November 3, 2013
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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?”
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.
Many Americans have begun to realize they’re paying too much for prescription drugs.
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.
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.
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?
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.
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.
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.
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.
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.