The Commonwealth Fund posted a new study on June 10th stating, “As of 2007, there were an estimated 25 million under insured adults in the United States, up 60 percent from 2003.”

What does it mean to be under insured?  Being under insured simply means that you can’t afford the basic services provided in contemporary medicine.  Sure, there’s coverage for catastrophic care, but the under insured patient will fore-go many traditional test due to the cost of deductibles and co-pays.  And being under insured means shifting costs.  If you’re 60 years old with a chronic disease like heart disease or diabetes, being under insured means you’re going to wait until you’re on Medicare to treat these condition.

Something’s just not right.  Consumers have lost control of how they can spend their dollars on health care.  Sure guidance from health care providers is helpful and can make us educated consumers of health service.  But the overall cost of buying health services is quickly becoming something that’s just out of reach for most of us in America.

Jeff

Is fee discounting by health care providers legal?  Would fee discounting be considered a fair shake to patients or would it be considered patient baiting?

In terms of hospital care, it seems the market is finding fee discounts a very acceptable method of doing business.  Here’s a link to a number of recent article related to fee discounts in medical care.

St. Louis hospitals give uninsured discounts.
SC court says uninsured not guaranteed discounts.
California opens hospital discount listing site.
SC court examines discounts for uninsured.
MN hospitals extend uninsured discounts.
MN health systems pay back uninsured patients.
Catholic Healthcare West uninsureds get 35 percent refund.

Special thanks to www.fiercehealthcare.com for these links.

Jeff
Jeff Oster, DPM
HowMuchDoc.com

An interesting article in The Washington Post on 3-25-08 highlighted the trial of insured Americans to obtain and utilize medical care.  The survey was sponsored by The ALF-CIO and relied on 26,000 union members in the survey. 

The article states, ‘Among the uninsured, 76 percent said that someone in their family didn’t see a doctor during the past year when they were sick because of cost. And 57 percent of the uninsured said they had to choose between paying medical costs or their rent, mortgage or utilities.’  For many of us, this finding is not new but rather the reality of every day.

And yet the insurance industry fights back in an effort to preserve their role.  ‘One critic of the survey, Mike Tuffin, executive vice president of America’s Health Insurance Plans, a health insurance company lobbying group, said the findings were at odds with other research that showed private health insurance is affordable and provides good access to care.

“There is a lot of data that suggests that those who do have private health-care coverage are very satisfied,” said Tuffin. One survey found that “87 percent of respondents with private insurance said their health-care coverage gives access to good medical care at an affordable cost,” he said. ‘

In talking to my patients, I’ve yet to find one who’s satisfied with their health care coverage.  Oy! 

Jeff
Jeffrey A. Oster, DPM
Medical Director
HowMuchDoc.com

One concern on the part of medical providers is whether discounting fees is legal.  Some insurance companies (Medicare in particular) have implied that discounting fees could be considered ‘patient baiting’.  By discounting services, a doctor could possibly be providing unnecessary services that were purchased by the patient solely due to the fact that they thought that they were getting a bargain.

In response to this issue, the OIG (Office of the Inspector General) of CMS (Center for Medicare and Medicaid Services) came out with a recent response to this issue.  At issue was fee discounting by a health care system for patients who pay promptly.  The OIG agreed that discounting is fair and reasonable.

Remember, OIG Advisory decision, like Advisory Opinion No. 08-03, are case specific.  Each case may vary based upon the details presented to the OIG.  But the decision by The OIG does bode well for organizations like HowMuchDoc.com.  In fact, it even says to individual providers that discounting fees for prompt payment is a reasonable incentive to their patients.

Jeff Oster, DPM
Medical Director
HowMuchDoc.com

I recently read an article in High Country News about a fellow who said his mom was so proud of him.  He had become a doctor.  And he didn’t even go to med school.  All he had to do was to watch TV.  As a result, he learned about depression, dry eyes, restless leg syndrome….you know the ads.

Are these ads good for consumers?  Are they bad?  Do these ads benefit patients by bringing them medications or technology that their doctors perhaps would have overlooked?  In my practice I see many patients that are on ‘these’ medications.  Would they use Restasis if it was non-covered by their insurance or would patients simply use Visine. 

What I’ve seen with my patients is that the marketing of these medications has been very effective.  So much so that many of my patients now seem to have restless leg syndrome when perhaps they didn’t know that they had had it in the past.

Most importantly is the cost of these medications.  For the most part, doctors are kept out of the loop in terms of cost.  We have no idea how much a prescription cost should a patient try to pay out-of-pocket.  How does a pharmaceutical company fund a TV ad campaign?  I think you see the point I’m trying to make.  Direct marketing of pharmaceuticals to consumers isn’t done to help them solve their medical problems.  It’s marketing and marketing is done to sell.

Jeff

Here’s how the conversation goes with a diabetic patient….(Dr.)So how’s your blood sugar doing?  (Pt)  Oh, it’s fine, doc.  (Dr.)When is the last time that you checked your blood sugar?  (Pt…head drops down) Oh, it’s been a couple of weeks, doc.  (Dr) Why?  Don’t you realize the long term implications of running high blood sugars?  (Pt)  It’s the test strip, doc.  They cost $3.00 each.  I just can’t afford it.  We don’t have any insurance.  All of our money is going to pay for the heart stents my husband just had.  (Dr.)You mean you’re paying for heart stent out of pocket?  (Pt)Yup.  We have no other way.  (Dr.) Are you going to be able to do it?  (Pt) I’m sure we’re looking at bankruptcy here sometime in the future.

This conversation is all too common.  And for all those who are brave enough to come into the office for care in light of their lack of coverage, think of all those who simply don’t see a doctor!  So what we end up with is a patient that could have lead a healthy and productive life.  this person is now knowingly doomed to a slow demise from kidney failure, amputation and blindness due to their diabetes.

And it all goes back to a $3 chem strip.

Jeff

I was midway through the morning last week seeing patients when I noticed the patient I was talking to was uninsured.  She told me that she was a single mom with one son out of the house and a teenage daughter at home.  She works at Tim Horton’s for minimum wage and earned too much to qualify for health coverage with Medicaid.  The last thing that this gal needs is a tax credit on her income tax for health care expenditures.  She needs more than that.  She needs health care.  Period.

So last night I watch the Republican candidates square off on a Fox News debate.  Each offers their own version of free market based solution.  Congressman Tom Cancredo summed up the misconception of most of those in government.  He said that for those who can’t afford to pay for health coverage, there’s Medicaid.  He should try working at Tim Horton’s.

And that’s the problem with health coverage.  Those who currently are in office and who do not have to worry about being covered have no idea of what it’s like on the streets.  What it’s like having a sick child when you can’t afford to pay the bill.  Or the ever looming threat of bankruptcy.  It’s real and it’s crippling so many.

Jeff

One of the most interesting problems with health care coverage is that all of those in decision making positions have health coverage.  I reckon that’s a good thing.  But when you have health care coverage, you think differently.  You have a safety net, therefore you can go out into the world knowing that if you are injured or become ill, you’re safe.  You’re OK.  But that’s not the case for 45 million folks in this country.

I was talking to a friend who said he saw Michael Moore’s ‘Sicko’.  My friend is a retired DEA agent who retired on disability and now draws a pension.  He also works for the county government and has health benefits through his job.  His wife is retired from state government and also has health benefits for life for both her and her husband.  My friends comment was that sure, there’s a lot of Americans who aren’t covered but for them, there’s assistance; Medicaid, grants etc.

My friend needs some time on the streets.  You can tell who has coverage and who doesn’t.  Just watch when people smile.  Bad teeth?  No coverage.  That may be one way to quickly establish a persons socioeconomic status these days.  But it goes deeper than that.  The cost of health care just keeps going up.  So how can you afford care? 

That’s what my friend doesn’t understand.  He doesn’t know what it’s like to try to buy something that you need that you simply can’t afford.  And that’s what politicians don’t understand.  They’ve never had to walk in those shoes singn’ the health care benefit blues.

An article in the 8-8-07 edition of USA Today announces how the Publix grocery chain is going to give away several antibiotics……. free.  The free medications aren’t free to Publix so the intent is obviously to use these medications as a loss leader.  A loss leader is a tool to bring customers into the store.  While in the store, in addition to the medications the customer will also pick-up milk, bread, etc.  And the hope is that the customer will become a loyal customer in the future.  Another version of ‘grateful patient syndrome’.

The blog posts on USA Today following this announcement were somewhat pessimistic.  Many noted that these were already inexpensive medications.  As a physician, I can see no harm.  A reduced cost of care is a reduced cost of care no matter how you wrap it.  Other comments noted the resistance that has been developed to antibiotics.  But hey, you still need an Rx to get the medications.

Who’d have thought that we’d be seeing the art of medicine used as a loss leader for large retail chains.

Jeff

It seems like the uninsured aren’t just folks who can’t afford health care.  Many of the uninsured are folks who are willing to take the risk of being uninsured.  And who’s most likely to take that risk?  It seems that most of these folks are young adults.

The CommonWealth Fund just came out with a review of who makes up the uninsured.  Interestingly, more than 13 million 19-29 year old young adults were uninsured in The US in 2005.