Young adults and healthcare. Who cares?

Young adults are the least likely among all age groups to get outpatient medical care even though there is plenty of evidence that seeing a doctor once a year or so would benefit people ages 20 to 29 just as much as older or younger folks.

A study published in the September issue of the Annals of Internal Medicine used national survey data from 1996 to 2006 to show that annual visits for healthcare drops sharply between peaks of heavy usage in childhood and middle age. Young men, especially, are unlikely to get regular healthcare, as are people without insurance. About one-third of young adults are uninsured, according to the researchers from the University of Rochester School of Medicine and Dentistry. Young adults are also less likely to have a primary care doctor.

People in their 20s often appear to be in good health, which may lead many to conclude that they don't need healthcare. But numerous studies show that many health problems peak in early adulthood, including homicide, accidents, sexually transmitted diseases and substance abuse disorders. Rates of suicide, smoking, HIV infection and psychiatric disorders are also higher in this age group than in several other age groups. A large portion of young adults are overweight or obese or sedentary.

"In contrast to adolescents, young adults garner relatively little attention from researchers, advocacy groups, or policymakers," the authors wrote. "Our findings emphasize the need for a national agenda to improve access to care and preventive services for all young adults."

-- Shari Roan

Photo credit: Mark Boster  /  Los Angeles Times

He's uninsured but unafraid; his readers are (largely) supportive but skeptical

J. Duncan Moore had a fine insurance policy -- a "luxury" policy, he calls it. But that was when he wrote about health insurance for a news organization. Now he finds himself a freelance writer -- and he's decided to forgo the safety net that so many Americans have and that so many others desperately want.

He writes in today's Health section: "I have no insurance partly by accident and partly by intent. I'm not freaking out, though. Should I be? I'll tell you what I know. Then you decide."

In "Choosing to not have medical insurance," he then told us. And readers then decided...

From Barbara in Venice:

"Those who decide to go without insurance are the reason that insurance has to become mandatory, with a stiff penalty assessed to those who evade it. Otherwise, we will be paying very large sums for their irresponsibility."

But then this from Bonnie in Los Angeles:

"I could tell Mr. Moore about the $50,000-plus in retinal surgery costs I incurred, for a condition I never knew I had until a black spot appeared in my field of vision. I could remind him that cancer strikes healthy nonsmokers too, and that even people with savings accounts can be driven to bankruptcy without insurance coverage. I'd tell him all this, but he wouldn't want to hear it. Good luck, Mr. Moore. I hope someday you'll live in a country where you don't have to choose between ruinously expensive insurance and playing Russian roulette with your health."
 
From Patrick in Santa Monica:

"I kept looking for hints that this article was written tongue in cheek, but it didn't happen, so I will address it directly. Many of the points made stand up on their own, but they do not add up to risking all you've got on the chance you won't be afflicted with a terrible medical problem unexpectedly. I know. Nearly six years ago I was diagnosed with multiple myeloma (a blood cancer) for which there is no known cause or cure."

From Jim in Santa Monica:

"I have thought often of doing what you describe. Here's why it doesn't work. Should you ever require any serious surgery, which you seem to think "can't happen to me," you will be billed by the hospital at 5 times the rate that they pay insurance companies for the same surgery."   

From Stuart in L.A.:

"Unless Mr. Moore, 53, has socked away a couple million, ... he better stay safe and healthy until Medicare clicks in. And pray that those health industry-owned legislators in Washington don't aid their benefactors by, wink-wink, extending the age of eligibility."

... And those are just some of the responses. Many have been supportive (a few almost envious), but others have an edge reflected in the current debate. The status of the uninsured, after all, affects everyone.

-- Tami Dennis

Photo: For the uninsured, safety measures take on new meaning.

Credit: Al Seib / Los Angeles Times

They're baaack! Healthcare reform's spokes-couple returns to the airwaves

Honey, what was the name of that nice couple ... you know, the ones who were always talking about healthcare? The last time we saw them was around the time of the Democratic convention? That couple who switched sides on healthcare reform... You know...

Yeah, Harry and Louise, and they're back at their kitchen table -- and on your TV screen starting this weekend -- calling for a healthcare reform bill.

"A little more cooperation, a little less politics, and we can get the job done this time," says Louise to Harry, after the two banter about the right reform package: one that would allow people to get affordable health insurance regardless of pre-existing conditions and when they change jobs or lose one.

A little less politics? Huh? Isn't this the same Harry and Louise whose 1994 advertisement, aired in the midst of the Clinton administration's efforts to draft a healthcare reform, helped scuttle reform back then? "They choose...," said Harry, referring to the "government bureaucrats" who, a voice-over tells us, would design the healthcare plans into which Americans would be herded. "...we lose," added Louise. Back then, Harry and Louise were brought to us by the coalition of business groups allied against Clinton's healthcare reform efforts.

But by August 2008, Harry and Louise were a bit more open to healthcare reform. "Whoever the next president is, healthcare should be at the top of his agenda. Bring everyone to the table, and make it happen," Louise said in a political ad aired around the Democratic and Republican conventions.

Harry and Louise were on Capitol Hill this morning as well -- part of a campaign of mounting pressure to ensure that healthcare reform gets done this year. They appeared with Sen. Christopher Dodd (D-Conn.) who's shepherding the bill through Congress, and executives of the two organizations that sponsored the advertisement and the media buy that will see it air for at least three weeks on cable and national networks and on the Sunday talk shows. The campaign's cost is estimated at $4 million.

And who are those political bedfellows bringing Harry and Louise into our homes this time? The Pharmaceutical Research and Manufacturers of America (PhRMA) and Families USA, a group that has been active in advocating for universal healthcare coverage. Dodd and others pointed out that when such groups -- typically feuding -- join for a common cause, the consensus behind a reform measure is strong indeed.

This time, however, neither Harry not Louise weigh in on the controversial "public option" -- a proposed government-run plan that Republicans and many in the insurance industry argue will create unfair competition for private insurers, but which Democrats have argued is necessary to ensure universal coverage. A recent survey found that between 68% and 88% of Americans supported some form of government-run healthcare option as part of a reform package.

The actors' names are, in fact Harry and Louise -- hers is Louise Caire Clark and his is Harry Johnson, and yes, they look a little more AARP and a little less "Family Ties" now. They're not, in fact, married to one another. "But they're still pretty good at finishing each other's sentences," said Bob Meissner of Families USA, who spent time with the pair this morning.

-- Melissa Healy

Prostate cancer treatment could be a marker for health reform

For men with prostate cancer, even those with the early-stage type, the urge to treat is undeniable and understandable. The same apparently holds true for their doctors. But sometimes no treatment, at least for a while, is better -- both for men with cancer and for the healthcare system as a whole.

More men -- and, again, their doctors (who are paid by procedure, not by performance) -- need to ask themselves whether less might ultimately provide more. That's the suggestion posed by a smart, making-the-big-picture-personal piece in today's New York Times.

For writer David Leonhardt, the true test of health reform can be summed up with our medical and insurance systems' approach to prostate cancer, specifically the common, slow-growing kind. It's the kind that can often be monitored with what is known as watchful waiting without the risk of side effects that comes with radiation and surgery.

He writes:

But if the treatments have roughly similar benefits, they have very different prices. Watchful waiting costs just a few thousand dollars, in follow-up doctor visits and tests. Surgery to remove the prostate gland costs about $23,000. A targeted form of radiation, known as I.M.R.T., runs $50,000. Proton radiation therapy often exceeds $100,000.

And in our current fee-for-service medical system — in which doctors and hospitals are paid for how much care they provide, rather than how well they care for their patients — you can probably guess which treatments are becoming more popular: the ones that cost a lot of money.

If you doubt that similar-benefits contention and want an in-depth look at how the treatments compare, there's this report: "Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer" from the Agency for Healthcare Research and Quality.

The report, released last year, concludes:

Published evidence indicates that no one therapy can be considered preferred for localized
prostate cancer due to limitations in quality of the body of comparative effectiveness evidence. All treatment options result in adverse effects (primarily urinary, bowel, and sexual) though the severity and frequency may vary between treatments and according to the provider/hospital. Even if differences in therapeutic efficacy exist, differences in AEs [adverse effects], convenience, and costs are likely to be important factors in individual patient decision making. Despite this uncertainty, patient-reported satisfaction with any individual therapy received is high.

Leonhardt is right. This one example highlights the seemingly large and intractable problems of rising healthcare costs (proton radiation therapy isn't cheap) and getting the most effective healthcare for our national dollars.

And, come decision-making time, if less-expensive treatments are as effective as more high-tech ones,  perhaps it's time to question some of the recommendations for expensive treatment and screenings.

-- Tami Dennis

Illustration: Wes Bausmith / Los Angeles Times

In terms of health, white women are usually better off

That finding may not be as notable as the fact that it's still stubbornly true. A report released today by the Kaiser Family Foundation offers a state-by-state look at American women's health. Among the key findings:

--Women of color fared worse than white women across a broad range of measures in almost every state, and in some states these disparities were quite stark. Some of the largest disparities were in the rates of new AIDS cases, late or no prenatal care, no insurance coverage, and lack of a high school diploma.

--For Hispanic women, access and utilization were consistent problems, even though they fared better on some health status indicators.

--Black women experienced consistently higher rates of health problems. At the same time they also had the highest screening rates of all racial and ethnic groups.

Here's a quick by-the-numbers look at California. Of the state's 11.2 million women ages 18-64, 45% are white, 32% are Hispanic, 14% are Asian, Native Hawaiian or Pacific Islander, and 6% are black.

Having employer-backed or private health insurance is obviously a marker of who has relatively easy access to care. Those numbers for California: 78% of white women, 71% of Asian women, 58% of black women and 48% of Hispanic women.

Here are stats on other states.

And here's the full report, titled "Putting Women's Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level."

The conclusions state: "More than a decade after the Surgeon General’s call to eliminate health disparities, the data in this study underscore the work that still remains."

--Tami Dennis

Photo: Dermatologist Susan Stuart, left, discusses skin cancer prevention with Lucy Chard, 43, of Rancho Bernardo at Scripps Memorial Hospital in La Jolla. Credit: Al Schaben / Los Angeles Times

How much do the uninsured cost the insured?

The question refers specifically to the amount passed along via healthcare premiums, not less tangible factors. And the answer is: $1,017 a year for family coverage and $368 for an individual policy.

Those are the figures in a new report from healthcare advocacy group Families USA. The introduction states:

"As the number of Americans without health insurance continues to rise, so too do the costs borne by those who have coverage, who face what might be called a 'hidden health tax.' Private health insurance premiums are higher, at least in part, because uninsured people who receive health care often cannot afford to pay the full amount themselves. The costs of this uncompensated care are shifted to those who have insurance, ultimately resulting in higher insurance premiums for businesses and families."

That's not to say the uninsured are gleefully living it up. The report says that the uninsured directly pay for more than 37% of the total costs of their care. Government, charities and other third-party sources pay for another 26%. The rest is uncompensated care.

Those are the costs eventually handed off to families and businesses in the form of higher premiums. See the numbers above.

-- Tami Dennis

An ounce of prevention in the economic downturn

Doctors are reporting that patients are putting off preventive care during the economic downturn -- things like blood cholesterol checks, colonoscopies and management of chronic health conditions such as high blood pressure and diabetes. (Read about it here in a Los Angeles Times story.)

It's a money saver, but it could be a bad idea. Dr. Brian Johnston, medical director of the emergency department at White Memorial Medical Center in East Los Angeles, says at the end of the article, "I say to patients, 'If the transmission fails in your car, you would put out money to fix that ... your heart, kidneys and brain are more valuable than your car.' "

Here's some more potentially helpful formation that didn't make it into the article:

* Doctors may negotiate prices, Johnston said: “It’s worth asking. Find out if there is some way they would agree to see you and take care of you.”

* A modest investment in home test kits, such as a home blood pressure monitor for hypertension or a peak flow meter for asthma can also help people monitor their health, Johnston advised. And now, he said, may be a good time to take up exercise, stop smoking or address other bad health habits.

* More practitioners are helping their clients continue care by offering healthcare credit cards that carry no interest and no payments for one year, said Michael Fulbright, a Redondo Beach dentist quoted in the story. “It’s a way to offer my patients something so they can get their work done. We have to ask ourselves how are we going to keep the patients we have?” he said.

Finally, recent surveys suggest that some Americans, including people who have been laid off, are trying to improve their health and manage stress by joining gyms. According to the International Health, Racquet & Sportsclub  Assn., a trade group for commercial gyms, memberships increased in the last quarter of 2008, and modest growth is forecast for this year.

Nilo Sarraf, who has a degree in cognitive psychology, was laid off from her Bay Area-job in December. She founded a nonprofit group called Layoffs Cafe, a support network for people who are looking for jobs.
She has health insurance but doesn’t want to use it because of the out-of-pocket costs. She lacks dental and vision insurance, which is a bigger problem at the moment. She is trying to wear her monthly contact lenses for two or three months to stretch her dwindling supply.

 But Sarraf, who is in her 30s, also says she is taking better care of herself. She tries to eat healthy and recently splurged on a $50-per-month gym membership. “I see it as an investment,” she said.

-- Shari Roan

Photo: Dena Lansford of Wildomar lost her job and health insurance last year. She is postponing any preventive care until she gets a job with benefits. Credit: Glenn Koenig / Los Angeles Times

Help for children with costly medical needs

Families of children who require medical care or products that are not covered by their health insurance and are otherwise unaffordable can apply for grants to help pay for those needs from the UnitedHealthcare Children's Foundation, the organization announced yesterday.

For several years, UHCCF has made grants of up to $5,000 available to pay for treatment, services or equipment not covered by insurance, or not fully covered. These are the kinds of products or services that may be partially covered by insurance but are so expensive that families cannot afford their share of the costs. The most common grants, which average $3,000, are to pay for hearing aids; speech, occupational or physical therapy; or some type of medical equipment. In 2008, UnitedHealthcare Children's Foundation helped nearly 600 children nationwide whose families were struggling to pay their share of the costs of medically related services and equipment.

The program is open to families enrolled in employer-sponsored health plans or who have purchased an individual policy. Parents or legal guardians may apply for a grant by completing an online application at www.uhccf.org. Visitors to the site can also make tax-deductible donations online.

-- Shari Roan 

Unemployed? Stimulus plan has you (partly) covered**

As the days wound down to final passage of the national stimulus bill, Booster Shots reported the tentative provisions that the package was expected to include on subsidies to those paying for COBRA, the health-insurance extension that many employers are required to offer to workers they have laid off for up to 18 months after their departure.

Now, the massive stimulus bill is making its way to President Obama's desk for his signature, which is expected Tuesday. And attorneys, human resources professionals and even a few out-of-work journalists are scouring the fine print for the details as they finally emerged.

Here are a few of the highlights, with thanks to Sibson Consulting, a New York-based HR consulting firm with an L.A. office on Wilshire Boulevard:

— You're eligible if you were laid off after Sept. 1, 2008 (an earlier version of this article reported that lay-offs following Sept. 30th would be eligible), or are laid off any time between Tuesday (when the bill is expected to become law) and Dec. 31, and if you worked for an employer required to offer you the option of extending your group healthcare coverage for 18 months (and under California law for 36 months), at 102% of the cost to the company.

You are not eligible if you made or will make more than $150,000 (individual) or $250,000 (joint return) in the year in which you would receive the subsidy. There's no proof of income required at the time you sign up. But if, once you have filed your taxes, you discover you earned too much to qualify, you will be required to repay the subsidy you've received.

— Starting with March 2009, the subsidy will pay 65% of your monthly COBRA bill directly to the employer (in the form of a payroll tax credit), once you have paid 35% of the bill. If you did not elect to continue your insurance coverage under COBRA — say, because the bill was too steep — your former employer is now required to give you another chance to sign up. If you did elect to buy the COBRA insurance and have been paying the full cost of the insurance, the subsidy is not retroactive (an earlier version of this article reported that it was). But if you have make your full COBRA payment for March (say, because of uncertainty about the COBRA subsidy program), your former employer must give you that subsidy either as a credit toward future COBRA payments, or as an outright refund if you are no longer enrolled (an earlier version of this posting indicated that the subsidy was retroactive to September; that is not the case).

— The subsidy ends after nine months — shorter than the 12 months that had been written into an earlier version of the bill.

— The stimulus bill also extended a COBRA subsidy program that had been part of the Trade Act of 2002 but had expired. This would give a 65% COBRA subsidy to any worker whose job was lost due to foreign trade competition and whose employer has applied for and been granted entry to the program.

All of these details (and doubtless many, many more) are to be posted and disseminated by the Internal Revenue Service and the U.S. Department of Labor in the next 30 days. To get them, you'll want to check here over the next several weeks. Follow the link to Cobra Continuation Health Coverage FAQs, and all the answers to the questions the IRS and Department of Labor thought to ask should be there.

— Melissa Healy 

   

Major overhaul of health insurance unlikely

Americans have high hopes for changes to the nation's health insurance system in order to provide more people with coverage and lower costs. But the healthcare reform plan presented by President-elect Barack Obama during his campaign called for only modest changes, not a radical overhaul. That was a wise move, according to a paper published online in the Journal of Health and Social Behavior.

The study, by an international team of medical and political sociologists, explored the healthcare systems in 21 countries and concluded that it's difficult for any country to make big changes to its system because of history and long-standing traditions that created the system. The study found that many countries wish for change in their healthcare systems, but changes usually come about incrementally and are unique to the country and its people. For example, U.S. residents who were surveyed were less likely that people from other countries to agree that government should be responsible for healthcare (38% supported that idea compared with 80% or more of the people in Slovenia, Great Britain, Spain and other countries).

"One of the arguments you hear about healthcare reform tends to be, 'Why can't we be more like this or that country,' " said Indiana University sociologist Bernice Pescosolido, a co-author of the study, in a news release. "This study suggests there are real cultural limits to the kinds of policies that can be proposed, because people are attached to the history of their own system."

The changes suggested in Obama's plan, she said, were less radical than other presidential candidates. But, she said, "it showed an understanding of the tolerance for change."

-- Shari Roan

Photo: New Jersey Gov. John Corzine (D) and Elizabeth Edwards, wife of former Sen. John Edwards (D-N.C.) testify about healthcare reform on Sept. 18, in Washington D.C. Credit: Chip Somodevilla / Getty Images.