Dear Santa:
This is truly a monumental moment for me. Being Jewish, I have never had the urge to write to you, but in the spirit of "change" and crossing over, I had this overwhelming need for audacious hope and a prayer. Being Jewish, I accept the stereotype of sometimes arriving late to the party. That said, my wishes are priceless if not timeless.
My list is short. I am only asking for reason and sensibility to come to our nation and our leaders. And, if you'll throw in ethical behavior and a sense of morality, I'll leave extra milk and cookies.
You see, even as a graduate of Wellesley in Economics, I can't grasp the concept of purchasing a "legal" swap in the face of selling short. Isn't that sort of like buying fire insurance while your house is burning and knowing that with the taxpayer's help, you'll recover your mortgage and enough to buy another luxury condo? I mean, talk about Christmas. Rep. Barney Frank and his buddies in Congress must have had a few too many hot toddies when they were thinking that they could actually regulate and mandate "toxic" mortgages for the poor and get the taxpayer to pay for their "vision."
My concern is that this same "team" is going to continue to make decisions affecting my future and the future of all our children. They are about to embark on decisions regarding the health of the nation.
To date, this discussion about health care reform really has me guessing what medication combination this country has been taking... clearly an overdose. It is not clear how we can rationally discuss "health" insurance. Health is not an insurable commodity. Rather, sickness is the unpredictable event that we might insure and health is an investment, like buying good shoes or wearing a warm coat (with a wool lining in the winter months).
Trying to insure the health of all Americans is likely to bankrupt the nation for sure. Massachusetts, a state smaller than the county of Los Angeles is already in financial trouble and they are only two years into their state system having insured an additional 3% of their residents. Hawaii had to pull the plug this year on its new state-funded health insurance program for children when it found out that virtually all of the children in the program previously had insurance, but their parents had dropped it in order to sign the children up for for the new taxpayer-funded program. (Now you see why I am asking for "reason.")
If you could just inject good sense into Secretary-designate Daschle's brain, maybe he would see the way to suggesting that the government might only provide catastrophic insurance (even in the Medicare program) and only for those who are not able to make their own purchase. I know that you can help our leaders with the intellectual argument that government controlled, population based health care is just not good for any individual person. It is politically correct and very expensive egalitarianism. But, if in the end, the reform we engage is reforming our government mandated insurance opportunities to mean ONLY catastrophic insurance for sickness or accident, we will have allowed for the purchase of valued additional health benefits in a free market. Santa, this is the rational conversation that I am putting at the top of my list of wishes. Americans deserve no less.
Reason would suggest that all Americans should make their own personal investment in their life and in their health. That was the intent of our forefathers when they constructed the constitution and established our protected rights. Those rights did NOT include any obligations on the part of the government to impose the services of hospitals, physicians, or employers to guarantee a level of health or preventive care. Our rights are our opportunities to engage and do not include obligations of any professional to serve us.
If we are going to legitimately engage reform, we must first confirm our duty to deal with confirmed fact. (I guess that is another wish. Could you spread a whiff of intellectual integrity over all the conversations about health reform?) Health is indefinable on a "population basis.” We resort to the discussion about insurance when we really want to talk about affordable accessible care. We have never been able to successfully "sell" health across a population. Let's stop that conversation before it bankrupts us further.
Reason would have us believe that every American deserves health care choices and that those choices should be "value based.” Reason would suggest that we need to make our health care delivery system transparent (that does not mean that the government has a right to any patient's health record). It is time that hospitals and doctors post retail prices. Rational health care purchases can only be made with information about cost and the specific utility for an individual patient.
And finally, Santa, as long as we are "facing the facts,” I would ask that we engage a societal debate about the morality of establishing law that defacto creates a class of citizens who are forced into retirement and Medicare at a defined age. Morally, the nation has decided to pay for the continued "health" for those seniors who are mandated into a (relative) non-productive state of co-dependence. But, that decision fails to protect the working public and sanctions an economically unsound system that robs the elderly of their opportunity for continued productivity and taxes "pre-seniors" far too heavily. That 1965 decision was about power and lacked reason and forethought.
It would seem that any debate about health care reform must include a much fuller discussion about all the social systems the government has mandated since 1965 when the nation established this new sense of moral collectivism… but forgot to fund it. Unfortunately, in that new "morality" the rights of individualism that were truly the basis of our constitution were thrown overboard, much like tea from a ship moored in Boston.
Santa, it is reason, rational thought, and responsible debate that every American deserves to hear in the Congressional deliberations about reforming the means by which we deliver sickness insurance and health opportunities to America’s patients. Most important, please infuse a new sense of respect for the rights of every individual to make their own choices for their health and for their life.
PS: next year… if all goes well, you’ll find physicians’ waiting rooms filled with patients eager to speak with their individual doctor about their personal health choices and that better day that our forefathers dreamt would be every American’s dream: the right to personally invest in life and health in pursuit of happiness.
Marcy Zwelling-Aamot, MD FACEP
562-596-7584
Los Alamitos, California
Saturday, January 3, 2009
Letter to the editor
Below is a letter to the editor in reference to this article..
Thank you so much for some very good suggestions about saving money while maintaining good health in your article Cut health costs, not your care, (December 9, 2008). I would like to add that investing in a medical home thru a physician engaged in a "direct practice" is another means of investing in your health. Providing a retainer up front to pay for all your care is a wonderful means of making sure that you have an ongoing relationship with a caring physician thru the year for relatively few dollars. Imagine being able to talk to your physician thru an email or having your doctor's cell phone number. Why waste money and time in a waiting room or an emergency room? Investing in a relationship with a primary care physician with your HSA or FSA dollars is a great opportunity to get the best care for fewer dollars and the cost of catastrophic insurance is far less than the usual HMO or PPO. Personal choice is not expensive and the value is "priceless."
Marcy L Zwelling-Aamot, MD FACEP
562-596-7584
Marcy@choicecare.md
From the Los Angeles Times
Cut health costs, not your care
Balancing your budget shouldn't mean your health pays the price. Here are smart ways to manage both.
This is an expanded first installment of an ongoing Health feature on cutting costs, not care--with tips for balancing your health and budget needs. Part one covers: Drugs, Doctor visits, Surgery, Flexible spending accounts, Preventive care, and Insurance.
By Francesca Lunzer Kritz
December 29, 2008
Amber Eyerly, 32, says she's never been much good at saving money. But with only minimal raises, at best, expected for 2009 at the Los Angeles public relations firm where she works, Eyerly carefully studied her health insurance benefits package this year to see where she could trim costs.
She made one cut for 2009 by signing up for a medical flexible spending account, which takes money, pre-tax, from each paycheck to spend on healthcare costs and reduces her taxable income. And when she read that, unlike trips to a specialist, visits to her primary care doctor don't require her to first pay down a health insurance deductible, Eyerly arranged to have her dermatology records for a minor skin condition sent to her primary care physician, who now writes prescriptions for any dermatology medicines the young executive needs.
Eyerly's personal health cost review is being repeated across the country, as the economic downturn worsens and jobs -- and the benefits that often come with them -- get slashed. "Millions of consumers are weighing their medical costs and trying to see what expenses they can jettison to save some money," says Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt. A Watson survey of 2,500 U.S. employees released this month found that 17% of those surveyed had avoided a recommended doctor's visit this year to save costs (the question was not asked in the firm's 2007 survey). And 17% did not fill a prescription or skipped doses of prescribed medicine, an increase from 13% in 2007.
But healthcare leaders worry that short-term savings could lead to serious illness, and even deaths. "We're seeing that consumers are willing to take risks by not doing what they perceive to be small things, such as putting off going to the doctor and deciding not to pay for medicines," says Dana Goldman, head of health economics at research firm Rand Corp. in Santa Monica. "That puts the individual at risk, but the potential harm doesn't stop with them," Goldman says. "It also becomes a problem for society if, for example, infections spread because some people don't fill a needed antibiotic prescription, or if an increase in hospitalizations for chronic illnesses places a deeper financial burden on a hospital or city."
Says J. James Rohack, president-elect of the American Medical Assn.: "Consumers need to take steps to stay healthy, such as getting exercise and losing weight, if necessary, and finding help through private and public channels to help pay for healthcare costs."
FLEXIBLE SPENDING ACCOUNTS
Save by reducing taxable income
Surprisingly, these accounts, offered by many companies, even small ones, are often not used by consumers -- so if you didn't sign up for 2009, consider it next time around. Employees of companies that offer the accounts can have set amounts (minimums and maximums are set by each company) taken from their paychecks pretax and put into these accounts to be used for health expenses as major as brain surgery or minor as contact lens solution. (Each company can decide what it will allow in its specific plan; you can get a good idea of allowed expenses under the federal government's flexible spending program at www.fsafeds.com/fsafeds/eligibleexpenses.asp. According to Laurie Brubaker, a benefits expert with Aetna, which administers some of these accounts for businesses, setting aside $2,000 from a salary of $25,000 will create a tax savings of $450. Use Aetna's calculator to match your allocation with your salary at www.aetnafsa.com/fsa/index.php.
Spend it or lose it
Many people often don't open an account because any money left at the end of the year is forfeited. Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt, suggests making a list of medical needs for the year, including prescription sunglasses and new contact lenses or a visit to the doctor to check on an allergy, and making those appointments before the benefit year ends. And remember: The money is deducted over the course of 12 months, but the full amount you choose to set aside is available to you from the first day of your benefit year.
DRUGS
Review what you take with a doctor
Shopping for lower prices isn't necessarily the first step you need to take if you want to lower your prescription drug bill, says Michael Cohen, president of the Institute for Safe Medication Practices in Horsham, Penn. First, review the drugs you take (a good practice once each year regardless, doctors say), to determine whether you still need the drug or that dose and whether you could safely substitute a less expensive option for the drug.
A visit with your doctor to review the drugs is your best bet. If you're concerned about the cost of the visit, you can ask if the doctor will go over your list by phone. (And see below for strategies to reduce the cost of an office visit.) A local pharmacist can also review your drug list and make suggestions to your physician for changes, but never stop taking a drug unless the doctor has specifically given you the OK.
Ask your pharmacist if your particular medicines can be split or if you can use two lower doses to make up the dose you need. Review the costs, including any co-pays. Those options can sometimes save money over the cost of buying the exact dose prescribed. Then . . .
Price shop
Sure, the corner drugstore may be convenient, but it may also be expensive. According to the National Center for Policy Analysis in Washington, D.C., comparing prices among local pharmacies can save consumers almost 10% on brand-name drugs and up to 81% on generic drugs. You can check comparison prices in your area at www.destinationrx.com, but also call the local pharmacy to confirm. And some pharmacies may match competitors' prices. Costco's prices for brand-name drugs often rank among the lowest, and the warehouse store doesn't require a membership fee for people buying only prescription medicines.
Don't assume Internet prices are cheapest. Local pharmacy prices for a 30-day supply of the cholesterol drug Lipitor (80-milligram dose) hovered around $83 recently. The same drug cost $119.99 at drugstore.com.
Go for the generic
This year, many pharmacies, supermarkets and big retail stores such as Walgreens, Ralphs and Target began offering hundreds of generic drugs for as low as $3 per month per prescription. Not all stores offer all generics for the low price, and the list can vary from chain to chain, so check by phone or at the store's website. CVS charges $10 per year for a savings pass that entitles cardholders to buy 90-day supplies of more than 400 generic drugs for $9.99 each. That fee also gets you some discounts on nonprescription drugs and on visits to its Minute Clinics, staffed by nurses who can give some vaccinations and treat minor illnesses. As the economy continues to falter, expect more deals from drugstore chains. Kmart, for example, lets many customers at most stores buy one of several nonprescription products such as pain relievers and a decongestant for the discounted price of $1 each time you buy a prescription, for a savings of about $3 to $6. Find the website addresses for the stores you frequent and sign up for alerts.
Buy in bulk
Sixty- and 90-day supplies of drugs are often cheaper by mail order and at retail stores than a 30-day supply. That's especially true for people with insurance coverage for prescription drugs; buy a 90-day supply and most insurers charge only a two-month co-pay, which can be a savings of at least $20 per year for each generic drug you take, and at least $80 per year for brand-name drugs. Consumer Reports Best Buy Drugs advises checking online prices, for U.S. and foreign pharmacies, at pharmacychecker.com. Use the price per pill to compare the costs on the site, and factor in the shipping costs that most sites charge. The Food and Drug Administration offers advice at www.fda.gov/buyonlineguide on buying drugs online through only verified Internet pharmacies.
Scout for coupons and offers
You can get discounts on some brand-name drugs by looking for coupons on the drug's website (plug the drug name into a search engine to find the site) or at www.internetdrugcoupons.com. Discounts can sometimes apply to co-pays as well.
Check out other cost-saving programs
Additional deals that can save you money include the Together Rx Access card, sponsored by 10 drug companies and offering discounts on many brand-name drugs, and the SunRx Discount health pass, sponsored by pharmacy benefits manager SunRx. Checkwww.togetherrxaccess.com or call (800) 444-4106 for income eligibility and the current list of drugs that qualify. Anyone without insurance (as well as many small business owners) can sign up and print out the SunRx card, which offers -- at participating pharmacies -- up to 15% on many brand-name drugs, up to 70% on many generic drugs and some money off nonprescription drugs. Sign up at www.sunrxdiscount.com/Healthpass or call (800) 650-3184.
DOCTOR VISITS
Delay may lead to serious problems
Even if you have insurance and are paying only a co-pay to see a physician, the costs can mount, especially if you have young children. But not seeing the doctor when necessary could result in a far more serious illness -- and far more serious costs, says Carolyn Clancy, head of the federal Agency for Healthcare Research and Quality (AHRQ). So . . .
Talk with your doctor
J. James Rohack, president-elect of the American Medical Assn., advises people facing economic problems to be upfront with their physicians about cost concerns. "The doctor cannot waive a co-pay required by insurance -- that's a part of his or her contract with insurers -- but doctors may be able to help with some costs, such as providing samples of certain medicines," he says. Consumer advocacy groups such as the Medicare Rights Center, based in Washington, D.C., and New York City, suggest trying to negotiate the fee if you're paying out of pocket. Doctors have to wait weeks to months for payment from insurers, and may be willing to forgo some profit for faster payment, says Paul Precht, communications and policy director for the group.
Insured? Stay in your network
If you do have insurance and have been seeing doctors outside your plan, ask physicians, colleagues or friends if they can recommend doctors from your list. That may mean saying goodbye to a trusted physician, but it can save you more than $100 on a single visit. Ask your out-of-network doctor if you can stay in touch by e-mail or phone if you have questions, and also ask if the doctor would consider joining your insurance network.
Try bartering
People who own their own business, such as plumbers or lawyers, may consider barter to help pay doctor fees. Joanne Levine, who owns a PR firm in Chicago, does public relations for a few companies in exchange for barter credits that go into an account with a bartering firm. Levine has used the credits to pay for care by a periodontist, an optometrist, a surgeon and a dermatologist. "But not very many general practitioners are registered with the firm I use," she says. There may be fees involved in maintaining a barter account, so this option may be best for people who pay for other expenses through bartering as well. Find information about barter memberships at www.bartermax.com or the International Reciprocal Trade Assn. at www.irta.com.
Go to a retail clinic
If you or a child has a minor problem such as a low fever, a scratchy throat or a minor skin infection, a retail clinic may be all you need. They're staffed by experienced health professionals, typically registered nurses or physicians' assistants. Fees are about $50 to $65 for a visit, often well below doctors' offices, and if you have insurance, you may be charged just a $10 or $20 co-pay, well below the cost of an emergency room visit co-pay or fee. Check the websites of clinics, such as Minute Clinic (owned by CVS), at www.minuteclinic.com and Take Care (owned by Walgreens), at www.takecarehealth.com; there may be a discount offer that can save you an additional $5 or $10.
Visit community health centers
These local clinics offer care on a sliding scale, based on income. If you're not eligible for free care, the centers will work with you on payment options, which could include helping you find financial assistance in your area.
INSURANCE
How to get -- or keep -- a policy
In danger of losing your job, and the health insurance that comes with it, in 2009? Take a breath. This is a topic we'll revisit often in 2009, but we have some basic advice right now.
Take COBRA
If you lose your job in 2009, before you officially leave the premises, ask the firm if it would consider paying for your health coverage for an extended period of time, says Emily Spitzer, executive director with the National Health Law Program in Washington, D.C. If not, and if the firm offers a COBRA (Consolidated Omnibus Budget Reconciliation Act) plan, sign up for it for at least in the short term. It's an opportunity to pay for the same health insurance you've had while employed with the company. Though firms are allowed to charge up to 102% of what they pay to cover you, and, if applicable, any dependents, it is likely to be the most comprehensive coverage for the least amount of money, Spitzer says. During that period, you can look at other health-insurance possibilities, including an employed spouse's insurance options, an individual policy and public assistance, if you qualify. But buy yourself that time. Remaining insured is important; not just because of a possible emergency, but also because an interruption in coverage for you, or for a dependent who has an ongoing medical problem, could mean a delay in coverage for a preexisting condition, even when you get the new job and its benefits.
Then do your research
Here are some resources that should help:
California's Health Consumer Alliance:
www.healthconsumer.org, a partnership of consumer-assistance programs;
Families USA:
www.familiesusa.org/consumer-info, a nonprofit seeking affordable healthcare for all Americans;
HealthCareCoach:
www.healthcarecoach.com, a project of the National Health Law Program.
SURGERY
Ask financial questions first
The AHRQ's Clancy says too often the only question patients have about surgery is where to park on the day of the operation. But many hospitals offer free parking for one car (with a patient's identification number), so don't worry excessively about that . . .
Talk with the hospital brass
Whether or not you have insurance, a meeting with a financial officer at the hospital could help with costs. Showing a willingness to pay, even if over time, can generate goodwill, says Mark Rukavina, executive director of the Access Project, based in Boston, an affordable healthcare advocacy group. Some hospital financial staff workers may work with your insurer ahead of time to let you know what costs will be covered and what you will have to pay out of pocket. If you can't pay, the financial office may be able to direct you to financial assistance options, or set up a payment schedule.
Don't agree to use a credit card or retirement account
Recently, articles in the Wall Street Journal and Business Week have reported on some hospitals running credit checks on patients seeking care, before treatment is even provided. In some cases the check has turned up assets such as an available credit limit on a credit card, or a 401(k) account, and the hospitals have asked patients to use those assets to guarantee and then pay their bill. Rukavina of the Access Project advises against using credit cards to pay medical bills unless you plan to pay the bill in full by the end of the month. If not, your medical bill rises by the monthly interest fee you pay, and not paying it can result in penalties and higher fees on all of your credit cards because of the changes to your credit score. And any early use of a 401(k) account will trigger penalties and leave you without resources for retirement, the reason you set up the account in the first place. If you are asked to use these resources, Rakavina advises asking to see the hospital's chief financial officer and to insist that you be allowed to set up an extended payment plan. Consumers who find themselves in this predicament can visit the Access Project website for assistance at www.accessproject.org.
Consider surgery in a foreign country
Medical tourism, having surgery in a foreign country such as Singapore or Thailand, has been making headlines as a lower-cost option for people without insurance -- surgeries can cost as much as 90% less, according to the Medical Tourism Assn., a trade organization. However, the National Business Group on Health, which advises large corporations about healthcare expenses, recently issued a brief that pointed out concerns about medical tourism, in addition to benefits, such as a risk to patients who speak English only but must interact with medical staff who do not. The American Medical Assn. says people who opt for surgery in a foreign country should arrange for a doctor to monitor them on their return. That, of course, would involve additional fees, especially if the doctor thinks follow-up care or even a repeat surgery is necessary.
So far, most insurance companies don't cover surgeries overseas, though WellPoint, which insures millions of Californians, is doing a trial run with a small company in Seattle. If successful, WellPoint and others could cover the option for a larger number of people beginning in 2010. Because of the huge cost savings, largely due to lower salaries and lower-cost malpractice insurance in many foreign countries, insurers could decide to waive all co-pays for foreign surgeries, in addition to covering travel and lodging costs for the patient, and, often for a travel companion as well. For more information, have a look at the Medical Tourism Assn.'s website at www.medicaltourismassociation.com, or contact PlanetHospital, a firm in Calabasas that arranges surgical care overseas.
At least one company, North American Surgery Inc., based in Vancouver, Canada ( www.northamericansurgery.com), negotiates on behalf of individuals and small companies and is able to offer prices for many surgeries at U.S. hospitals that can rival foreign rates. The company checks on accreditation and even patient outcomes before signing on with surgeons and hospitals, but you'll want to check on your own as well, and ask your primary-care doctor to speak with the surgeon you choose.
PREVENTIVE CARE
Early detection can pay off
Even if you have no known health problems, certain tests such as mammograms and prostate exams should be done regularly so that any indication of a problem can be detected as early as possible, Clancy says. AHRQ recently created test checklists for men,www.ahrq.gov/ppip/men50.htm, and for women, www.ahrq.gov/ppip/women50.htm. And . . .
Look for free or low-cost screenings
Many associations offer free screenings for many conditions at certain times of the year. Type the name of the condition and the word "screening" into a search engine to see what's available. In the Los Angeles area, screening dates are often posted at www.healthycity.com, or you can find some free tests by calling 211. Type in "health observation days" at healthfinder.gov and you'll find a calendar with an observance day for just about every disease. Organizations often hold screening programs on those days, and websites for hundreds of organizations that offer information, and, often, free or low-cost tests are listed.
Look after yourself
The AMA recently introduced a program called Healthier Life Steps -- a guide for consumers with or without their physicians. Go to www.ama-assn.org/ama/pub/category/18471 .html. The point here is that by stopping smoking, losing weight, exercising and controlling chronic diseases, Americans can save money on healthcare and be healthier. For example, when Mike Huckabee, the former governor of Arkansas and a presidential candidate, was diagnosed with diabetes, he opted for losing weight and exercising and never took -- and so never spent money on -- any medication.
health@latimes.com
___
Thank you so much for some very good suggestions about saving money while maintaining good health in your article Cut health costs, not your care, (December 9, 2008). I would like to add that investing in a medical home thru a physician engaged in a "direct practice" is another means of investing in your health. Providing a retainer up front to pay for all your care is a wonderful means of making sure that you have an ongoing relationship with a caring physician thru the year for relatively few dollars. Imagine being able to talk to your physician thru an email or having your doctor's cell phone number. Why waste money and time in a waiting room or an emergency room? Investing in a relationship with a primary care physician with your HSA or FSA dollars is a great opportunity to get the best care for fewer dollars and the cost of catastrophic insurance is far less than the usual HMO or PPO. Personal choice is not expensive and the value is "priceless."
Marcy L Zwelling-Aamot, MD FACEP
562-596-7584
Marcy@choicecare.md
From the Los Angeles Times
Cut health costs, not your care
Balancing your budget shouldn't mean your health pays the price. Here are smart ways to manage both.
This is an expanded first installment of an ongoing Health feature on cutting costs, not care--with tips for balancing your health and budget needs. Part one covers: Drugs, Doctor visits, Surgery, Flexible spending accounts, Preventive care, and Insurance.
By Francesca Lunzer Kritz
December 29, 2008
Amber Eyerly, 32, says she's never been much good at saving money. But with only minimal raises, at best, expected for 2009 at the Los Angeles public relations firm where she works, Eyerly carefully studied her health insurance benefits package this year to see where she could trim costs.
She made one cut for 2009 by signing up for a medical flexible spending account, which takes money, pre-tax, from each paycheck to spend on healthcare costs and reduces her taxable income. And when she read that, unlike trips to a specialist, visits to her primary care doctor don't require her to first pay down a health insurance deductible, Eyerly arranged to have her dermatology records for a minor skin condition sent to her primary care physician, who now writes prescriptions for any dermatology medicines the young executive needs.
Eyerly's personal health cost review is being repeated across the country, as the economic downturn worsens and jobs -- and the benefits that often come with them -- get slashed. "Millions of consumers are weighing their medical costs and trying to see what expenses they can jettison to save some money," says Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt. A Watson survey of 2,500 U.S. employees released this month found that 17% of those surveyed had avoided a recommended doctor's visit this year to save costs (the question was not asked in the firm's 2007 survey). And 17% did not fill a prescription or skipped doses of prescribed medicine, an increase from 13% in 2007.
But healthcare leaders worry that short-term savings could lead to serious illness, and even deaths. "We're seeing that consumers are willing to take risks by not doing what they perceive to be small things, such as putting off going to the doctor and deciding not to pay for medicines," says Dana Goldman, head of health economics at research firm Rand Corp. in Santa Monica. "That puts the individual at risk, but the potential harm doesn't stop with them," Goldman says. "It also becomes a problem for society if, for example, infections spread because some people don't fill a needed antibiotic prescription, or if an increase in hospitalizations for chronic illnesses places a deeper financial burden on a hospital or city."
Says J. James Rohack, president-elect of the American Medical Assn.: "Consumers need to take steps to stay healthy, such as getting exercise and losing weight, if necessary, and finding help through private and public channels to help pay for healthcare costs."
FLEXIBLE SPENDING ACCOUNTS
Save by reducing taxable income
Surprisingly, these accounts, offered by many companies, even small ones, are often not used by consumers -- so if you didn't sign up for 2009, consider it next time around. Employees of companies that offer the accounts can have set amounts (minimums and maximums are set by each company) taken from their paychecks pretax and put into these accounts to be used for health expenses as major as brain surgery or minor as contact lens solution. (Each company can decide what it will allow in its specific plan; you can get a good idea of allowed expenses under the federal government's flexible spending program at www.fsafeds.com/fsafeds/eligibleexpenses.asp. According to Laurie Brubaker, a benefits expert with Aetna, which administers some of these accounts for businesses, setting aside $2,000 from a salary of $25,000 will create a tax savings of $450. Use Aetna's calculator to match your allocation with your salary at www.aetnafsa.com/fsa/index.php.
Spend it or lose it
Many people often don't open an account because any money left at the end of the year is forfeited. Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt, suggests making a list of medical needs for the year, including prescription sunglasses and new contact lenses or a visit to the doctor to check on an allergy, and making those appointments before the benefit year ends. And remember: The money is deducted over the course of 12 months, but the full amount you choose to set aside is available to you from the first day of your benefit year.
DRUGS
Review what you take with a doctor
Shopping for lower prices isn't necessarily the first step you need to take if you want to lower your prescription drug bill, says Michael Cohen, president of the Institute for Safe Medication Practices in Horsham, Penn. First, review the drugs you take (a good practice once each year regardless, doctors say), to determine whether you still need the drug or that dose and whether you could safely substitute a less expensive option for the drug.
A visit with your doctor to review the drugs is your best bet. If you're concerned about the cost of the visit, you can ask if the doctor will go over your list by phone. (And see below for strategies to reduce the cost of an office visit.) A local pharmacist can also review your drug list and make suggestions to your physician for changes, but never stop taking a drug unless the doctor has specifically given you the OK.
Ask your pharmacist if your particular medicines can be split or if you can use two lower doses to make up the dose you need. Review the costs, including any co-pays. Those options can sometimes save money over the cost of buying the exact dose prescribed. Then . . .
Price shop
Sure, the corner drugstore may be convenient, but it may also be expensive. According to the National Center for Policy Analysis in Washington, D.C., comparing prices among local pharmacies can save consumers almost 10% on brand-name drugs and up to 81% on generic drugs. You can check comparison prices in your area at www.destinationrx.com, but also call the local pharmacy to confirm. And some pharmacies may match competitors' prices. Costco's prices for brand-name drugs often rank among the lowest, and the warehouse store doesn't require a membership fee for people buying only prescription medicines.
Don't assume Internet prices are cheapest. Local pharmacy prices for a 30-day supply of the cholesterol drug Lipitor (80-milligram dose) hovered around $83 recently. The same drug cost $119.99 at drugstore.com.
Go for the generic
This year, many pharmacies, supermarkets and big retail stores such as Walgreens, Ralphs and Target began offering hundreds of generic drugs for as low as $3 per month per prescription. Not all stores offer all generics for the low price, and the list can vary from chain to chain, so check by phone or at the store's website. CVS charges $10 per year for a savings pass that entitles cardholders to buy 90-day supplies of more than 400 generic drugs for $9.99 each. That fee also gets you some discounts on nonprescription drugs and on visits to its Minute Clinics, staffed by nurses who can give some vaccinations and treat minor illnesses. As the economy continues to falter, expect more deals from drugstore chains. Kmart, for example, lets many customers at most stores buy one of several nonprescription products such as pain relievers and a decongestant for the discounted price of $1 each time you buy a prescription, for a savings of about $3 to $6. Find the website addresses for the stores you frequent and sign up for alerts.
Buy in bulk
Sixty- and 90-day supplies of drugs are often cheaper by mail order and at retail stores than a 30-day supply. That's especially true for people with insurance coverage for prescription drugs; buy a 90-day supply and most insurers charge only a two-month co-pay, which can be a savings of at least $20 per year for each generic drug you take, and at least $80 per year for brand-name drugs. Consumer Reports Best Buy Drugs advises checking online prices, for U.S. and foreign pharmacies, at pharmacychecker.com. Use the price per pill to compare the costs on the site, and factor in the shipping costs that most sites charge. The Food and Drug Administration offers advice at www.fda.gov/buyonlineguide on buying drugs online through only verified Internet pharmacies.
Scout for coupons and offers
You can get discounts on some brand-name drugs by looking for coupons on the drug's website (plug the drug name into a search engine to find the site) or at www.internetdrugcoupons.com. Discounts can sometimes apply to co-pays as well.
Check out other cost-saving programs
Additional deals that can save you money include the Together Rx Access card, sponsored by 10 drug companies and offering discounts on many brand-name drugs, and the SunRx Discount health pass, sponsored by pharmacy benefits manager SunRx. Checkwww.togetherrxaccess.com or call (800) 444-4106 for income eligibility and the current list of drugs that qualify. Anyone without insurance (as well as many small business owners) can sign up and print out the SunRx card, which offers -- at participating pharmacies -- up to 15% on many brand-name drugs, up to 70% on many generic drugs and some money off nonprescription drugs. Sign up at www.sunrxdiscount.com/Healthpass or call (800) 650-3184.
DOCTOR VISITS
Delay may lead to serious problems
Even if you have insurance and are paying only a co-pay to see a physician, the costs can mount, especially if you have young children. But not seeing the doctor when necessary could result in a far more serious illness -- and far more serious costs, says Carolyn Clancy, head of the federal Agency for Healthcare Research and Quality (AHRQ). So . . .
Talk with your doctor
J. James Rohack, president-elect of the American Medical Assn., advises people facing economic problems to be upfront with their physicians about cost concerns. "The doctor cannot waive a co-pay required by insurance -- that's a part of his or her contract with insurers -- but doctors may be able to help with some costs, such as providing samples of certain medicines," he says. Consumer advocacy groups such as the Medicare Rights Center, based in Washington, D.C., and New York City, suggest trying to negotiate the fee if you're paying out of pocket. Doctors have to wait weeks to months for payment from insurers, and may be willing to forgo some profit for faster payment, says Paul Precht, communications and policy director for the group.
Insured? Stay in your network
If you do have insurance and have been seeing doctors outside your plan, ask physicians, colleagues or friends if they can recommend doctors from your list. That may mean saying goodbye to a trusted physician, but it can save you more than $100 on a single visit. Ask your out-of-network doctor if you can stay in touch by e-mail or phone if you have questions, and also ask if the doctor would consider joining your insurance network.
Try bartering
People who own their own business, such as plumbers or lawyers, may consider barter to help pay doctor fees. Joanne Levine, who owns a PR firm in Chicago, does public relations for a few companies in exchange for barter credits that go into an account with a bartering firm. Levine has used the credits to pay for care by a periodontist, an optometrist, a surgeon and a dermatologist. "But not very many general practitioners are registered with the firm I use," she says. There may be fees involved in maintaining a barter account, so this option may be best for people who pay for other expenses through bartering as well. Find information about barter memberships at www.bartermax.com or the International Reciprocal Trade Assn. at www.irta.com.
Go to a retail clinic
If you or a child has a minor problem such as a low fever, a scratchy throat or a minor skin infection, a retail clinic may be all you need. They're staffed by experienced health professionals, typically registered nurses or physicians' assistants. Fees are about $50 to $65 for a visit, often well below doctors' offices, and if you have insurance, you may be charged just a $10 or $20 co-pay, well below the cost of an emergency room visit co-pay or fee. Check the websites of clinics, such as Minute Clinic (owned by CVS), at www.minuteclinic.com and Take Care (owned by Walgreens), at www.takecarehealth.com; there may be a discount offer that can save you an additional $5 or $10.
Visit community health centers
These local clinics offer care on a sliding scale, based on income. If you're not eligible for free care, the centers will work with you on payment options, which could include helping you find financial assistance in your area.
INSURANCE
How to get -- or keep -- a policy
In danger of losing your job, and the health insurance that comes with it, in 2009? Take a breath. This is a topic we'll revisit often in 2009, but we have some basic advice right now.
Take COBRA
If you lose your job in 2009, before you officially leave the premises, ask the firm if it would consider paying for your health coverage for an extended period of time, says Emily Spitzer, executive director with the National Health Law Program in Washington, D.C. If not, and if the firm offers a COBRA (Consolidated Omnibus Budget Reconciliation Act) plan, sign up for it for at least in the short term. It's an opportunity to pay for the same health insurance you've had while employed with the company. Though firms are allowed to charge up to 102% of what they pay to cover you, and, if applicable, any dependents, it is likely to be the most comprehensive coverage for the least amount of money, Spitzer says. During that period, you can look at other health-insurance possibilities, including an employed spouse's insurance options, an individual policy and public assistance, if you qualify. But buy yourself that time. Remaining insured is important; not just because of a possible emergency, but also because an interruption in coverage for you, or for a dependent who has an ongoing medical problem, could mean a delay in coverage for a preexisting condition, even when you get the new job and its benefits.
Then do your research
Here are some resources that should help:
California's Health Consumer Alliance:
www.healthconsumer.org, a partnership of consumer-assistance programs;
Families USA:
www.familiesusa.org/consumer-info, a nonprofit seeking affordable healthcare for all Americans;
HealthCareCoach:
www.healthcarecoach.com, a project of the National Health Law Program.
SURGERY
Ask financial questions first
The AHRQ's Clancy says too often the only question patients have about surgery is where to park on the day of the operation. But many hospitals offer free parking for one car (with a patient's identification number), so don't worry excessively about that . . .
Talk with the hospital brass
Whether or not you have insurance, a meeting with a financial officer at the hospital could help with costs. Showing a willingness to pay, even if over time, can generate goodwill, says Mark Rukavina, executive director of the Access Project, based in Boston, an affordable healthcare advocacy group. Some hospital financial staff workers may work with your insurer ahead of time to let you know what costs will be covered and what you will have to pay out of pocket. If you can't pay, the financial office may be able to direct you to financial assistance options, or set up a payment schedule.
Don't agree to use a credit card or retirement account
Recently, articles in the Wall Street Journal and Business Week have reported on some hospitals running credit checks on patients seeking care, before treatment is even provided. In some cases the check has turned up assets such as an available credit limit on a credit card, or a 401(k) account, and the hospitals have asked patients to use those assets to guarantee and then pay their bill. Rukavina of the Access Project advises against using credit cards to pay medical bills unless you plan to pay the bill in full by the end of the month. If not, your medical bill rises by the monthly interest fee you pay, and not paying it can result in penalties and higher fees on all of your credit cards because of the changes to your credit score. And any early use of a 401(k) account will trigger penalties and leave you without resources for retirement, the reason you set up the account in the first place. If you are asked to use these resources, Rakavina advises asking to see the hospital's chief financial officer and to insist that you be allowed to set up an extended payment plan. Consumers who find themselves in this predicament can visit the Access Project website for assistance at www.accessproject.org.
Consider surgery in a foreign country
Medical tourism, having surgery in a foreign country such as Singapore or Thailand, has been making headlines as a lower-cost option for people without insurance -- surgeries can cost as much as 90% less, according to the Medical Tourism Assn., a trade organization. However, the National Business Group on Health, which advises large corporations about healthcare expenses, recently issued a brief that pointed out concerns about medical tourism, in addition to benefits, such as a risk to patients who speak English only but must interact with medical staff who do not. The American Medical Assn. says people who opt for surgery in a foreign country should arrange for a doctor to monitor them on their return. That, of course, would involve additional fees, especially if the doctor thinks follow-up care or even a repeat surgery is necessary.
So far, most insurance companies don't cover surgeries overseas, though WellPoint, which insures millions of Californians, is doing a trial run with a small company in Seattle. If successful, WellPoint and others could cover the option for a larger number of people beginning in 2010. Because of the huge cost savings, largely due to lower salaries and lower-cost malpractice insurance in many foreign countries, insurers could decide to waive all co-pays for foreign surgeries, in addition to covering travel and lodging costs for the patient, and, often for a travel companion as well. For more information, have a look at the Medical Tourism Assn.'s website at www.medicaltourismassociation.com, or contact PlanetHospital, a firm in Calabasas that arranges surgical care overseas.
At least one company, North American Surgery Inc., based in Vancouver, Canada ( www.northamericansurgery.com), negotiates on behalf of individuals and small companies and is able to offer prices for many surgeries at U.S. hospitals that can rival foreign rates. The company checks on accreditation and even patient outcomes before signing on with surgeons and hospitals, but you'll want to check on your own as well, and ask your primary-care doctor to speak with the surgeon you choose.
PREVENTIVE CARE
Early detection can pay off
Even if you have no known health problems, certain tests such as mammograms and prostate exams should be done regularly so that any indication of a problem can be detected as early as possible, Clancy says. AHRQ recently created test checklists for men,www.ahrq.gov/ppip/men50.htm, and for women, www.ahrq.gov/ppip/women50.htm. And . . .
Look for free or low-cost screenings
Many associations offer free screenings for many conditions at certain times of the year. Type the name of the condition and the word "screening" into a search engine to see what's available. In the Los Angeles area, screening dates are often posted at www.healthycity.com, or you can find some free tests by calling 211. Type in "health observation days" at healthfinder.gov and you'll find a calendar with an observance day for just about every disease. Organizations often hold screening programs on those days, and websites for hundreds of organizations that offer information, and, often, free or low-cost tests are listed.
Look after yourself
The AMA recently introduced a program called Healthier Life Steps -- a guide for consumers with or without their physicians. Go to www.ama-assn.org/ama/pub/category/18471 .html. The point here is that by stopping smoking, losing weight, exercising and controlling chronic diseases, Americans can save money on healthcare and be healthier. For example, when Mike Huckabee, the former governor of Arkansas and a presidential candidate, was diagnosed with diabetes, he opted for losing weight and exercising and never took -- and so never spent money on -- any medication.
health@latimes.com
___
Doing the numbers on medical tourism - is it worth it?
Carol Lloyd
Friday, January 2, 2009
What with the glories of the new, new economy, it's easy to imagine consigning "health and fitness" to the ash heap of personal history. Remember when we could afford yoga and Pilates? Or when we didn't price-shop for vitamins?
During rough economic times, big-ticket treatments not covered by insurance pose an even greater challenge. If you need knee surgery, or back rehab, or God forbid, the dental nightmare my husband faced last year - two crowns, two fillings and two root canals to the tune of $3,700 - it may be time to think selfishly, act globally and consider the benefits of medical travel.
Patients have been crisscrossing the globe in search of better, cheaper and more expedient health care for centuries. Legend has it that ancient Greeks traveled to the coastal city of Epidaurus for cures. Twenty years ago, the phrase "medical tourism" generally evoked images of bargain-basement boob jobs, not state-of-the-art heart surgery. But in the past few years, increasing numbers of Americans (along with Canadians and Europeans weary of long waiting periods) have begun globetrotting for pricey procedures.
With more countries - from Singapore to South Korea - building modern hospitals catering to First-World patients and accreditation organizations vetting them for quality, the industry is developing the standards and protocols that will allow medical tourism to go mainstream.
"For a long time, some people said it was just a fad," says Melissa Skelton with the Medical Tourism Association, a nonprofit organization that sponsors the Medical Travel Congress and publishes Medical Tourism Magazine. "Now with the economy and the credit crisis, more people are waking up and paying attention."
Indeed, for the 47 million uninsured Americans, boarding a plane to see the doctor already offers an irresistible two-for-one: travel the world and save money. But if insurance companies and employers embrace and incentivize medical outsourcing, the profile of the medical tourist will change. Joining the armies of un- and under-insured Americans will be fully insured patients who are getting extra perks to cross borders for treatment.
A recent study by Deloitte Center for Health Solutions concluded that the number of Americans traveling for medical care will soar: from 750,000 last year to 6 million in 2010. Although some experts question that prediction, most agree that medical tourism has the potential to transform the way Americans access health care.
"I'm not sure the numbers will rise that fast, but it's growing," said Patricia Look, a benefits and compensation analyst with J. J. Keller & Associates, whose recent white paper explored the rise of institution-sponsored medical tourism. In her paper she profiled a handful of early-adopting employers and insurance companies that are offering elements of medical tourism as a part of their health plans. "Institutions are slowly jumping on the bandwagon."
Not surprisingly, the good doctors at the American Medical Association haven't issued a ringing endorsement of this medical outsourcing. They rightly caution that a lack of legal recourse in case of medical malpractice and doctor and hospital credentialing makes medical trips potentially dangerous. Yet earlier this year they did issue guidelines suggesting that they know which way the trade winds are blowing. (The guidelines recommend seeking care from accredited hospitals, bringing medical records, learning about legal rights regarding malpractice and understanding the risks of long-distance travel after procedures.) Also, a number of major medical centers - including Duke Medical Center, John Hopkins Medical Center and Columbia University Medical Center - have partnered with international hospitals, indicating a growing awareness that medical tourism is here to stay.
While experts calculate medical tourism's benefits for institutions, my family's experience offers testimony of its appeal for individuals. During a recent trip to Costa Rica, my husband got his dental work done for a fraction of the American price - about $950 - paying for the price of the rest of the trip. Encouraged by his gleaming smile, I subjected myself to "Chequeos Medicos Plan B" - one of several preventive health exams offered at CIMA, a brand-new hospital in San José, run by the Dallas-based hospital chain. In six hours, I received a mammogram, full blood work, fecal and urinalysis, cardio stress test, abdominal ultrasound, chest X-rays, eye exam, meeting with an internist, consultation with a nutritionist and breakfast for $397. By my calculations, I would have spent several thousand dollars for the same number of tests and it would have taken no fewer than 10 visits to the doctor spread over weeks or even months.
No trip into any hospital nowadays guarantees a safe return for your body, but some certainly promise a better return on your buck.--
Freelance writer Carol Lloyd is the author of "Creating a Life Worth Living."
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/01/02/CM6314G2BV.DTL
This article appeared on page P - 4 of the San Francisco Chronicle
© 2009 Hearst Communications Inc. | Privacy Policy | Feedback | RSS Feeds | FAQ | Site Index | Contact
Friday, January 2, 2009
What with the glories of the new, new economy, it's easy to imagine consigning "health and fitness" to the ash heap of personal history. Remember when we could afford yoga and Pilates? Or when we didn't price-shop for vitamins?
During rough economic times, big-ticket treatments not covered by insurance pose an even greater challenge. If you need knee surgery, or back rehab, or God forbid, the dental nightmare my husband faced last year - two crowns, two fillings and two root canals to the tune of $3,700 - it may be time to think selfishly, act globally and consider the benefits of medical travel.
Patients have been crisscrossing the globe in search of better, cheaper and more expedient health care for centuries. Legend has it that ancient Greeks traveled to the coastal city of Epidaurus for cures. Twenty years ago, the phrase "medical tourism" generally evoked images of bargain-basement boob jobs, not state-of-the-art heart surgery. But in the past few years, increasing numbers of Americans (along with Canadians and Europeans weary of long waiting periods) have begun globetrotting for pricey procedures.
With more countries - from Singapore to South Korea - building modern hospitals catering to First-World patients and accreditation organizations vetting them for quality, the industry is developing the standards and protocols that will allow medical tourism to go mainstream.
"For a long time, some people said it was just a fad," says Melissa Skelton with the Medical Tourism Association, a nonprofit organization that sponsors the Medical Travel Congress and publishes Medical Tourism Magazine. "Now with the economy and the credit crisis, more people are waking up and paying attention."
Indeed, for the 47 million uninsured Americans, boarding a plane to see the doctor already offers an irresistible two-for-one: travel the world and save money. But if insurance companies and employers embrace and incentivize medical outsourcing, the profile of the medical tourist will change. Joining the armies of un- and under-insured Americans will be fully insured patients who are getting extra perks to cross borders for treatment.
A recent study by Deloitte Center for Health Solutions concluded that the number of Americans traveling for medical care will soar: from 750,000 last year to 6 million in 2010. Although some experts question that prediction, most agree that medical tourism has the potential to transform the way Americans access health care.
"I'm not sure the numbers will rise that fast, but it's growing," said Patricia Look, a benefits and compensation analyst with J. J. Keller & Associates, whose recent white paper explored the rise of institution-sponsored medical tourism. In her paper she profiled a handful of early-adopting employers and insurance companies that are offering elements of medical tourism as a part of their health plans. "Institutions are slowly jumping on the bandwagon."
Not surprisingly, the good doctors at the American Medical Association haven't issued a ringing endorsement of this medical outsourcing. They rightly caution that a lack of legal recourse in case of medical malpractice and doctor and hospital credentialing makes medical trips potentially dangerous. Yet earlier this year they did issue guidelines suggesting that they know which way the trade winds are blowing. (The guidelines recommend seeking care from accredited hospitals, bringing medical records, learning about legal rights regarding malpractice and understanding the risks of long-distance travel after procedures.) Also, a number of major medical centers - including Duke Medical Center, John Hopkins Medical Center and Columbia University Medical Center - have partnered with international hospitals, indicating a growing awareness that medical tourism is here to stay.
While experts calculate medical tourism's benefits for institutions, my family's experience offers testimony of its appeal for individuals. During a recent trip to Costa Rica, my husband got his dental work done for a fraction of the American price - about $950 - paying for the price of the rest of the trip. Encouraged by his gleaming smile, I subjected myself to "Chequeos Medicos Plan B" - one of several preventive health exams offered at CIMA, a brand-new hospital in San José, run by the Dallas-based hospital chain. In six hours, I received a mammogram, full blood work, fecal and urinalysis, cardio stress test, abdominal ultrasound, chest X-rays, eye exam, meeting with an internist, consultation with a nutritionist and breakfast for $397. By my calculations, I would have spent several thousand dollars for the same number of tests and it would have taken no fewer than 10 visits to the doctor spread over weeks or even months.
No trip into any hospital nowadays guarantees a safe return for your body, but some certainly promise a better return on your buck.--
Freelance writer Carol Lloyd is the author of "Creating a Life Worth Living."
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/01/02/CM6314G2BV.DTL
This article appeared on page P - 4 of the San Francisco Chronicle
© 2009 Hearst Communications Inc. | Privacy Policy | Feedback | RSS Feeds | FAQ | Site Index | Contact
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