Would You Walk Away from $2 Billion? Then Why Is Virginia (and 26 Other States)?

Hey, I just won the lottery! Two billion dollars! But you know what? I think I’ll just refuse it.

That, dear readers, is what my much beloved state of Virginia is prepared to do. On March 24, the General Assembly meets in a special session to consider the new budget — which is tied to expanding Medicaid. The Republican-led body has already voted against the budget because of the Medicaid requirement.

The expansion is part of the Affordable Care Act. If states expand Medicaid eligibility to those making up to 138 percent of the federal poverty level, including childless adults, the feds will pay for 100 percent of the expansion for the next five years, after which it picks up 90 percent. That’s a big bonus given that the state and the feds split the cost of traditional Medicaid.

Currently, Virginia covers children up to age 19 and pregnant women with  family incomes  up to 133 percent of the poverty level, and parents …Continue reading…

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Reigning in the Cost of Health Insurance, or, Why We Can’t Have Granite Countertops on a Laminate Budget

This blog comes to you courtesy of a nasty exchange on Facebook. It started with a posting about the fact that an insurance plan offered through the state exchange did not include the regional children’s hospital in its network.

This is happening around the country as insurers limit provider networks in order to keep premiums within  prescribed limits, whether those limits are mandated by the Affordable Care Act or by the employer paying for the health insurance. And it’s no secret that specialty hospitals like children’s hospitals and teaching hospitals have far higher costs than community hospitals. Reasons include the cost of training medical residents and fellows, the high percentage of Medicaid patients they see as well as the high percentage of uncompensated care they provide, and their mission to do research as well as provide patient care. They do receive additional federal and state funding to compensate — at least partly — for those expenditures, but in this day of …Continue reading…

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Time to Get Our Patientzilla On!

I just finished talking to a woman about her experience traversing our paternalistic medical system. She’d been having very strange symptoms for months — dizziness, numbness and tingling in her head and hands, blurred vision. After a particularly scary episode, she went to the emergency room where the ER doctor, in her words, basically dismissed her by telling her she had none of the risk factors for a stroke — she was only 40, in good health, a nonsmoker. “It’s probably anxiety,” he told her. “Of course I’m anxious!” she said. “I have two little girls in the waiting room scared to death because they’ve never seen their mother like this and I’m scared because I don’t know what’s going on!”

Nonetheless, she left without any idea of what was going on, convinced it was all in her head. Another visit a week later to another emergency room, where this time the doctors performed a battery of tests, including a CT …Continue reading…

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How Much for That Shoulder Replacement?

Forgive the blog silence, I’ve been online trying to sign up for health insurance on www.healthcare.gov (just a little healthcare reform humor there).

So today we’re going to do a bit of math. Don’t worry — I’m not a math person so this will be simple and painless.

We’re going back to my aunt, who was prominently featured in my last post.

She’s doing quite well ( thanks to all who sent good wishes). And she just received the first of what will be many bills.

This one was for the surgery and hospitalization. The hospital billed Medicare $11,851. Keep in mind that’s for the hospital only. Not the radiologist who read her xrays, or the anesthesiologist who made sure she felt no pain, or the surgeon who replaced her shoulder, or the visiting nurse, or the physical therapist, or the outpatient prescription medications. Just the facility charges for the surgery and three days in the hospital.

Medicare and her supplemental insurance paid the hospital …Continue reading…

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What I Learned About the Healthcare System From My Aunt’s Shoulder Surgery

I’m here in the cold northeast helping my 80something aunt out for a couple of days as she recovers from shoulder replacement surgery. It’s been a great real-life example of the good and the bad in our  healthcare system.

The good part is that the surgery went well and the hospital arranged for post-discharge physical and occupational therapy, as well as a home health nurse to check on my aunt, all of whom are great.

But the main problems come with the coordination of care for my aunt, as well as the communication. Our changing healthcare system relies on greater patient empowerment and patient-centered care. That, in turn, relies on educating patients about their condition. That so did not happen here. Here’s where I think the failures occurred:

– My aunt’s doctors did not set realistic expectations. She talked to several people who’d had the surgery before who told her what a breeze it would be. So when she experienced swelling, bruising, nausea, …Continue reading…

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Would You Buy a Car the Way You Buy Medical Care?

I was at book club the other night, pouring another glass of Chardonnay, when my friend told me that in August she was diagnosed with three blocked arteries, one of which is 100 percent blocked. I could rant about the fact that she’s been walking around like this for three months with only a beta blocker and statin as treatment, but that’s fodder for another blog.

When I talked to her she had an appointment with a cardiologist in our area. “Oh, he’s wonderful,” she said. because that’s what she’d heard from other people. What she didn’t realize, however, is that “wonderful” doesn’t mean good. She didn’t know how often he performed the procedure she might need; how well his patients did with or without surgery; what ties he might have to the pharmaceutical or medical device industry that could bias his recommendations; if he’d had any malpractice suits against him and how they’d turned out.

Choosing a doctor based only on …Continue reading…

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Healthcare.gov — Fail!

Yes, it’s a mess. No, I’m not talking about 17-year-old’s bedroom (the mounds of laundry on the floor and 15 empty Gatorade bottles on his desk are fodder for another blog) but, of course, healthcare.gov, the web site that is the gateway to individual insurance for millions of Americans but which, unfortunately, is working about as well as Congress.

In case you haven’t noticed, I’m a pretty big advocate of healthcare reform and, despite its many flaws, the Affordable Care Act. Which is why I feel like curling up in a fetal ball in the recesses of the teenager’s (scary) closet and not coming out until an entire day goes by without a story on NPR about healthcare.gov.

Unfortunately, I still have to earn a living so the closet is not an option.

So I will face the critics and admit it. Yes, the Obama administration screwed this up in the most humiliating, embarrassing way. Then I will tell them what I tell …Continue reading…

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