Here's something to get your mind off the financial crisis swirling around and scaring everyone silly. Take a deep breath, relax... and start worrying about the crisis in healthcare costs.
A slew of recent reports, including one released today, show that more people are having problems paying their medical bills, that costs of insurance and hospital beds continue to rise and that fewer people are filling prescriptions and going to the doctor.
OK, one bit of bad news at a time.
About 57 million Americans, or 19.4%, reported having problems paying medical bills in 2007. That's up from 15.1% in 2003, or 14 million additional people, according to the Center for Studying Health System Change.
The center conducts a household health survey annually with information from 18,000 people. Most people, 42.5 million, with medical bill payment woes had health insurance.
"Increases in problems paying medical bills are affecting not only those who have always struggled with medical costs -- low income and uninsured people -- but also an increasing number of insured middle-income families," study author Peter J. Cunningham, a senior fellow at the center, said in a news release.
The worst consequence, one felt by 2.2 million people, was bankruptcy as a result of medical bills. But even when the damage didn't hit quite that hard, people reported other financial disasters. They had problems paying for food and housing. And they were more likely to have unmet medical needs because of cost.
Which brings us to our second piece of bad news, this from a report from IMS Health, which tracks market trends in the pharmaceutical and healthcare industries. The number of prescriptions filled fell by nearly 2%, the first time drug sales fell since the company began tracking the numbers in 1996. But don't worry too much about the drug companies. Despite falling sales, the dollar sales of prescriptions rose by 1.4% to $288 billion, according to a story in the Philadelphia Inquirer. It may be that people are worried about spending money on drugs. But it may also be that a slew of stories about dangerous drug side effects slowed down prescriptions from doctors and patients alike, the Inquirer reported.
The slowdown in patient visits to doctors may be more related to money worries. IMS found that doctor visits dropped by 1.2% from July 2007 to July 2008. And a survey by the National Assn. of Insurance Commissioners found that 22% of respondents avoided physician visits because of cost concerns, according to a report by the Kaiser Family Foundation.
We're almost done with today's bad news on healthcare, so let's try to put a pretty face on this report. Health insurance premiums are rising at a slower rate, according to an Associated Press report. Premiums rose about 5% -- just about even with inflation. Over the last decade, premiums have risen faster than overall inflation, so that's pretty good. However, the average premium of $12,680 for a family, or $4,704 for an individual, gets you skimpier coverage than before. People are paying more out of their pockets than ever before.
Oh, and one more thing. If you have to go to a hospital, it'll cost you more, according to a report from the Agency for Healthcare Research and Quality. For the uninsured, the cost of a hospital stay increased by 15%, but even for insured patients, who get a break because insurance companies negotiate lower rates, the cost went up by 6%. And (see bad news point No. 2), insured patients will be paying a greater portion of that charge out of their own pockets.
Don't say you didn't know, or can't understand, the presidential candidates' plans for dealing with America's healthcare crisis. Don't say you don't get how they might affect you. It's all out there, analyses from independent, nonpartisan groups as well as from very partisan groups. You can have a quick, thumbnail, side-by-side peek at how each candidate sees the future of healthcare. Or you can dig into papers examining the economic and societal impacts of each plan.
But you might want to see the two plans side by side, comparing and contrasting such things as the candidates' stated goals, overall approach to expanding access to healthcare, changes to private insurance, cost containment, what it'll cost and who will pay. The Kaiser Family Foundation, a private, nonprofit health policy and communications organization, has just what you need.
On Sept. 16, the journal Health Affairs offered a web exclusive with a critique of the Obama healthcare plan, saying its costs are unsustainable, and one of the McCain plan, saying the number of uninsured could grow from 45 million to 60 million in the next five years. Another article in the journal suggests that America's healthcare system could benefit from a mixing and matching from each of the plans.
The bottom line from the healthcare economists who examined each candidates' proposal is that the Obama plan won't curb the escalating costs of healthcare in the U.S., the most expensive system in the world. And McCain's plan won't reduce the number of uninsured, and likely would increase their ranks.
If that's too much to read, you can always go to a Sept. 16 L.A. Times story summarizing the Health Affairs articles.
Even if you've got a job with health insurance, don't think this debate isn't about you. The Segal Co., an actuarial and consulting firm, has put together a report on how the candidates' health reforms will effect your benefits.
If it's issues you want, healthcare is a good one. Don't say we didn't tell you.
-- Susan Brink
Photos: Presidential candidates John McCain and Barack Obama at recent campaign stops. Credits: Left, Gerardo Mora / Getty Images; right, Keith Srakocic / AP
The emergence of healthcare clinics in grocery, drug and big box stores has generated a fair bit of controversy in the medical world. Some people praise clinics for their convenience and affordability while others -- namely, the American Medical Assn. -- say they worry that the clinics provide inferior care and discourage a regular doctor-patient relationship.
Several studies in the current issue of Health Affairs throw some sorely needed light on this topic. One report, by Rand Corp. researchers, is the first examination of the types of patients who use retail clinics and what kinds of services patients seek. The study found that most of these consumers do not have a regular healthcare provider and use the clinics for simple conditions or preventive care. The clinics attract insured and uninsured patients. Researchers found that 43% of the patients were ages 18 to 44 and just 39% said they had a regular doctor.
The study is important because it discounts a couple of the criticisms aimed at retail clinics: That the clinics will be used by patients with serious health problems requiring a doctor's attention (clinic practitioners are typically nurses) and that patients will replace their regular doctor with retail clinic care.
"Since most of these patients do not have a primary care physician, there is no relationship to disrupt," said the study's lead author, Dr. Ateev Mehrotra, of the University of Pittsburgh School of Medicine. "However, future studies should investigate quality, the likelihood that patients are getting needed preventive and follow-up care."
Ninety percent of the visits were for 10 simple acute conditions or preventive care, the study showed, including colds, sore throats, inner ear infections, swimmers ear and screening tests.
Health Affairs also published some accompanying reports on the retail clinic trend. One study found that more consumers are using health insurance at the clinics rather than paying out-of-pocket, and more clinics are now accepting insurance. Another study found that care costs less at one retail clinic chain, MinuteClinics, compared with traditional healthcare settings. Finally, a report by former Los Angeles Times reporter Dan Costello examines the growth of retail clinics. Though there are about 1,000 such clinics in operation now in the United States, some have gone out of business and the growth of this trend is in doubt.
The Convenient Care Assn., an industry group representing clinic owners, praised today's studies. But the questions about the role of retail clinics in healthcare will continue. The American Medical Assn. has published a list for consumers about how to make sure you're getting quality care at retail clinics. And the association recently asked for an investigation on whether some clinics have conflicts of interest because they steer patients to the pharmacy in the store in which they are based. Assuming the quality of care is satisfactory, it seems to me that retail clinics serve a useful role in meeting the needs of people who don't have a regular doctor, who can't afford doctor's office fees or who need after-hours care. Moreover, anything that keeps people with such minor ailments as conjunctivitis or urinary tract infections out of the nation's beleaguered hospital emergency rooms is a very good thing indeed.
-- Shari Roan
Photo: Naomi Medina has blood drawn at a QuickHealth clinic inside a Farmacia Remedios drugstore in Oakland. Credit: Robert Durell / Los Angeles Times.
The organization representing the nation's 26,000 emergency medicine doctors fired back today at a John McCain campaign advisor who said, in effect, that as long as there are emergency rooms, no one in American is really uninsured.
The advisor, John Goodman, president of the National Center for Policy Analysis in Dallas, told the Dallas Morning News on Wednesday that emergency rooms are a last resort for healthcare for anyone because, by law, emergency rooms can't turn away a patient in need of immediate care. "The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American -- even illegal aliens -- as uninsured," Goodman said.
If you've been to a hospital emergency room in recent years you probably know those folks don't have a lot of time on their hands. Here's what Dr. Linda Lawrence, president of the American College of Emergency Physicians, had to say about Goodman's remarks:
"Emergency physicians can and do perform miracles every day, but taking on the full-time medical care for 46 million uninsured Americans is one miracle even we cannot perform. Access to care in the emergency department is no substitute for the comprehensive healthcare reform policy that should be at the heart of the platform of any presidential campaign."
It's a case of the good news being reported right before the ax falls. Providing children with health insurance makes a huge difference in whether kids receive the care they need, especially if they are chronically ill with such things as asthma or diabetes. The Robert Wood Johnson Foundation released a state-by-state report today, "A Needed Lifeline." The report was conducted by researchers at the University of Minnesota.
Insured children are three times more likely to have visited a doctor's office in the course of a year than are uninsured children, according to the report. About 60% of insured children are covered by private insurance plans, and about a third of children are covered under public programs, such as Medicaid (MediCal in California) or the State Children's Health Insurance Program (SCHIP). The L.A. Times, on Nov. 26, 2007, wrote about how the children's program can affect even middle-class families. The new report shows that although 41% of chronically ill kids who had no health insurance skipped needed care, only 10% of those covered under public programs skipped needed care.
"When children who need care do not receive it, their conditions worsen and are harder and more expensive to treat later," Dr. Risa Lavizzo-Mourey, chief executive of the Robert Wood Johnson Foundation said in a press release. "Because of Medicaid and SCHIP, millions of kids can get regular check-ups, take the medications they need to stay well and see a doctor when they are sick."
That's the good news. The bad news is that some states, including California, might be scrambling to stall new enrollments, or even un-enroll some kids from public insurance programs, because of a new set of rules set down by the federal Centers for Medicare and Medicaid Services.
The program covers about a million California children and mothers in families earning up to 250% of the federal definition of poverty, or $52,500 for a family of four. Efforts to enroll more children, in families earning more than that, have so far failed. But the state has used its authority to expand the program and enroll additional children by overlooking certain types of income, or offering credit for certain expenses, such as child care.
Last year, a federal directive with an Aug. 18 deadline came down from the Centers for Medicare and Medicaid Services that put some aspects of California's program at risk. For example, some county programs -- with federal permission -- that have enrolled children in families earning 300% of the federal poverty level may lose that permission for new enrollees. And all newly enrolled children must be uninsured for a year to qualify, according to the new rules. The old rule said they had to be uninsured for only three months before they could be signed up. Yesterday, the state decided not to comply with the new rules, according to CQ Healthbeat, saying that key requirements run counter to California law.
Congress has voted several short-term extensions of the SCHIP program, the most recent to expire in March 2009. But between now and then -- you may have noticed -- there's a general election, and state agencies can't be sure what will happen to programs for uninsured children. On top of that uncertainty, the new CMS rules have just about everyone scratching their heads.
So the SCHIP program, a success story in dropping the number of uninsured children from 11.1 million in 1998 to 7.9 million in 2004, has just received yet more evidence of its value from the new Robert Wood Johnson study. But with the deadline for the new CMS rules just four days away and no one certain how the feds will respond to California's refusal to comply, with a change in president certain, and possible changes in every other elective office in the land, is it any wonder that states just don't know what to do about the millions of children who are still uninsured?
If you need a laugh after reading through these see-sawing public policy changes, check out The Onion's satirical take on children's health insurance. Fake pollsters said they asked 2,000 children what they wanted. And the vast majority of kids ages 3 to 8 were adamantly opposed to any kind of healthcare. They didn't want shots, trips to the doctor, medicine or hospital stays.
-- Susan Brink
Photo: John Moore/Getty Images Lardon Clifton, 5, awaits care at a free traveling clinic, Remote Area Medical clinic, in Wise, Va.
I hate to break this to you, but you're paying more for health insurance. Your employer is paying more too, but you're picking up more of the increase by seeing a bigger deduction in your paycheck and by paying higher co-pays.
Duh! This probably doesn't come as a surprise. But what's really depressing is that pretty much the whole wad is coming out of your pocket, when you think about it. Your boss's contributions are actually coming out of foregone wage increases, the authors of a new study say.
A survey of health spending in 14 states, the 2008 Milliman Health Index, found that while your boss pays $9,442, or 60% of the average family of four insurance cost of $15,609, you shell out $6,167. Of your total, $3,492 comes out of your paycheck and $2,675 comes out of your pocket. Milliman is a global consulting and actuarial firm.
“The employee’s share of spending on healthcare services rose by double digits for the second consecutive year in 2008,” study co-author Lorraine Mayne, a Milliman principal and consulting actuary, said in a news release. “We estimate the employees’ portion of healthcare premiums increased 10.1% in 2008 over 2007. This is likely to increase pressure on the next presidential administration to address healthcare costs.”
For Californians, who pay $15,861 to cover a family of four, things could be better. Folks in Phoenix pay $13,868 for the same coverage. But cheer up. It could be worse. A family of four in Miami pays $18,780.
More than eight Californians die each day because they lack health insurance, according to a report released today by Families USA, a nonprofit consumer healthcare organization. An earlier report by the Urban Institute, an economic and social policy research center, estimated that 22,000 of the nation’s 47 million uninsured people died prematurely in 2006 because they did not have health insurance. The new report gives a state by state daily tally.
Uninsured people with diseases such as cancer are often diagnosed after the disease has spread and is more difficult to treat. For people between ages 55 and 64, lack of health insurance is the third leading cause of death, after heart disease and cancer.
“Our report highlights how our inadequate system of health coverage condemns a great number of people to an early death simply because they don’t have the same access to healthcare as their insured neighbors,” Ron Pollack, executive directorof Families USA, said today.
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is editor of The Times' Health section. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, Health section deputy editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Susan Brink has made health and medicine her beat for 26 of her 28 years in the business. She’s covered a wide range of disease and health policy stories, and is always on the lookout for fresh angles. Few things make her happier than busting through preconceived notions to give readers an accurate view of people behaving as…well, real people.
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
OK, one bit of bad news at a time.
thumbnail, side-by-side peek at how each candidate sees the future of healthcare. Or you can dig into papers examining the economic and societal impacts of each plan.
point of view. Sen. John McCain's site talks about 
Insured children are three times more likely to have visited a doctor's office in the course of a year than are uninsured children, according to the report. About 60% of insured children are covered by private insurance plans, and about a third of children are covered under public programs, such as Medicaid (MediCal in California) or the State Children's Health Insurance Program (SCHIP). The L.A. Times, on Nov. 26, 2007, wrote about 
