Your Best Health Care NOW

Reader’s Digest editor makes the mess somewhat understandable in his 2016 book subtitled ‘Get Doctor Discounts, Save with Better Health Insurance, Find Affordable Prescriptions’.

Lown’s motto for providers is: “Do as much as possible for the patient, and do as little as possible to the patient.” (page 12)

Teddy Roosevelt: “Nobody cares how much you know until they know how much you care.” (page 13)

Dr. Fine said that colon cancer could be virtually eradicated if everyone over fifty got regular colonoscopies. “Colon cancer is a preventable disease,” he said. “And it rarely affects people under fifty.” (page 13)

Medicare Advantage plans reserve the right to promise you more when you are shopping for your annual heath plan than they actually deliver during the year. Plans routinely shed doctors and hospitals at any time they choose. They also regularly alter their approved drug lists, usually by charging more for drugs and moving drugs into higher-cost tiers. And they can even cancel an entire plan with only a sixty-day notice. (pages 93-4)

Hospital specialists must see Medicare patients and accept, say, as little as $40 per visit rather than their normal $400. It’s not uncommon, for example, for Medicare beneficiaries to have to wait for four months to see specialists in New York City. (page 95)

As controversial as the ACS’s new guidelines are, studies show that the routine annual screening finds far too many false positives that lead to needless anxiety for patients; unnecessary testing, such as $1,000 to $5,000 biopsies; and sometimes even surgery. To save one life with mammograms, you have to screen two thousand women, deal with two hundred false positives, and endure ten unnecessary surgeries. What’s more, one study reported that 61 percent of women who got mammograms each year between the ages forty and fity got diagnosed with at least one nerve-wracking false positive. (page 117)

Insurance expert Wendell Potter said dental care has become so expensive that many of us can’t afford to go to the dentist. “More than one hundred thirty million of us lack dental benefits – far more than the number of people without medical coverage,” he added. And even people with dental benefits usually get billed for 50 percent of the cost of expensive procedures such as root canals and crowns. (page 134)

Many [dental] plans make members pay premiums for six months before receiving any benefits, including preventive care. (page 135)

Obviously, our system favors the drugmakers. Instead of having to negotiate with an entity as public and powerful as, say, the Department of Health and Human Resources, the manufacturers conduct discrete and largely secret bargaining sessions with an endless parade of buyers, including the nation’s roughly 5,000 hospitals, 125 major chain pharmacies, and 50 leading national health insurers. Deals are also brokered by powerful middlemen, called group purchasing organizations and medical benefit managers, who leverage the massive number of workers they represent to sometimes get around 30 percent discounts on very high-priced drugs. (pages 174-5)

According to one study, large pharma companies more than doubled the prices of four of the ten most commonly used drugs from 2011 to 2014. Patients with rheumatoid arthritis (RA) and multiple sclerosis were hit especially hard. AbbVie increased the price of Humira for RA by more than 126 percent, for example, and then launched a massive ad campaign to push the drug. (page 184)

As I’ve said, there is no law against raising prices. The Food and Drug Administration has no authority over drug prices. (page 185)

Politicians on the left rallied for Medicare for All, and those on the right vowed to kill Obamacare. But neither of those extremes amounts to much more than fund-raising gambits – red meat appeals for supporter greenbacks. (page 187)

New York governor Nelson Rockefeller, a Republican, crystalized the point decades ago: “If you don’t have good education and good health, then I feel society has let you down.” (page 189)

Despite the public’s hope that lawmakers will improve health care, don’t even bet on major changes in the ACA. The truth is that powerful health care players like Obamacare more or less the way it is. By guaranteeing millions of new health care customers generous federal subsidies each year, health care players will continue to do well under this system…. In addition, other providers, including doctors with more patients, drugmakers with more customers, and hospitals with fewer charity cases, are doing fine, too. Or as on physician lamented to me about his daughter who just entered the profession: “The best she’ll make is $250,000 a year. How can she get by on that?” (pages 189-190)

Since pharmacy owners, like any other merchants, can charge whatever they want for a drug, the exact same medication could go fro anywhere from $4 to $400 (or more!) in your neighborhood. No exaggeration. (page 203)

In a twist of that knife to patients, the drugmakers are charging about double here than the do in Canda and elsewhere. As I explained in chapter 15, other countries with single-payer government health programs negotiate for deep discounts. But out government, by law, prohibits even Medicare from negotiating for discounts, thanks to bought-and-paid-for lawmakers in both parties. (page 212)

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