Entries for March 2008

A survey released this week came to the unsurprising conclusion that people are having a hard time paying for healthcare. The totally nonrandom sample of more than 26,000 people who took the online survey skewed heavily toward the insured (77 percent), unionized (57 percent), college educated (80 percent), and white (86 percent). If anybody should be able to afford healthcare, it would be these folks, right? So it was interesting to see that a third of them said they'd skipped getting necessary medical care because it was too expensive, and half of those with health insurance said it doesn't cover what they need at a price they can afford.

The AFL-CIO, which sponsored the survey with an affiliated outreach group called Working America, has its eye on the upcoming election season, of course. "We're going to take this survey into the election and raise it with candidates at all levels," says Heather Booth, director of the healthcare reform campaign for the AFL-CIO. But with organized labor representing only about 15 percent of workers in the United States today, it's worth asking what role it plays in protecting healthcare benefits or setting the agenda for healthcare reform. Are labor unions still relevant?

You have to wonder if we're all using the same doctors and hospitals when 68 percent of Republicans say they think our healthcare system is the best in the world while only 32 percent of Democrats and 40 percent of independents would make that claim.

The surprisingly wide disparity in perception was revealed in a poll released yesterday by the Harvard School of Public Health and Harris Interactive. The poll also found that nearly three quarters of Republicans believed that patients in the United States get better quality care and face shorter waiting times to see specialists or be admitted to a hospital than do their counterparts in Canada, France, or Great Britain. Less than half of Democrats and independents felt that way.

Medicare Advantage plans came under fire last month when it was reported that these private managed care plans, conceived as a way to offer more comprehensive coverage than traditional Medicare while at the same time saving seniors and the government money, end up costing some beneficiaries more. The government report, which I wrote about, concluded that beneficiaries could face higher cost-sharing for certain services, including home health, skilled nursing, and inpatient hospital stays.

Now it turns out that savvy insurers are capitalizing on these coverage shortcomings, offering supplemental insurance policies to fill gaps in Medicare Advantage plans that weren't supposed to be there. California Health Advocates, a consumer advocacy group, described the practice in a report published last November. "The existence of these [supplemental] plans is a symptom of a larger disease," says David Lipschutz, interim CEO of California Health Advocates. "Enough of the Medicare Advantage plans don't provide sufficient benefits that people are being convinced to buy additional policies to fill in those gaps."

Corrected on 3/18/08: An earlier version of this story suggested that a recent study by the American Cancer Society involved only men. The study involved men and women.

Colonoscopies are the butt of many a bad joke—and pun. No wonder: Just reading about what getting one entails is enough to make me squirm. So no matter how many medical experts and celebrity spokespeople try to reassure me that the colon cancer screening test is not so bad, I think they're lying. And you better believe that I would snatch at any excuse, even a crappy one—there I go again—to avoid this invasive test.

Given my aversion, which many others share, states would be smart to make getting the test as easy and affordable as possible. So it's disappointing that not even half of states require insurance companies to cover colon cancer screenings, according to a new analysis. The 2008 Colorectal Cancer Legislation Report Card released this week gives D's and F's to 26 states that either have no colon cancer screening law on the books or laws that recommend but don't require screening coverage. The upside is that screening laws are on the rise. The first was signed in 2000 in Virginia, with the help of then state Sen. Emily Couric—sister of Katie, whose husband died of colon cancer in 1998. Five states added laws in 2007, bringing the total to 24 (the District of Columbia also requires coverage). The report card is sponsored by a coalition of public-health groups, including the American Cancer Society and the American College of Gastroenterology.

Good news for people with bad knees: A study released last week found that an old-fashioned X-ray may be better at diagnosing osteoarthritis than a much more costly magnetic resonance imaging, or MRI, test. Since you may very well be responsible for paying a chunk of the cost of these diagnostic tests, that's useful information to keep in mind.

The study examined a random sample of 50 knee replacement patients at the Illinois Bone and Joint Institute. It found that MRI tests didn't provide any diagnostic information that wouldn't have been seen on a "standing" or "weight bearing" X-ray. But the sophisticated imaging test sure costs a lot more: about $2,500, compared with just $150 for the X-ray, according to the study.

A new report finds that there may not be much advantage after all in Medicare Advantage plans over traditional Medicare, at least for certain seniors. The managed-care plans offered by private insurers are touted for offering extra benefits—vision, hearing, and dental coverage, for example—despite having lower premiums and out-of-pocket costs. What's not to like? Some 9 million seniors, about a fifth of all Medicare beneficiaries, have signed up. But last week the Government Accountability Office announced that seniors in some plans might actually pay more for certain services.

Unfortunately, the seniors likely to be hardest hit are the sick. According to the report, 19 percent of seniors in Medicare Advantage plans were projected to face higher out-of-pocket costs for home health services than under traditional Medicare in 2007, while 16 percent faced higher costs for inpatient hospitalization services. Nine percent were projected to pay more for care in a skilled nursing facility.

A new poll released yesterday found that 41 percent of Americans say they have trouble paying for their prescription drugs. If older folks' experience is any indication, the bite is certainly growing more painful: The AARP reported today that the prices of brand-name drugs used most by seniors rose an average 7.4 percent in 2007, more than twice the rate of inflation. But yesterday's poll also found that 32 percent have asked their doctor about a drug they saw advertised. I'm not suggesting that the very same people who say they can't afford their drugs are the ones inquiring about the pricey brand-name drugs they see on TV. But it makes you wonder when sizable numbers of Americans find both those statements to be true.

The study of 1,695 adults, jointly sponsored by the Kaiser Family Foundation, the Harvard School of Public Health, and USA Today, found that about two thirds believed there are too many drug ads on TV and a similar number said that prescription drug ads encourage people to take medications they don't need. Do people need the sleeping pills, impotence drugs, and stomach acid relievers that seem to get the most air time these days? I don't know. I'd like to think that doctors steer their patients — especially the low-income and uninsured ones who reported having the most worries about drug costs — to over-the-counter or generic alternatives if they're available. The study found that 82 percent of those who asked their doctors about an advertised drug walked away with a prescription for either that drug or another one. Maybe it was a generic. I hope so.