Healthcare

I've decided to devote some of my blog posts around issues that affect me and many others. I am writing from the perspective of someone who is partially disabled and chronically ill. Not all will agree with my perspective but take it for what it is, simple observations.

Healthcare in the U.S. is fabulous if you can afford it but flawed in many ways. There is no question we have some of the most advanced medical care in the world at our fingertips but why is it so complicated to figure out how to best serve the general population?

I have thought a lot about healthcare recently as our Senate tries to structure a bill that can successfully replace Obamacare. Do I agree with Obamacare? Not entirely but I do believe there is some value in its intention that needs to be conserved. Here are my observations.

• Pre-existing conditions are a real concern. I have more than one and can tell you it is frightening to think of managing serious health issues without insurance coverage. I am fortunate to be able to afford good insurance. There is a large population that is not that fortunate and yes the ACA has helped some of those people including my brother.

• Pharmaceutical costs alone for many conditions are out of control. I have had 2 of the most expensive conditions, MS and cancer. Some cancer drugs can cost as much as $10,000 a month and MS drugs average about $5,000 a month in the U.S. The annual cost of some of the same MS drugs increased from $16,000 to $60,000 a year between 2004 and 2014. Assistance is available for most people with or without insurance but why do we have to rely on special programs to be able to afford medication?

• The healthcare industry’s reliance on pharmaceuticals, especially in the U.S. creates a viscous cycle. Research often relies on funding from pharmaceutical companies which of course creates an emphasis on producing more drugs. Profits sky rocket when new, expensive drugs hit the market. Some drugs like the MS drugs I was referring to earlier continue to increase in price for no apparent reason other than lack of competition. The lack of financial regulation in the U.S. is one reason Americans pay more for most drugs than the rest of the world.

• The costs of tests and procedures to monitor health are also not closely regulated. CT scans and MRIs can range from a few hundred dollars to a few thousand. The average cost in the U.S. is significantly higher than any other country. Uninsured patients may receive a discount of anywhere from 15-40% but the average cash price is over $1,000.

• The current system of insurance billing and reimbursement does not make sense. Most of us don’t care as long as our medical care is covered but I pay attention. Hospitals and providers are billing outrageous amounts even though insurance companies typically only cover a fraction of what is billed. If you do not have insurance it is possible to shop around and save money sometimes but most people do not understand how to do that or put so much trust in the doctor, they do not question a recommendation or referral.

• My lab bills from MD Anderson are a prime example. For my last bill the insurance was billed over $1200 and the insurance paid about $650. I can go online and find the same tests as inexpensive as $44 for someone walking in off the street.

• I typically have a CT scan of my chest, abdomen and pelvis every 3-6 months to check for cancer. The last scans were billed just under $10,000. Of that the insurance only allowed $1600.

• Recently I found a company to help me order a wheelchair using insurance hoping to get a better quality wheelchair for less than I would pay out of pocket. I did pay less out of pocket but the wheelchair I was given cost less than $350 online. The insurance was billed $990 and paid $799.

• Clearly the system is flawed. No wonder insurance premiums are on the rise. So how do we fix it? Health care providers have to make money, insurance companies have to make money, and everyone including those that cannot pay for insurance need health care.

I wish I had the answers. My 2 cents worth is that disease prevention needs to be top priority, consumers need to be better educated on healthcare costs and options, and there needs to be better regulation over billing and pharmaceutical costs. I am not usually for more regulation but when the average billing cost for the same blood test ranges from $300-$1,200 something is out of whack. Why are American consumers paying more for the same services as the rest of the world? The next time you go to the doctor look around the room at the posters and free literature and then look for the name of the drug company providing it. Just like in any sales it is common practice for pharmaceutical reps to wine and dine doctors or even office staff to present their latest drug options. I remember being on chemo and always having food provided for the patients and staff members. Healthcare is BIG business but I am not sure we should trust our health to the influences of big business.