Why High Medical Bills Are Killing Us

TIME magazine coverIn his 38-page TIME magazine special report, “Bitter Pill: Why Medical Bills are Killing Us,” Steven Brill dives into our health care system to understand why things cost so much, avoiding the more traditional question of who pays for what. What he found was both disturbing and telling. (His 3:38 min video introduction is at the end.)

His first story starts with the MD Anderson Cancer Center in Houston, a nonprofit facility of the University of Texas, as he follows a patient who had to prepay $48,900 for six days of testing just to determine his cancer treatment regimen, which could easily run half a million dollars. An analysis of the itemized list of confusing charges showed that they were inflated as much as 100 times over retail prices, even before the hospital’s leveraged buying power. Those costs were also way higher than what Medicare would pay for the same tests, procedures and drugs.

MD Anderson, with its 19,000 employees, is one of the city’s top-10 employers, and its CEO last year was paid $1,845,000. Four other hospitals in the 1,300-acre Texas Medical Center are also in the top-10. Clearly, healthcare is a big business, but who’s making the money if it’s not doctors, nurses and technicians? It’s the hospitals, insurance companies, drug companies, equipment providers, and testing companies. Read More …

How to Avoid Contractor Scams

If you or someone you know was effected by storm damage, please share this article. It offers advice for hiring a contractor that I submitted in August in response to an eLocal poll on this topic, and it’s based on my experience as communications director for a nonprofit homeowner advocacy organization that I co-founded. UPDATE: New advice links added (11/1/2012 )

Wayne Caswell, Modern Health Talk, wins eLocal's Most Articulate Award

Hurricane Sandy slammed into the northeast this week and did lots of damage to homes, so if you need repairs, this article is about how to avoid potential scams.

 Avoid “storm chasers,” those unscrupulous contractors that show up after disasters to prey on people in a hurry to fix their homes. You can recognize them by the magnet signs on their trucks and their temporary offices and phone numbers, and you may also notice yard signs popping up everywhere to promote their services.

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Understanding Obamacare

Healthcare became a hot potato during this political season, even though the U.S. Supreme Court ruled that the Affordable Care Act is constitutional. Governor Romney wants to repeal “Obamacare,” but what’s actually in the law and why was introduced in the first place? To address these common questions, I’m reposting one of my first articles on the topic.

This article describes a great presentation by Dr. James Rohack on Health System Reform. Rohack is a practicing cardiologist and Director of Scott & White Center for Healthcare Policy. He is also a professor at Texas A&M Health Science Center and was the president of the American Medical Association from 2009 to 2010 during debates over Obama’s Healthcare Law.

The presentation was held in Sun City, a planned community north of Austin for retirees with active lifestyles. It didn’t include handouts, but I was able to find some of Rohack’s slides online and offer them below with my notes.

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The Waiting Room, a feature length documentary


The Waiting Room - Title Text

Certified Nurse Assistant Cynthia Y. Johnson at Highland Hospital in The Waiting Room

Certified Nurse Assistant Cynthia Y. Johnson at Highland Hospital in The Waiting Room

The Waiting Room is like a punch to the gut for people cast off and left out of our U.S. medical care system, what some call the best in the world. When Democrats and Republicans vie for your votes and debate healthcare reform, remember that these are not the people they are talking about. Most don’t even notice the plight of those at the bottom — this ugly underside. But our politicians, and the billionaires who set their agenda, should be made to watch this documentary, because these are the 47 percent they talk about — the people left out of the American Dream. They’re real people.

This character-driven documentary film uses unprecedented access to go behind the doors of Oakland’s Highland Hospital, a safety-net hospital fighting for survival while weathering the storm of a persistent economic downturn. Stretched to the breaking point, Highland is the primary care facility for 250,000 patients of nearly every nationality, race, and religion, with 250 patients – most of them uninsured – crowding its emergency room every day. Using a blend of cinema verité and characters’ voiceover, the film offers a raw, intimate, and often uplifting look at how patients, staff and caregivers cope with disease, bureaucracy, frustration, hope and hard choices during one typically hectic day.

The ER waiting room serves as the grounding point for the film, capturing in vivid detail what it means for millions of Americans to live without health insurance. Young victims of gun violence take their turn alongside artists and uninsured small business owners. Steel workers, cab drivers and international asylum seekers crowd the halls. (movie trailer follows)

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As Our Health Goes, So Does Our Economic Recovery


It’s the Health Care, Stupid:

As Our Health Goes, So Does Our Economic Recovery

As Our Health Goes, So Does Our Economic RecoveryBy Peter Abaci, M.D., Chronic pain specialist
(original on Huffington Post)

“We cannot solve our problems with the same thinking we used when we created them.”
— Albert Einstein

As we head into the final stages leading up to election day, expect the fight over whom and what is best for our economy to rage on. Debating how best to stimulate the economy has been anointed as the de facto topic of importance heading into our upcoming election, but let’s not forget that the health of Wall Street and Main Street is inextricably linked to the health of our citizens. As I have written here in the past, I am no economic expert, but I do work in the trenches every day in a profession that impacts our nation’s budget like no other.

The fact that doctors like me seem to drive the spending of tax dollars more than other occupations like teachers, governors, and generals tells you right there that health care is the elephant in the room of any debate on our economic future.

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How to Avoid Contractor Scams

Modern Health Talk is recognized this month for submitting the most articulate response to an eLocal.com poll on How to Avoid Scams after a Storm, which also applies to home remodeling and modifications for aging in place too.

Wayne Caswell, Modern Health Talk, wins eLocal's Most Articulate Award

We’re into Hurricane season, and Isaac just slammed into New Orleans, so this reminder about potential scams is timely, especially since local laws often favor builders, remodelers and contractors rather than homeowners (at least in Texas). Here’s some advice when hiring a contractor to fix your home or replace your roof.

 Avoid “storm chasers,” those unscrupulous Read More …

Healing America’s Health Care System

By Susan Blumenthal, M.D., Former U.S. Assistant Surgeon General
Written in Collaboration with Jenny Shelby
(Original text and statistics graphic from Huffington Post)Healing Health Care

Not all threats to our nation are overseas. Within our own borders, enemies such as chronic and infectious diseases, as well as rising medical costs, threaten individuals, families, communities, and the national security of our country. Health care costs constitute 18 percent of the Gross Domestic Product (GDP) of the United States, amounting to $2.6 trillion. In comparison, approximately 6 percent of the GDP is spent on defense. Although the U.S. spends twice as much on health care as any other nation, the World Health Organization (WHO) reports that the United States ranks 50th in life expectancy and 39th on the overall health status of its citizens worldwide. America’s health care system is in crisis: It is a “sick care” system, not a health care system. However, healing has now begun. Just over a month ago, the United States Supreme Court handed down its landmark ruling to largely uphold the Patient Protection and Affordable Care Act of 2010, a major step toward redesigning the U.S. health care system and improving the health of all Americans. Read More …

Long Term Care and the Home Healthcare Opportunity

Long Term Care InfographicThis article presents statistics about the Home Healthcare Opportunity (see more statistics) and an infographic about Long Term Care costs (from Northwest Mutual).

“We can save Trillions by moving at least 50% of healthcare services from institutions to homes.” (Eric Dishman, Intel)

  • Boomers have a “fierce” desire to remain independent.(AARP)
    • >90% of people 65+ want to age at home if safe as long as possible.
    • This will lead to an expansion of organizations offering home- and community-based care.
  • Avg. Nursing Home private room = $83,000 a yearin 2010. Assisted Living rent = $39,000 a year. (MetLife)
    • Avg. Independent Living Community = $32,000/yr (Long Term Living Magazine)
    • Avg. In-Home Care = $18,000/yr (health aid, meals on wheels, maid, etc.)
  • Global Home Healthcare market = $40.5 billion  in 2009, growing to $67 billion by 2016 (GBI Research)
    • US Digital Health market = $5.7B by 2015 with 55% CAGR (Parks Associates)
    • US Home Remote Monitoring = $295M by 2015 (Frost & Sullivan)
    • US Remote Patient Monitoring = $7.1B in 2010, with 25.4% ACGR and 2015 estimate of $22.2 billion (Kalorama Information)
    • Health & Fitness Apps market = >$400 million in 2016 (ABI Research)
  • Global mHealth market = $10B by 2016 (mHealth Networking Group on LinkedIn)
    • With over 72% of the globe connected via mobile technology and over 60% of US physicians owning tablet devices, the promise of mobile health to profoundly impact, on the delivery of healthcare cannot be understated.
    • Most of these physicians are using iPads and about half of all tablet-toting physicians use the devices at the point of care.
    • Asia Pacific mHealth market = $7B by 2017 (GSMA)
    • >20,000 medical/health apps = 3rd fastest-growing, with 60% aimed at consumers vs. health professionals
  • U.S. Health Care Fraud = $80 billion per year. (conservative estimate from CNBC’s Health Care Hustle series) Read More …

How will you pay your lifetime $4 million healthcare bill?

Your $4 Million Bill and The Anatomy of Health InsuranceThe following infographic shows that a typical 22 year old worker and his employer can expect to pay over $4,000,000 in his lifetime for healthcare and health insurance. That number seemed awfully high, so I created a spreadsheet model to see if I could match it. I did, and here are my assumptions.

  • Starting salary at age 22 = $53,000 ($870,000/year by age 70)
  • Annual salary increase = 6% compounded
  • Percent of income for healthcare = 18%, increasing by 0.3% per year

I assumed a modest salary that increased at 6% compounded each year, but that’s a simplistic view since raises are larger earlier in a career and generally taper off (or even go negative) as you get older. I calculated to age 70 to account for longer lifespans and the likelihood that young people will continue working that long by then.

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CAPABLE means Home, not Nursing Homes, for Seniors

Source: Newswise (6/26/2012) — Nursing homes do not have to be inevitable destinations for frail older adults. Many—even those with long-term health problems—can remain at home and be independent. All it takes is a little help to change “disability” to “capability”.

A handyman with a few nails to fix a wobbly bannister can make the difference between staying at home and a nursing home stay. Visits from a nurse or occupational therapist can help simplify a bewildering medication regimen or improve the ability to get around the house and neighborhood. Simple, inexpensive steps may change the equation for thousands of seniors, but in reality, services like these are rarely available for many at greatest need—the poorest and sickest older adults receiving Medicare and Medicaid.

CAPABLE, short for “Community Aging in Place, Advancing Better Living for Elders,” and a $4 million Health Care Innovation Award from the U.S. Department of Health and Human Services Center for Medicare and Medicaid Services, is about to change that reality. Read More …

Innovator’s Prescription: Disruptive Healthcare Solution

book cover of The Innovator's PrescriptionHarvard Business School’s Clayton M. Christensen — whose bestselling book, The Innovator’s Dilemma, revolutionized the business world — now presents The Innovator’s Prescription, a comprehensive analysis of the strategies that will improve health care and make it affordable.

In this meaty 87-min lecture at MIT, Professor Christensen explains how you can’t believe everything you learn in business school and reveals insights into such socially significant and complex industries as health care. “It’s the principles of good management that can cause successful companies to fail,” he says.

The lecture introduced concepts from his latest book, where Christensen applies his principles of disruptive innovation to the broken health care system. With collaboration from two pioneers in the field — Dr. Jerome Grossman and Dr. Jason Hwang — he examines a range of symptoms and offers proven solutions.

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Hospital-Insurer-Doctor lines start to blur

In The Future of U.S. Health Care, Wall Street Journal reporter Anna Wilde Mathews writes a wonderfully comprehensive report about innovation in different models of delivering healthcare with aims at containing or lowering costs.

The story includes a close look at what five people are doing to help remake the $2.6 trillion U.S. health-care industry. They include a doctor, a hospital CEO, an insurance-company official, a human-resources executive, and a patient, and each of their stories and audio interview are provided.

Qualcomm Life connects Wireless Medical Devices & Cloud

Qualcomm announced this week that Qualcomm Wireless Health is now Qualcomm Life,  a wholly-owned subsidiary whose mission is to define and connect the global wireless health network and bring medical devices to life by securely connecting them to cloud-based services. The encrypted and HIPAA compliant bimetric data is then remotely accessible by device users, their health care providers and caregivers. (video & illustration below)

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It’s Fall – Time for Talking Turkey about Healthcare…


Medical Economics - follow the Money

We need to talk about healthcare, the role of funding, the need for healthcare teams, and core infrastructure from workplace culture to technology.  Parts of this post began as a comment in Employee Benefit News, a LinkedIn group.  Let’s start with the money.

There’s a pattern here—banks collect a 5% margin on health insurance cash flow.  This is not small potatoes.  Healthcare insurance, mostly self-insured employer costs, was about 33.5 percent of the $2.3 trillion spent on healthcare in 2008, i.e., almost 70 percent of the half of health cost not paid by Medicare and Medicaid (see National Health Expend Data). This annual $770 billion allows the 5% margin to feed some $38 billion into the banking sector’s P&L statement.  And, the annual $770 billion flow is money banks can invest in securities markets, or can lend.


In Snake Bit, I took a different look at annual health insurance evaluation and the danger of getting Snake Bit if we don’t dig into the details, compare plans, and consider our historical and anticipated medical costs.

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Putting Patients at the center of their Health Care

HealthITBuzz logoHere is full text of an article by by by Jodi G. Daniel / JD MPH, Director of the Office of Policy and Planning at the U.S. Department of Health & Human Services. It is provided with full attribution and a link to the original article but without copyright concerns, because I believe it’s important enough to be promoted widely and don’t expect any complaints. If, however, the Office of the National Coordinator for Health Information Technology (ONC) asks me to remove it, I will surely do so.

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Snake Bit – It’s health insurance renewal time

Don't get Snake Bit by the health insurance industryEven more than the demographics of aging, the perverse incentives of insurance companies and the Fee-for-Service business model are driving healthcare costs higher and higher. Take control now or get snake bit later.

The United States ranks 47th in life expectancy at birth, behind Bosnia, and 54th, behind Bangladesh, in “fairness,” a measure of the extent to which the best care is available equally throughout a country.  — Wendell Potter

Halloween’s passing means it’s time to renew your health insurance

Insurers make it nearly impossible for consumers to find out in advance what is actually covered by their policy and you’ll pay if you get injured or sick. That’s why the Affordable Care Act that Obama signed last year requires full disclosure in plain and simple terms. But it’s not that simple.

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Why Americans pay so much for Prescription Drugs

As a colleague participant in a Linkedin discussion said, The entire medical system only gets paid when they can convert a non-patient into a patient. Moreover, it is in the best interest of the system, to keep the patient a patient, so as to continue getting paid.

That perspective even extends to prescription drugs and why so many Americans seek lower cost solutions from Canada even when their health plans include discounts on generics ordered online. It also reminds me of Eat Your Medicine, which views food as pharmacology and promotes changes in diet and lifestyle rather than the quick fix of a pill.

INFOGRAPHIC: Why Americans pay so much for drugs, and Canadians don’t.

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Peter Pan housing – for people who won’t get old

Peter PanNPR host Michele Norris explores housing options for America’s aging population in her interview with Jon Pynoos, a professor of gerontology policy and planning at USC. (Listen to the broadcast or read the transcript HERE.)

Pynoos describes the high costs of nursing homes and assisted living facilities and the insurance options that pay for them, including Medicare & Medicaid. He then promotes aging-in-place at home as a much lower-cost option, but most homes were designed for people who aren’t old. He calls them Peter Pan homes. They have stairs, inaccessible bathrooms, and inadequate lighting, and they lack many of the safety features that would help people avoid falls.

“I won’t grow up.    I don’t want to go to school.
Just to learn to be a parrot,    And recite a silly rule.”

To help you assess your home and make modifications, contact a certified aging in place specialist (CAPS).

Related Articles:

Health Insurance premiums surge in 2011

rising health care costs are not just a federal budget problemWe all know that health costs are high and rising steadily, but new data now shows that the cost of employee health benefits increased 114% in 10 years while wages only went up 34%. That’s according to a new report by the Kaiser Family Foundation, which forms the basis of this article. The average family health care premiums now top $15,000 a year, which is like buying a new Ford Fiesta or Chevy Aveo every year.

The cost increase this year snapped a trend toward more moderate growth, and some have blamed that on “Obamacare,” but most provisions of the Affordable Care Act don’t go into effect until 2014. Kaiser said the changes so far have only had a combined impact of 1-2 percentage points, suggesting that the sluggish economy is responsible for most of the increase this year. The two big changes this year include (1) allowing young adults up to age 26 to stay on their parent’s insurance policies and (2) requiring some plans to cover preventive services at no cost.

cumulative increases in health insurance premiums

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