Healthcare premiums rise, as healthcare spending slows. Three ways health care consumers can cope.

Healthcare premiums rise, as healthcare spending slows. Three ways health care consumers can cope.

by William D. Charschan DC,CCSP, author Cheating Mother Nature, what you need to know to beat chronic pain.

I predict that in five years, there will be a growing chorus within the United States to adopt a single payer system. While this is a bold statement, there are huge problems that we as a country are now presented with, as we pay more for health care and get less. It is simply becoming unaffordable for the average family. Through the frustration and confusion, many employers are now saddling their employees with high yearly deductibles, lower levels of benefits for healthcare and unfortunately, many needed services are being put off. On the other hand, many people found out that during the recession, as they put off expensive medical procedures, that after a few years, their bodies functioned perfectly well and they avoided costly procedures that would have had no health benefit.

According to a NY Times article on the growth of healthcare costs, one of the drivers of our continuing escalation in our health care premiums continue to be drug costs. Drug companies have become experts in having the public believe it wants their products, and having health care providers back them up as their prescription patterns are monitored closely by computers and drug reps who visit often. In sales, if you are able to create something that people want, they will pay for it. To counter the high prices and deductibles, many drug companies are now offering coupons to offset the patient out of pocket costs, further driving sales. The dirty secret is that big pharma creates products that fix nothing, but have a biological effect to relieve a condition while it is being taken. Blood pressure medication is an example, where you need it to lower the pressure but if you stop taking it, your pressure goes up again. Since it solves nothing, but relieves a symptom, you must renew the subscription forever or until something in the body changes requiring an adjustment to the cost of treatment. Americans take more drugs than any other country. Perhaps we need to reevaluate what is wrong with this paradigm which continues to drive health care costs. This year again, we are paying more for health care while getting less, paying higher deductibles and paying higher premiums than ever before says the NY Times.

Hospital and facility costs continue to stay high, while most doctors receive only a small portion of the procedures cost. This is why many specialists have invested in the surgery centers that exist throughout NJ and other states, it is a way for them to pay their bills, since insurers pay severely pared their reimbursement levels for the actual work being done. To put it in perspective, a 1 hour room in a surgical suite for a colonoscopy will likely cost you $1200, the doctor may receive 2-300 dollars, the anesthesiologist may receive 400 dollars. The doctor performing the procedure should be paid more and the surgicenter should be paid less, as they may book 20 procedures during the day. You can do the math on this but surgicenters are huge profit centers. Perhaps, a global fee split among everyone may be a more equitable solution, which should add up to less in total than the a la carte method we use n0w. This is the coming formula for medical home and some of the other models now developing to deliver care. You can actually get a room at the Ritz Carleton in NYC overlooking central park for an entire day for about 1000 dollars, less than the cost of the surgicenter. True, the surgicenter is best equipped for any emergencies, however for the consumer, the value system is broken for what they get for their dollar in our insurance covered medical system( by the way, insurers are fine with this even though it makes little sense).

End of life and expectations of what the medical system can do for us is out of wack. Last May, 9 specialty groups described how 45 preventative disease screens had little worth, but had become gospel in our healthcare system. This news traumatized many people who had faith their doctors kept them alive with this lifesaving intervention and their tests. In reality, it caused mental anguish, trauma, unnecessary procedures, intervention and in the end, prevented little. It will take years for the public to fully accept these findings, which included breast and prostate monitoring. One might ask, since this data was not new, why now? It is likely that some of the new ideas such as ACO’s or accountable care organizations which will likely globalize physician reimbursement for procedures will not allow for procedures that have no value so we may as well deal with it now before these ideas take hold fully.

Palliative end of life care will be a growing consumer trend, since most hospitals have little in the way of procedures or protocols for dealing with end of life except for intervention. Family counciling and honesty is a great step forward, while deemphasizing procedures and constant testing, poking and prodding that happens to many seniors who are older. Our healthcare system needs to have better ways of moving forward to embrace these facts and have a healthier way of dealing with something all of us will eventually experience.

From a consumers perspective in 2013, here are some things you need to do.

1. Become a better healthcare consumer and make your decisions based on knowledge rather than through fear. Most people agree to procedures because they feel threatened, or their body does not work the way it should. Often times, other diciplines may have answers to why you have problems. An example of this is stomach discomfort. The term IBS is often thrown around when there is no explanation for the symptoms. It would be helpful to know that a chiropractor could help these symptoms because they often are problems in the abdominal muscles, and even in the musculoskeletal realm. Keep an open mind, because other thought processes though other professions may have your answer.

2. When a loved one is older, and is having failing health, check into other options such as palliative care. Rather than trying to be heroic, the methods are for comfort. Why should someone suffer needlessly, when the outcome is no different.

3. Know what your insurance will and will not pay for. If you have a high deductible plan, does your employer pay for part of most of the deductible? If so, how? Some will give you a credit card to use, others, you need to pay first and then put in for them to pay, while others, have a plan that has the insurance carrier pay out of a fund until the insurance deductible is reached. Once the deductible is reached, your insurer will pay your doctor. You may be responsible for a co payment after reaching the deductible or just a co pay. You as the consumer are in charge now and you need to understand the costs and are you receiving value for the money, your money, that you are spending to help yourself.

I value your opinions. Please feel free to comment. Cheating Mother Nature is available through Amazon.com and other booksellers.