not medically necessary?” she asked. “Why? How should a consumer respond?”

Thinking About Health: Quiz — Will next year's insurance rates go up or down?

It’s now the silly season for insurance rates with government agencies, consulting groups and the media all speculating about next year’s premiums. Will your insurance premiums go up or down this fall? Never before have I seen such intense interest in insurance rates, which editors have usually considered a snoozer of a story.

Thinking About Health: Pushing back against high-priced medicines

Many Americans have begun to realize they’re paying too much for prescription drugs.

Thinking About Health: Taking unnecessary antibiotics can be harmful

How many times have you walked away from the doctor’s office with a prescription for an antibiotic to treat a cold? Probably many. Over the decades we’ve been conditioned to believe that antibiotics are sort of an insurance policy against some malady that might be worse than a cold or that they will make the nasty symptoms magically disappear.

Thinking About Health: Who comes between you and your doctor?

How many times have you heard politicians say that no bureaucrat should come between you and your doctor? You and your physician should decide when you need to go to the hospital or when you might want to wait out that cold before taking an antibiotic. At least that’s been the American ideal of the doctor-patient relationship. The reality is something very different.

Thinking About Health: How many calories are in that Big Mac?

When you next eat at McDonald’s, here’s an exercise in consumer choice: Would you choose a Bacon Club House burger with 750 calories, a Big Mac with 550 calories, or the premium McWrap with bacon and grilled chicken giving you 460?

Thinking About Health: What does your insurance pay for?

If you’ve signed up for Obamacare or have begun using the coverage you already had, you’ve moved from the buyer’s stage to the owner’s stage. Like owning a car, you have to read the fine print in the owner’s manual to know what to do when things go wrong. In particular, you need to know who pays what for your care.

Thinking About Health: Facing realities of high deductible insurance

Pat Mallett, a self-employed businessman in Littleton, had heard a lot about Obamacare and thought a policy available in the new state shopping exchange would offer him a better deal than the coverage he had. The policy that covered him, his wife and two teenage kids cost about $400 per month and came with a $5,000 deductible, which meant they paid cash for routine office visits and annual physicals — up to a total of $5,000 per year.

Thinking About Health: Tax penalties await those who don’t sign up for insurance under the ACA

The day of reckoning is coming for the Affordable Care Act, widely called Obamacare. March 31, the day nearly every American is supposed to have health insurance, is fast approaching. And judging from the government’s February enrollment numbers, many uninsured people still have not signed up.

Thinking About Health: Obamacare questions remain valid

The Obama administration official at the New York City panel missed a chance to explain an important aspect of the law that gets to the “what’s in it for us” question.

Thinking About Your Health: Are patients tired of spending too much for health care?

The conversation around health care and what we pay for it is beginning to change. The realization that we pay way more than other countries for the same services is beginning to sink in. Why do Americans on average pay $8,143 for hospital and physician services for cataract surgery while the Swiss pay $2,566 and the French only $1,938? By all accounts, outcomes are similar.

Thinking About Health: High health care costs pinch seniors’ budgets

The median annual household income for seniors is $34,000, and it’s just under $30,000 for people living on Social Security disability benefits. Looking at the stats another way, half of all people with Medicare live on annual incomes of $23,500 or less; one-quarter have incomes below $14,400. Both reports found that even with Medicare, high health care costs are eating up a substantial portion of those incomes as Medicare beneficiaries know all too well.

Thinking About Your Health: How much should we pay for medicines?

At the end of last year, the Food and Drug Administration approved a drug that may cure some 3 million Americans who have hepatitis C, a disease that interferes with liver function and eventually can lead to liver cancer. It’s a serious illness; many people don’t know they have it until the first symptoms show up years later, and those who do have it undergo grueling and sometimes ineffective treatments.

Challenges of signing up for Obamacare

Buying health insurance is tough enough for anyone. It’s hard to slog through the terminology. You have to ponder the unknowns about next year’s illnesses and make your best guess about the coverage you’ll need. Add in the hassle of navigating the new state shopping exchanges, and you’re facing one of the most complicated shopping decisions, ever.

Thinking About Health: There's more to good health than health care

Because so much of the national discussion lately has focused on health, the Affordable Care Act and its troubles, you might think that health insurance is all that matters when it comes to making people healthy. It isn’t. That good health is more than health care was a point I heard many times on my recent Fulbright fellowship visit to Canada, and it’s a topic we don’t talk much about in the U.S.

Thinking About Health: Your options for Medicare open enrollment

After recently reviewing options for next year’s Medicare coverage, it’s important to understand how Medicare fits with the Affordable Care Act, often called Obamacare. With all the media attention focused on shoppers in the individual market and their troubles navigating the government’s website, it’s no wonder seniors want to know if they have to sign up somewhere to keep getting their Medicare benefits. Do they have to shop in the exchanges? What happens to their premiums?

Your options for Medicare open enrollment

Before reviewing options for next year’s Medicare coverage, it’s important to understand how Medicare fits with the Affordable Care Act often called Obamcare. With all the media attention focused on shoppers in the individual market and their troubles navigating the government’s website, it’s no wonder seniors want to know if they have to sign up somewhere to keep getting their Medicare benefits. Do they have to shop in the exchanges? What happens to their premiums?

Thinking About Health: Choosing insurance in the state exchange

Buying health insurance is not fun. But if you make the wrong decision, it could cost you, so it pays to think carefully about the policy you buy in the state shopping exchange.


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