ME vs. MM: The Cost Of Treatment
Most (if not all) of us know that treating cancer is not cheap.
During my first year of treatment, my insurance was billed approximately $250,000, which covered blood tests, x-rays, bone marrow biopsies, stem cell collection, appointments, infusions, and other various and sundry expenses throughout the year. Since I was part of a clinical trial, the costs of Revlimid (lenalidomide) and Kyprolis (carfilzomib) were not billed, otherwise the cost would have been almost doubled.
During my second year of treatment, the total billed to insurance was "only" $125,000, primarily due to less frequent infusions, fewer blood tests, and no x-rays or stem cell collection. Again, if the chemo drugs had been billed, the cost would have been over $350,000.
Interestingly though, the amounts actually covered by insurance each year were $162,000 and $70,000 respectively. As explained to me, the differences between the billed amounts and the paid amounts are due to discounts the insurance company has negotiated with the various medical providers. Depending on the insurance company and the medical provider, the billed amount and the paid amount for services can be significantly different.
Thankfully, I have fairly good insurance through my employer. However, as with many employers in the United States, the cost of insurance keeps going up and employees are asked to share more of the cost. In my case, I have to cover $11,000 a year through deductibles and copayments, plus any uncovered costs in full. While $11,000 is quite a lot of money, it pales in comparison to the total cost of my treatment, which would otherwise bankrupt me.
Even though insurance is covering the majority of my medical expenses, my wife and I have needed to be vigilant regarding the billed and paid amounts. We have found errors on several occasions that would have cost either us or the insurance company several thousands of dollars.
Most often the errors are due to double billings. This typically occurs when the insurance company takes too long to process a claim, or we do not pay promptly enough. Generally the insurance company detects this and voids the second billing, but on a few occasions we've had to call the medical provider or the insurance company to clear it up.
A second source of double billing occurs when a medical provider wraps several charges up in a single billing, but then doesn't seem to apply the payment correctly and subsequently bills one or more of the items from the conglomerate claim separately. This is the most difficult to clear up and usually requires a lengthy discussion with the billing department for the medical provider.
Other erroneous claims occurred when we were billed in full for something that was supposedly not covered by insurance but should have been. This was usually due to the medical provider submitting the wrong code or providing insufficient information for a claim, and was typically cleared up through calls to the insurance company or medical provider.
While some errors are bound to crop up due to the number of claims that are processed, and can then be corrected, it unfortunately has required my wife and I to compare the billings from medical providers to the insurance payments and review the details associated with them when they differ.
Fortunately, I am an Excel master, so I set up a spreadsheet tracking the billings to insurance and their payments. My wife is a CPA with a knack for numbers and weeding through the idiosyncrasies of billings, payments, etc., so she digs through the spreadsheet and makes sure everything balances.
My wife also handles most of the calls with the insurance company and the billing departments of the medical providers, which is a blessing to me since I hate dealing with this kind of stuff.
Left to deal with it on my own, I might end up handling it like one of the other patients I became friends with over the course of my treatment. He figured he had been overbilled and paid an extra $3,000 to $4,000 one year, but didn't plan to do anything about it since it wasn't worth the hassle of working through it with the billing departments and the insurance company.
I sometimes wonder whether it might be better to have a government-subsidized medical program similar to ones in other countries, which typically standardize treatments and payments, though I'm not sure whether that would solve the billing inconsistencies. It might just make it less likely errors are caught, since the government might not be as diligent checking into claims as the insurance companies are.
I'm also not sure I'd like to give up the flexibility I currently have in choosing my treatment, even though it comes at a cost.
Peace, and live for a cure.
Kevin Jones is a multiple myeloma patient and columnist at The Myeloma Beacon. You can view a list of all his columns here.
If you are interested in writing a regular column for The Myeloma Beacon, please contact the Beacon team at
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Nice article. I can see both sides of the issue insofar as government-run or subsidized health care is concerned. My wife is from Spain and we spend a great deal of time there and have used the Spanish health care system ourselves and with our kids. I have mixed feelings about it. My father-in-law died of colon cancer there several years ago and was given adequate, but, in my opinion, not the level of care he would have received in the US. Maybe, I am wrong. I often read the Myeloma UK site which has a forum where the NHS there seems to have one standard formula for treatment for everyone without many second opinions or input from the patients. There don't seem to be many clinical trials with novel agents. All in all, I like the options we have here for myeloma in terms of the diversity of treatment options and the availability of novel agents. I had the choice of severla trials at several myeloma centers. You and I both got access to carfilzomib as newly diagnosed. I don't think that would have happened any where else. Just my two cents worth.
Kevin
Thanks for the article. My wife is three years into MM and the insurance company has been great. However, for all the reasons that you described, I think that I need to track these costs closer.
While not an Excel wizard, I am confortable with it. Have you considered offering your template? I'd be happy to send a fee or contribute even more to IMF or Dana Farber or MMF as well.
Harry
Kevin said:
"A second source of double billing occurs when a medical provider wraps several charges up in a single billing, but then doesn’t seem to apply the payment correctly and subsequently bills one or more of the items from the conglomerate claim separately. This is the most difficult to clear up and usually requires a lengthy discussion with the billing department for the medical provider."
YES! That is the scenario that my wife and I confront TOO DAMN OFTEN!
Talk about a Gordian knot!
S.
In the government health care system in Canada we do not have private insurance companies acting as the 'broker' between patients and the medical system...it is done through a provincial government department. Thus we patients do not see the cost of our treatments, but of course they are substantial, just as yours are! To me, this shows how the power of many people paying into a system, be it through taxes or through insurance premiums is what helps us through financially. The cost of being treated in the modern ways for myeloma would be beyond the reach of just about everyone...only a small minority of people could afford it. So I will be forever grateful and in a way, indebted to, the health care system that saved my life! I know tHAT I received the best treatments available at the time of my dx.
An important aspect of being an mm patient that gets not enough attention. Well written Kevin.
At 64, I am a 10 year survivor, thanks to my oncology team at the Dana Farber. Like you, I believe those involved in the entire process, from medicine to billing to reimbursement, act in good faith. The problem, in my opinion, is that the system relies on bureaucracies attempting to interface along the chain, each bringing a particular set of unique complexities into the mix. Medical staff dealing with in hospital administrators and billing departments, who in turn try to connect with a myriad of insurance companies, each with its particular method of doing business. If that's not enough, add in the interests of the drug and medical technology industries (and of course us, the patients), and the result is a massive, national policy issue. An issue the policy makers in Washington lack the guts to deal with effectively.
Medicare is the most efficient of all reimbursement entities. That's why congress prevents it from negotiating drug prices with drug companies, which is why we, (in the US) pay 50% more than Europeans for the same drugs. Medicare's administrative costs are less than 5% compared to about 12% for private insurance companies. Medicare, like other insurance companies, does not tell doctors what kind of care to provide. With only 800 actual government employees managing Medicare, it's too small to interfere. And because it contracts with 1700 private sector entities to interface with health care providers, it supports free market capitalism.
My point is that the system is costly and regionally inconsistent because health care policy is non existent. As with every issue, it seems this congress works best playing chicken at the edge of a cliff. Makes for good sound bites until they trip over the edge taking us down with them.
My husband has dual British and Canadian citizenships. He is presently recovering from his auto stem cell transplant done at MD Anderson in July at the age of 77. When he was first diagnosed I thought it might be a solution to move back either to Canada, Britain or the Netherlands should the costs become too prohibitive.
I called Princess Margaret Hospital in Toronto, the "premier" canadian cancer center, where I was told me that they do not offer stem cell transplantations after the age of 70 and could only get access to the newly approved "novel" drugs by clinical trials which he would not be allowed to participate because of his low kidney functions. The quality of MM care and other diseases is also factored by which province you live in. You would wish to live in a "rich" province such as Alberta and Ontario which have the funds to afford covering the costs of acquiring the latest diagnostic tools or drugs. My brother who is presently being treated for aggressive prostate cancer in Quebec has to pay for his expensive cancer drugs. Fortunately he has private insurance which covers them but at a high deductible and co-pay.
I also researched what Britain and the Netherlands, the latter having a very good health care system (1/2 government and 1/2 private insurance) had to offer. Britain's cut off age is 55 and Holland is 65 for a transplant. Britain is very restrictive regarding overall care for elderly MM patient with kidney failure, as is the case for my husband, in other words he would have probably died within a few weeks of his diagnosis.
There is a reason why people come to the U.S. from all over the world to be treated for "complicated" diseases. The U.S. does not discriminate or restrict the best and more advanced care, if you can afford it! Most countries with national health care do.
On our first day at MD Anderson we were paired with our own "financial planner" who explained to us the probable costs for his treatments and our side of responsibility for them and offered financial help should we meet their requirements. We didn't, but they did work with us to find a way to cover the high costs such as enrolling us with The Chronic Disease Fund which are covering all of our deductibles and co-pays for Revlimid. Maybe being on Medicare is different than private insurance. We have had problems with the hospital billing but Medicare took care of it.
There are no words to describe how grateful we are for living in the U.S. where my husband had the best care possible even though he was of advanced age, he was able to get a stem cell transplant which worked and hopefully will give him many more years.. Had we lived anywhere else, we would not be looking at this rosy scenario!
Excellent article on a critical topic. I read it and gulped, thinking "I need to pay more attention to the billing side, starting now." (This thought running through my head as I write a check to the hospital billing department...)
Thanks for the article Kevin. I wish I had your organizational skills for just 15 minutes a day. I have an HSA which is very, very simple for us. After we pay $11,000 out of pocket, everything else is "Free"...there's no 80% for this, 20% for that. The bookkeeping is simple and, for cancer, the price is right. Our premium is $700 per month for my wife, 3 kids and myself.
With this disease, January is painful. But by February, we've met our deductible and the next 11 months are free.
Suzanne -- That is an amazing comment. Thank you for sharing. I can't imagine living somewhere and realizing you can't get the most current treatment, but citizens from other countries can have it. And when it's the difference between living and dying...wow, that is so powerful. Too many Americans do not appreciate what they have.
Kevin,
Thank you for your article. I found it very interesting.
I can't speak about health care in USA or about other patient experiences. However, as a Scottish citizen, I can say that the care I have personally received under the National Health Service in the UK has been wonderful. I have been in complete remission since the beginning of 2007 and I owe my doctors a huge debt of gratitude. Back in 2005 (when first diagnosed with MM), I had private health insurance coverage as part of the remuneration package attached to my employment but I decided to use our publicly funded national health service for treatment. Like most systems, our NHS may not be perfect but thus far I am very happy with the care that I've received and I'm relieved to live in a country with a well developed social welfare system. I only hope that going forward it will be possible to maintain high standards in the face of rising healthcare costs and an ageing population.
I feel compelled to post, a long time lurker.
I live in the UK and have myeloma, at present the cut off age for an SCT on the NHS is 70 not 55 - and this isn't strict, if you are a very fit 70 year old you are likely to be offered one.
@ Terry - there is not one option for treatment available to NHS patients but several and there are numerous trials that you can elect to enter. I was offered 2 trials on start of my treatment and am currently receiving an induction treatment of Velcade, Dex and Adriamycin leading up to my SCT.
As far as I'm aware the only treatments that you in the US have available to you that we don't currently in the UK are the newly approved drugs of Pomalyst and Kyprolis. We tend to be 24 months behind in terms of availability on the NHS but they are in the pipeline.
I'm not really interested in directly comparing systems of healthcare but just thought I'd bring it to attention
Interesting article thanks
Hi Tom, thanks for the post and the additional information. I read Myeloma UK because I enjoy the forum (lots of folks with great senses of humor and great advice regardless of nationality)and I got the impression from numerous British posters that the standard treatment was a rigid CTD protocol with upfront SCT in 4 months or so. Not many of the posters seem to be involved in clinical trials, let alone ones that don't automatically involve upfront SCT. Sorry if I presented a skewed view of the situation. Good luck with your treatment! Terry L.
This is an excellent discussion and I appreciate Kevin's column taking on such an important issue. I also appreciate how people have been rather respectful of others' opinions.
I have just a few points right now ...
First, Tom, just because a treatment is approved in the UK (or Europe, or Canada for that matter) doesn't mean it is actually widely available. Revlimid is approved in Europe, but it is hardly ever used as frontline therapy, nor is maintenance therapy with Revlimid common anywhere in Europe (as far as I know). Yet, in the U.S., Revlimid is commonly used in both of those ways.
Likewise, the combination of Revlimid, Velcade, and dexamethasone, which has shown a 100 percent response rate in newly diagnosed myeloma patients, is commonly used in the U.S., but hardly used at all in Europe (or Canada).
The difference in usage has little to do with treatment preferences of U.S. versus ex-U.S. doctors. It has to do with strict enforcement of off-label prescribing, which, in turn, is done very much for financial reasons.
Second, you are treading on thin ice as a U.S. cancer patient if you criticize the U.S. healthcare system, because the few comparative studies that have been done have routinely shown that the survival of U.S. cancer patients is among the best -- if not the best -- of cancer patients anywhere in the world.
And, by the way, if you're curious as to which Western countries, outside of Eastern Europe, typically end up at the bottom of the list when it comes to cancer survival statistics, they are ... England, Wales, and Scotland.
Here's one of the most comprehensive studies that's been done on the subject, as far as I know. Unfortunately, it uses data from the 1990s. There are more recent comparisons, but they are not as comprehensive. See, in particular, Figure 1, which is in the last quarter or so of the document.
http://bit.ly/Xw63ZE
Thank you for the CONCORD study link, JimNY. There is no doubt in my mind that US cancer survival statistics are among the best in the world, for those who have good health insurance or are independently wealthy. The problem is that some 50 million US residents have no insurance, and many others are underinsured, leading to medical bankruptcy (the #1 cause of that financial catastrophe).
Therefore, I am proud to be a member of the Physicians for a National Health Program, supported by an ever increasing number of us. ObamaCare is not likely to fix the inequities of our health care. We need to spread the risk across the entire population, as Nancy pointed out above for Canada. I realize that even then, those with financial means can afford more treatment than the average resident, as occurs in all countries. And that is fine with me.
But health care should not and is not a laisses faire capitalist enterprise; the demand when needed is not related to the supply and cost in this case. Capitalism needs a human face; otherwise it becomes immoral. So I will "skate on thin ice", as you put it. As a physician, I am embarrassed to work in a wealthy country that allows many to die because they do not have the financial means to obtain adequate medical treatment!
I have a few more comments after a short sleep night: it's pretty obvious that my weekly dex dose has something to do with my passionate comments above. I also wanted to thank Kevin and the rest of of the commentators above for discussing another "elephant in the room", like Pat Killingsworth's death and dying column recently.
It becomes a philosophical point: I strongly feel that basic health care is a crucial societal right, just like education, police and fire protection. Every other industrialized country in the world feels that way! And it is not just the compassionate thing to do. Emergency care is the most expensive way to provide medical care; yet it has become the defacto way of providing care for the uninsured in the US. Texas is the worst in this regard. Preventive care is much more cost effective.
My state, Oregon, is one of the states (Massachusetts and Vermont included) leading the efforts for reform. Local organizations in Eugene like Volunteers in Medicine and Cascade Medical Team that I help out with are helping to plug the gaps in the meantime. Benefit concerts and bake sales for inflicted individuals in our community are common, and sad to see when over trillion dollars are spent on wasted wars like Iraq (started ten years ago this week).
Most economists agree that the escalating cost of health care is a major factor in reducing growth of our economy, both for small and large businesses. With 30% of the health care dollar going for administration, and top health administrators making over a million dollars yearly, having a national single payer health care program is far more efficient. The profit motive in health care is the major problem, and yes, many physicians, hospitals, and the pharmaceutical companies all need to share the blame. There are no easy solutions, sure, but an honest national discussion of this topic would sure help.
So thank you again for stirring up a crucial topic for my dex night! Jan
This was published in Wall Street Journal the other day - Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation's biggest firm projecting that rates could more than double for some consumers buying their own plans.
Can you imagine paying 100% more for your already outrageously high premiums? The old healthcare system didn't work and it sure looks like the new one (Obamacare) will not work either.
Mike
Hi Jan, a double chamomile tea chased with xanax worked wonders on dex days for me! Terry L.
I recently had a SCT at Dartmouth/Hitchcock in New Hampshire ( a very professional and caring hospital). On return to Virginia I was faced with another increase in insurance to approx. $18,500.00 a year and a $5,000.00 deductible. Pharmas are 60/40.
It is not pleasant to think that bankruptcy at 64 yrs. old and having worked hard all of one's life is now an imminent prospect. I am currently working on becoming too big to fail, like our illustrious bankers, but do not have enough cash left to buy myself some congressmen or senators. Multiple myeloma sucks.
Hi Again Kevin and All, Kevin thanks so much for discussing another 'elephant in the room'...the costs of treatment. This has evolved into a free flowing discussion that cuts across national boundaries. I just wanted to state that I very much get a lot out of reading about the treatments and research being done elsewhere, especially in the US. We have had a national healthcare system here since the 1960's, and so it is difficult to even remember how things were before that. It has to be funded out of tax revenues though, and it has stresses in it that I won't go into here....not a perfect system but quite good for most of us. Of course, I think there will always be 'medical tourism', whereby people go to other countries and pay for healthcare that is either provided more quickly or that is not available at home.
So I can't really comment on the system in other countries, since am not knowledgeable about all of the 'ins and outs' of that. Hard for us here to imagine other systems since we are so used to ours, though!
When I write my columns, it can be hard to predict what will hit a chord with people and what won't. With this column I wasn't sure whether people would relate more to the mistakes I've encountered with billing and insurance, or the suggestion of government subsidized health care. Looks like both had their audiences, though government health care seems to be the more popular.
As a couple of you have also mentioned, it's nice to see the interaction it's generated between people and the perspectives we get from people with a variety of backgrounds and experiences.
Harry, Stann,
Being an engineer, I use Excel a lot to do quick planning and analysis when I don't feel like using some of the more sophisticated tools available to me. I've also been using Excel for as long time, so it was pretty natural to dump the information from my insurance company into a spreadsheet. It's made it a lot easier to track the data and look for discrepancies. It's pretty specific to the information I get from my insurance company so I doubt it would be of much value to others.
Steve,
I like the Gordian knot analogy!
Stephen,
You make a good observation as to the number of people and organizations involved in the process and the complexity it causes. As an example, in a typical visit I might see three or four different medical personnel. However, when the bill is submitted, there may be as many as 10-15 different people or organizations submitting claims as a result of the visit. Thanks also for the info regarding Medicare. I don't use Medicare, and have not looked into it, so it was interesting to read.
April,
I think a lot of people just get the bill and pay. It admittedly takes some effort to keep track of it all. As I mentioned though, my wife is an accountant so this is something she's used to (and has rubbed off on me over 32 years of marriage).
Terry L, Suzanne,
You have more personal experience with health care in other countries than I do, but seem to relate a similar belief that options are much more limited in other countries, particular those with government health care systems. This is consistent with a lot of what I've heard from others. As is mentioned by a couple others though, there may be more options than some of us may realize.
Nancy S,
I've read a lot of your postings regarding the Canadian health care system, and that you have generally been pleased with it. My brother in-law has dual citizenship between the US and Canada and he has generally preferred the Canadian system (though he has indicated he would probably come to the US if he required specialized or urgent treatment).
Dorothy, Tom
Thanks for enlightening us regarding your experiences with the UK's National Health Service. Most of my knowledge has generally come from what I've heard from others griping about it (but then, it's typically those that have something to gripe about that speak up the most).
Tom,
Thanks for coming out of the lurker woodwork and posting. It's always nice to hear from someone new.
JimNY,
Thanks for the link to the worldwide survival statistics - they were very interesting. I definitely have benefited from being in the US and having the CRD trial available to me.
Jan Stafl,
Glad I could provide food for thought during a dex night - I certainly had my share of those over the past two years and haven't missed them one bit since being off treatment for the past six weeks or so.
Jan Stafl, Mike,
I have to think there could be an approach to health care that would benefit everyone without crippling us financially. As I've been exposed to the cost of health care these past two years, I realize how lucky I am to have insurance and access to good health care. There are so many competing interests and differing opinions on how to handle health care, I wonder whether we can ever find a way to solve an need that should be fundamental to us as human beings.
Terry Lemasurier,
Your cost for insurance works out to only a bit more than what I pay based my employee contribution and my maximum out-of-pocket expense for the year. Fortunately, I have a good job and have been able to continue working. These kind of costs however, are more than the majority of people can afford. I often think that I might get to the point where I refuse further treatment if the cost becomes so high that it would leave my wife financially strapped if I died.
Great article Kevin, regardless of where we live and who actually pays for it the cost of treatment of MM is enormous.
In Australia we have Medicare, the public health care system that is paid through taxes. If you earn or your family earn over certain amounts you are taxed more if you dont have private health insurance. If you have private health insurance (We currently pay ~ $4000/year for the family) you can be treated in a public hospital and it is up to you to decide to either go in as a private patient or as a public patient. If you go in as a private patient your insurance company will be billed for your stay (usually there are no out of pocket expenses to you) the main difference is you might get a private room and the doctor of your choice. If you are being treated as a public outpatient in a public hospital you may not get the same doctor each time you visit. I can imagine for some newly diagnosed public patients it must be a bewildering experience.
The treatment side gets a little complicated with what is available on PBS (the pharmaceutical benefit scheme). Currently if a prescription is on PBS it will cost you ~$37 AUS or on a pension $5.90. Where it gets expensive is if the treatment is not on the PBS.
When I was first diagnosed Revlamid wasnt on the PBS (except for special circumstances) so a months supply was ~$28,000. Too bad if you have to be on it for 10 months. The pharmaceuticals are not paid for by private health insurance. My option was thalidomide which cost me $32/month for 9 months on PBS as opposed to $1400/month off PBS. I have been extremely lucky in my treatment as Velcade went on to the PBS ~2 months before I needed it. As it was an in hospital infusion I didn't pay for the drug but off PBS it would have been $7000 per dose (~$42,000 for a month). BUT there are restrictions to the availability of the drugs. For example with Velcade (at the time of my treatment) to be eligible for subsequent treatment after 4 cycles the paraprotein level has to drop by at least %50 - mine dropped by 45%! So no more Velcade - we couldn't have afforded to pay full price (thankfully I am in remission now from the allograft).
Would my treatment have been different if I lived in the states? Possibly. I really dont know. The shock of diagnosis, needing treatment quickly to relieve pressure off the spinal cord - would I or my husband have made an informed decision? Hindsight is a wonderful thing if you have it beforehand.
A change that I would like to see to our system in Australia for the treatment of MM is to ensure the identification of the mutations responsible for the disease are known prior to treatment. Then have the treatment specific for that mutation(s) (covered by PBS of course). One way I can see that happening is if a large number of MM patients have different treatments from the outset - that doesn't happen here.
Jan, I couldn't disagree with you more. Who is not getting treatment? If Oregon had the same number of illegal immigrants crossing it's border, Oregon's ER would be in the same boat as Texas.
When you and others change the argument from lack of insurance to lack of health care, it is so, so disingenuous. But enough uninformed voters heard it and believed it, so your side won.
I live in a community with 80% hispanics. Most of them are first and second generation in the US. They are friends of myself, wife and my children. They are "poor". But they all get free health care and have no insurance. I spent 2 days rooming with a homeless man at UCSF. We were both getting our SCT's. (No, he didn't just lay there and die, watching me get treatment)
It's too bad the anti Obama healthcare side didn't push the Health Savings Account option (Bush pushed for it, but was ignored). It puts the consumer back into the equation yet covers you for the big stuff. We pay $700 for my family of 5. I've had 2 SCTS, and 3 years of MM meds. After meeting a $11,000 deductable every year, the rest is free. Yes, we pay for breast exams, colonoscopies, and flu shots. But we pay about 1% the cost of cancer treatment. And that is what insurance should be for. I'm sure some would have to declare bankruptcy if in my shoes. When the sole bread winner gets cancer, bad things happen, but living is a risky endeavor. HSA's would work for the majority of families. And now, as indicated by Mike above, our plan will soon be destroyed by Obama Care in the next year. Blue Shield has bent over backwards and then some to provide me with the best possible care. I can choose any doctor I want. They even assigned me a specialist who stayed in email contact with us to guide us through the process.
And yes preexisting conditions needed to be dealt with, maximum life time coverage too. But to throw out the best health care system in the world because politicians and many in the media couched it as "lack of healthcare" is beyond wrong. I'm not even on Dex but this topic makes me fume.
Hi Stann,
It sounds as though you've had a positive experience with the health care available to you. But that level of care is not available to all. The fact remains that at least 50 million Americans have no health coverage and about a third of those are children. If it's important for the US to invest in infrastructure and technological advances in plant and equipment, how can we not invest in our people?
Your comment referring to ours as the best health care system in the world is far from accurate. Overall life expectancy and infant mortality place us embarrassingly below the top. In areas where specialty medicine provides a significant profit margin, we are number one. A consumer driven health care system is great if everyone has a job and thus the ability to consume. Unfortunately because of the damage the last recession did to the job base, employment is not recovering as rapidly as corporate profits. It follows that the unemployed and under employed have difficulty buying health coverage.
Fume away if you must. It's better than being forced to rely on the emergency room for health care.
Stephen, Thanks for reply. I'm post fume now, sort of.
It's just that I did everything right and now I'm going to be punished. I didn't get our health plan from a government job, a union job or even a business with an HR department to guide me through the process. I figured it out on my own, and I'm not the brightest bulb in the pack. I am flummoxed as to how the health care debate ignored the presence of Health Savings Accounts. Putting consumers back into the equation is what the system needed. If I can have my broken finger fixed for $900 instead of $10,000, and I do the research and realize both will give me same result, I'm going to save money and force the over charging facilities to get realistic. Instead, with non HSA insurance plans, we just look at the bills and laugh, because we have ZERO input into the charges. Fraud loves this environment, look at Medicare.
I did the right thing, got cancer and WAS prepared. Now I will be pushed out and into a government plan.
To borrow from Libby's experience..."With Velcade...to be eligible for subsequent treatment after 4 cycles the paraprotein level has to drop by at least %50 – mine dropped by 45%! So no more Velcade"
Can you imagine having that conversation with your doctor? "uh..chart says you only qualify for thalidomide" Is that really ok with you? I cannot imagine accepting that. If that doesn't bother you, would it bother you if it was your child getting treatment and the chart says nope, too expensive?
Those 50 million people you talk about ARE getting care. Not only did I share a room with a homeless man getting an SCT, down the hall was a prisoner getting the same (sheriff outside the door).
The issue is about the INSURED going bankrupt, and I believe HSA's have prevented many bankruptcies. Regular policies are good for broken arms etc, but bad for cancer. HSA's are bad for broken arms, but great for cancer. After $11,000 deductible is met, there is no cost sharing, no 80% of this, 20% of that. The bills all come with a big fat "0" due. Most bankruptcies occur when people start getting medical bills of $100K and more. You don't get those with HSA's. At this rate, I'm gonna have a heart attack before MM get's me....sorry if I went out of bounds.
Hi Stann, Well within bounds and an interesting point of view. HSAs are health savings accounts? How do they work outside of an employer offering? I've used them as supplementary vehicles that allowed one to put cash away before taxes. So $5000 coverage for a year and if over that the employee health plan kicked in. Do they now exist as a stand alone product?
Wow! The conversation is still going. To me the comments show the complexity of the economics of US health care, and the need to have the best minds propose the best way of expand equitable medical coverage. I agree that HSA accounts are useful (I use mine), but again, the great majority of Americans do not have them.
The organization Physicians for a National Health Program has great statistics to illustrate the problem of access, and practical solutions which only need political will. Despite efforts of some to preserve the status quo, with the attitude damn be everyone else, anyone researching this topic will realize that the present system is NOT sustainable.
I am one of the privileged, blessed to have good health insurance, similar to "fuming Stann". That does not make me blind to the real problems facing American health care. Compassion and generosity of spirit is needed to progress beyond self serving efforts to kill reform. Let the conversation continue, especially at the national and state level, where real progress needs to be made. Do not fear change; instead of being forced upon us, physicians and patients can be an integral part of it! No dex tonight, just gratitude for this forum. Thank you, Jan
Hi Jan,
I wouldn't call it "privileged" to have worked, done the due diligence and obtained good health insurance. Again I ask, who is not getting medical care? Where are these people?
We have so many Public Service Announcements promoting government services, how about PSA's that encourage young people to get insurance. Educate people about Health Savings Accounts. Educate people about getting insurance prior to "pre-existing conditions". HSA's are also great if you don't have cancer. When you retire, you can withdrawal the money not spent (pay a tax, but no penalty) and use it for whatever you want.
Steve, yes they are usually stand alone products. At the beginning of the year, we put $6000 into the account, pre-tax. Then we spend that money throughout the year for medical purposes. If we didn't spend it all, the amount grows and earns interest.
HSA's are the antithesis of the Affordable Care Act. They put consumers back into the picture. HSA's will be eliminated.
Stann
Really great article, we have the best treatment options available if you can afford it or have right insurance. I agree most with Suzanne she has experience with other developed countries. I am very grateful to the doctors we have, and, company my father works for, insurance we have, is “self-insured” meaning claims are paid by the employer and the insurance plan administered by an insurance company. Having said this I have seen "explanation of benefits" the costs are enormous. Some hospitals practice price gouging, refer patients unnecessarily to other doctors and perform unnecessary test to generate profit. ER doctors are told to admit patients if they know if patient is on Medicare or has good insurance and if they can easily justify. Hospitals have EMR (Electronic medical records) systems designs to tell doctors based on given symptoms and insurance if they should or should not admit a patient. I would say for about 90% of medical conditions one can get better treatment in other developed countries at a lower cost, for 10 percent of rare complicated diseases there is no place better than the US if you have the means. For example the cost of heart bypass surgery, Knee/hip replacement, and cost in the US will be 4 times more, all the profit going to hospitals. Switzerland and Germany are great example where everyone can get great health care, the government spends 12 percent of GDP on healthcare and everyone is covered. We spend 17 percent of our GDP on health care and have 50 million uninsured. We spend more money than anyone else and have the worse outcomes. Hospital reimbursement rates should be reduced, this will reduce insurance premiums. Also we have 400 insurance companies they represent overhead, they are middlemen denying care and skimming profits, our premium cost goes to their CEO salary and administrative staff. I am not proponent of single payer system; at the same time we also do not need to have 400 insurance companies. We should have 10 highly regulated insurance companies who will have negotiating power with hospitals and will spend 95 percent of premiums collected on healthcare claims not on CEO salaries. Hospital/Insurance companies are destroying our economy and draining US tax funded Medicare system. Some hospitals call themselves “nonprofit” and game the system by collecting millions from government grants and tax savings. Blue cross and blues shield save huge amount of money on taxes by being “nonprofit”.
I am a big believer in profits but not in price gouging, everyone is entitled to make money using their God given talents and skills. We should be able to shop for medical care the way we shop on Amazon.com everything should be transparent. No hidden prices, different prices for different groups of people.