Why You Need a Second Opinion

Early in the summer I wrote about a good friend who was diagnosed with ovarian cysts and endometriosis. She saw a gyn oncologist because there was a small chance it was cancer (thankfully, it wasn’t). The doctor drained the cyst and started my friend on  oral contraceptives to control the hormonal shifts that contribute to endometriosis (which contributes to the cysts).

A couple of weeks ago, however, my friend texted me to say that her leg/foot was really hurting. She thought she might have a deep vein problem. I immediately told her to go to urgent care because it might be a blood clot, which can be quite serious. Her own primary care physician had left his practice, so found another that took her insurance.

Here’s her story:

“I went to the primary care physician my insurance company recommended. I specifically asked her if my leg problem could be a blood clot and she said “no” and sent me to a sports medicine …Continue reading…

Should You Listen to Your Doctor?

When I speak about the US healthcare system, I always like to tell the story of my mother. A couple of years ago, she emailed my sisters and I. “Good news!” she wrote. “My nuclear stress test was normal!” (The test  involves injecting a radioactive dye into a vein after which a special camera scans the heart to determine if there are any blockages).

At the time, my mother was 70 and, with the exception of very-well-controlled high blood pressure (that she’d had all her life), extremely healthy. No sign of heart disease. No angina. No shortness of breath. In short, no indications for an expensive, invasive, potentially dangerous, test. So why, I asked her, did she have the test? “Because my doctor told me it was time,” she said.

At which point I began banging my head against the wall.

Even regular stress tests (where you run on a treadmill or ride a bike) are only recommended in people with heart disease …Continue reading…

How Much is Three Extra Months Worth?

I’m in the middle of a project about the future of cancer care in this country. And you can’t talk about cancer treatment these days without also talking about cost. That’s because cancer drugs are among the most expensive in the world, with several costing more than $100,000 a year. If you have a 20% copayment, that means $20,000 out of your pocket.

Yet most of these drugs extend life just a few months and most have significant side effects.

Let’s take a look at one drug approved this year: Zykadia, indicated for a type of late-stage lung cancer. It costs $13,200 a month, or $158,000 a year. It works exactly the same a drug approved three years earlier for the same type of cancer, Xalkori, which costs about $2,000 a month less (although still pricy at $11,500 a month). In clinical trials, it staved off cancer progression for a median of seven months (meaning half the patients in the trial …Continue reading…

Welcome to the Roller Coaster Ride of the Affordable Care Act

I’m behind in the blog, I admit it. Last week I was planning a blog on all the good news about the Affordable Care Act (ACA), including the 10 million people who signed up; the lower-than-expected premiums; the lower-than-anticipated medical inflation predicted for the coming year, the result of which is due, at least in part, to the ACA.

Then came the ruling from a federal circuit court that the government could not provide subsidies for people to buy health insurance in states that did not set up their own exchanges. The ruling comes from a couple of sentences in the huge bill (about 900 pages) that states that the subsidies are available for people who sign up through state exchanges. Of course, that was when we thought the states would all set up their own exchanges (since the feds were paying for it).

How naïve were we?

Today, just 16 states and the District of Columbia run their own exchanges, with residents …Continue reading…

Help! I’ve Lost My Insurance and I Can’t Get Up!

The serendipity of the universe never ceases to amaze me. A couple of days ago I gave the keynote speech on healthcare reform at the Texas Medical Association’s CME Association’s annual meeting in Austin. A physician in the audience brought up an issue that was trumpeted in the press when the health care exchanges rolled out for open enrollment; namely, that people had lost their insurance and couldn’t see their doctors. I knew that a very small minority of people had actually “lost” their insurance, and that, in most cases, that insurance provided pretty bad coverage at fairly high prices. But I didn’t want to get into it with him, so I just agreed that yes, the Affordable Care Act certainly has flaws, then moved on to the next question.

If only I’d checked the news before my talk. I could have told him about a Kaiser Family Foundation survey of non-group enrollees (ie, they don’t have employer-provided insurance and bought …Continue reading…

74 and Counting. . . Why Gun Control is a Public Health Issue

This map shows every school shooting since December 14, 2012–the Sandy Hook Elementary School massacre. Don’t bother counting — there are 74. The only reason the map won’t break 100 in the next two months is that school is out for the summer.

Certainly, this is a moral issue. And a political issue. But first and foremost, the issue of gun control is a public health issue.

As the Johns Hopkins Center for Gun Policy and Research notes: “More than 31,000 people a year in the United States die from gunshot wounds. Because victims are disproportionately young, gun violence is one of the leading causes of premature mortality in the U.S. In addition to these deaths, in 2010, there were an estimated 337,960 non-fatal violent crimes committed with guns,2 and 73,505 persons treated in hospital emergency departments for non-fatal gunshot wounds.” Other fun facts from the Center:

The homicide rate in the U.S. is seven times higher than the combined homicide rate of …Continue reading…

Time for Healthcare Providers to Act Like La Guardia Airport

You see the photo to the left? That’s a shot of a restaurant in Terminal D at La Guardia airport. In fact, the entire terminal looks like that, with iPads at every seat in every restaurant as well as most of the tables in the waiting area. So this morning, I sat down for breakfast, browsed through the electronic menu, placed my order electronically, swiped my credit card, and waited for my baked eggs and coffee. No fuss. No muss.

Now, let’s imagine what it would be like if our doctors’ offices (and other healthcare facilities) were as technologically savvy.

A week before my annual physical, I get an alert from the app on my phone letting me know that an order for blood work has been sent to the lab, with a link to its web site. While I’m on the doctor’s office app, I update my personal information, including insurance (and email a scanned copy of my latest insurance …Continue reading…