Interesting Tidbits from the Medical Literature

More on Losing Health Insurance
It is worse than I thought. Up to 14,000 Americans per day may be losing their health benefits during this economic downturn (a nice term for "crisis") according to a report by the Center for American Progress and Health Care for America Now.

"Approximately 2.4 million workers and their families have lost the health insurance their jobs provided since the current recession started in December of 2007, according to an analysis by Nayla Kazzi at the Center for American Progress. "

"More than 51 million Americans under age 65 do not have health insurance as of January 2009, and millions more drift in and out of coverage as their employment and financial situation changes. According to a March 2009 study from Families USA, approximately 87 million Americans under 65 - nearly one in three - went without health insurance for some period in 2007 or 2008."

(See "When You Have No Health Insurance or Money" blog post). More and more people are being qualified for the government's Medicaid program - millions of people are already enrolled and the number is growing. If families try to purchase private insurance, they need to expect rising costs there as well (assuming they are healthy enough to qualify and do not have any pre-existing health problems).

And More on COBRA... It Strikes Employers, Too
The economic stimulus package will subsidize 65% of the COBRA health insurance costs for up to 18 months. Some companies feel that this will be an additional (and costly) burden to companies who have to pay the administrative costs to manage this program for laid-off workers. Personally, I think the minor administrative costs are the least a company can do for these disadvantaged workers. In a way, it was nice for our government to help out.

Get Ready for the Upcoming Epidemics
Most young families have never seen measles or Hib-related diseases, but that may change soon. There have been pockets of Hib and measles cases popping up across the country. There were about 400 cases in the U.S. last year. Unimmunized families may see them first-hand, unfortunately. As more and more families opt not to vaccinate their children due to unfounded fears that they cause autism and other developmental disorders, those diseases will surely return - perhaps with a vengeance. Measles has never left and continues to be among the leading causes of death in children worldwide. I suspect that families without health insurance will also be skipping these important vaccines.

According to the CDC, there were 131 cases of measles in 2008, the most since 1996. Most experts feel that this resurgence of measles is due to the highly vocal anti-vaccine movement.

Swine flu may be less serious than we expected, but expect an unprecedented vaccine campaign in the fall. Not only should a swine flu vaccine be available, but we will still have our usual and customary annual strains that take about 35,000 lives each year. Anticipating the circulating strains is becoming more and more difficult as these ancient viruses mutate and change. The World Health Organization fears that up to two BILLION people could be infected by swine flu if the current outbreak turns into a true, global pandemic

Speaking of Vaccines
The pneumococcal conjugate vaccine, Prevnar, which has been protecting infants and children against seven of the more common streptococcal strains is now going to be even better. A newer, improved vaccine called Prevnar 13 will be adding protection against six additional strains, offering even more protection against pneumonia, meningitis, and yes, even the dreaded middle ear infection.

In the last decade, the insertion of tympanostomy tubes for recurrent ear infections has increased 35%; a whopping 85% increase since 1996. Although there has been an active campaign to reduce the astronomical amounts of antibiotics used in the management of pediatric ear infections, the overall usage has not drastically improved. Many parents feel that tubes are a less-risky alternative to frequent antibiotic use.

Cell Phones May be Contributing to Hospital-Acquired Infections
First they blamed dirty hands, then stethoscopes (rightfully, so). A few years ago, a study proved that our neckties (I stopped wearing them and I have a great collection of medical ones) may be spreading dangerous pathogens. Now, cell phones are being blamed for the spread of MRSA (Methicillin-Resistant Staphyloccoccus auerus) - the superbug in a study of Turkish hospitals. It doesn't surprise me at all. Since I do not carry a cell phone with me during clinic hours, this does not pertain to me. Computer keyboards and other hospital equipment may also be contaminated. Personally, I consider EVERYTHING in the hospital potentially contaminated. I hate touching elevator buttons ("Can you push three from me, please?) and I never touch stairway banisters.

Electronic Medical Records (EMR) "Depersonalize" Medicine
I read a New York Times story about how EMRs are going to transform medicine into a highly-efficient machine, saving billions in healthcare costs. This is not without a big price, however, in the social arena. Not only do medical providers have to spend additional time documenting their medical records (not all medical providers are good typists!), but computers have created yet another depersonalized barrier in the medical relationship.

We have used EMRs for several years in our office, but I rarely use the computers in the exam room during the encounter unless I am just briefly checking lab results, etc. I just do not want a flat screen between me and making eye contact with the patient, I am sorry. I find it terribly disruptive to have a medical provider typing away as a patient is talking. I experienced this as a patient with my own medical provider. As in the past, I still jot down my notes, only to type the later, in the comfort and quiet of my own office.

We get less than 15 minutes allotted for each patient visit. I am not going to waste 12 minutes of that precious time by typing notes.

Related Topics:

• Ear, Nose & Throat Message Board with Rod Moser, PA, PhD
• Living Better Newsletter - Wellness news to keep you healthy and strong!

When the COBRA Strikes

More and more patients have been presenting to my office for complete physical examination, asking for extensive lab work and refills of medications. Why? They are losing their insurance, often due to losing their jobs. And, even if they do quickly find a job in this troubled economy, there is often a delay of months until a new insurance will be in effect. To make matters worse, the new insurance may be an HMO may not have our office as a preferred provider. This visit may be their last visit to our office. Obviously, continuity of care and provider preferences are not high priorities for insurance companies. Their unwritten goal is to provide an acceptable quality of care for the least amount of money.

It is required by law that employers offer COBRA insurance when an employee leaves or is terminated. The law does not require that the insurance is affordable. Since many companies pay all or at least a significant part of the premiums, the terminated employee, without an income, is required to pay the full amount. In many cases, it can cost a family $1000 a month. I like to call this the bite of the COBRA. As long as people do not eat or pay their housing costs, their unemployment checks may cover COBRA costs.

Companies have group insurance, usually at a discounted rate, and usually from the low-bidder. The insurance company is required to insure all employees (and their family members), even if they have a pre-existing medical condition, such as diabetes or cancer. When the employee loses their jobs, any pre-existing condition would preclude them from getting private insurance from another vendor. So, often, the only option for recently terminated employees is to pay the astronomically-high COBRA premiums.

Obama's Economic Incentives Plan has a provision for the government to pay about 65% of the cost of COBRA for people who have lost their jobs, for up to nine months. This will help, but what will really help is complete health care reform, and some government oversight on what insurance companies can charge. The housing market has taken a huge dive, so it is really time for a substantial adjustment in health care costs, including insurance premiums and drug costs. Health care giants, like oil companies, have taken huge profits in the last few decades. Universal health coverage is in all industrialized countries, except the U.S. About 28 percent of the country is receiving health benefits through the federal government, however, through Medicare, Medicaid, and Veterans services. All in all, 15% of our country's GNP is health-related services, more than any other country. In addition, illegal aliens living in the U.S rack up billions of dollars in charges just using the emergency room for mostly non-emergencies.

Compared to other countries, the cost of medical care in the U.S. is among the most expensive. An American friend of mine, living in Mexico, pays only a few hundred dollars a year for basic health insurance. While the level of technological care in Mexico may not be up to U.S. standards, neither are their standard fees. Granted, I would rather receive medical care in the U.S. if I were ill, but it would really be nice if those fees reflected the cost of doing business. A private doctor that I know once bragged about charging $30 for a lab test that cost him about three CENTS in his office. He laughed all the way to the bank.

While traveling in New Zealand years ago, I saw a posting of charges on a health clinic wall. I was shocked that the same services provided in the U.S. are many times greater. One common antibiotic in the US was nearly sixty dollars; it was on eight dollars in New Zealand. The pharmacist explained to me that the entire country of New Zealand is the collective bargaining unit, so the government negotiated for a lower fee. In the U.S., we pay what the market allows. Walmart is advertising hundred of prescriptions now for just $4.00 and why not? Naprosyn 500mg, for instance, costs a pharmacy about $17 per thousand. They are able to fill over 17 prescriptions of sixty tablets - a one month supply - at $4.00 each, they would still make a 388% profit (not counting the cost for the pharmacist to put it in a smaller bottle, of course).

Basically, insurance premiums are high largely in part because medical charges are high. Medical charges are high for many reasons - high malpractice premiums, high salaries, expensive laboratory tests, expensive imaging (x-ray, CT, MRI) studies, administrative costs, and of course, expensive medications. In the end, the wage-earning consumer (or the federal government) eventually picks up the heavily inflated tab.

A former patient of mine, a Hiroshima survivor and now a U.S. citizen, was between a rock and hard place. She is entitled to free medical care in Japan, but in the U.S., she has to pay out of pocket. She cannot afford health insurance. Since the atomic bomb dropped on her city, she has been worried about cancer (rightfully so). Every time she had a sore throat, she would think it was throat cancer. When she coughed, it was lung cancer. I spent a great deal of time reassuring her and trying to keep down her costs by charging less (sometimes free). I was on vacation when she ended up at the local emergency room with a cough. Since they were not familiar with her medical history, they ran some very extensive tests. Her total ER bill for a one hour ER visit was about $5000. In tears, she showed me the bill. I spent the better part of one month trying to negotiate a lesser fee for those excessive charges, to no avail. She ended up paying it all from her savings. She told me that it would have been less expensive for her to fly back to Japan for care. More and more Americans are doing just that - they are flying to other countries to get medical care, like hip replacements.

The cobra is one of the most poisonous snakes on this planet. Like its insurance namesake, its bite can kill and certainly disable a victim - medically and financially.

I am in my 36th year of medical practice and I pray for health care reform. I pray for less-expensive insurance and medical services. I pray that Mr. Obama can pull it off. If not, praying may be our ONLY insurance.

Related Topics:

• Laid Off? 10 Health Care Tips
• Hefty Health Spending in Stimulus Bill
• Living Better Newsletter - Wellness news to keep you healthy and strong!