Consumer Directed Healthcare

By JULIE PACE
The Associated Press
Thursday, October 23, 2008; 1:07 PM

SENECAVILLE, Ohio — Even if the issue doesn’t often get star billing on the campaign trail, health care remains a huge issue for voters. It seems like everyone’s got a story to tell about their medical challenges and how they do _ or don’t _ get insurance coverage.

An Associated Press-Yahoo News survey taken last month shows that 78 percent of voters say health care is a very important or extremely important issue.

Both presidential candidates have promised that, if elected, they’ll propose significant changes to the way Americans purchase health insurance, a process that is often cumbersome, confusing, and that has left 47 million people in the Unites States uninsured.

Republican presidential nominee John McCain is proposing a tax credit of up to $2,500 for individuals and $5,000 for families so people can buy the insurance of their choice. That credit would replace the tax break that people currently get when they obtain health coverage through their employer.

Democrat Barack Obama’s plan calls for the government to subsidize health coverage for millions of Americans who otherwise could not afford it. He has also proposed a government-run plan that couldn’t turn away people with certain pre-existing health problems.

A look at how three American households grapple with finding and paying for health care:

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KRISTOPHER YGLESIAS, 34, Keller, Texas.

Ygelesias doesn’t consider himself a gambler, but he knows he’s taking a risk by going without health insurance.

The father of three used to pay about $1,000 a month to buy coverage through his employer, but concluded it wasn’t worth it.

“I decided I simply can’t afford to put that much money out when I don’t use it,” Yglesias said.

Yglesias now pays for everything from routine doctor’s visits to prescriptions in cash. When his third child was born, he arranged a payment plan with the hospital and doctors.

Yglesias said his medical costs are lower now that he pays his own way than they were when his family was covered by insurance. But the family has never had to face the costs of treating a catastrophic accident or illness.

“If something terrible were to happen, we would have a very serious problem,” he acknowledges. “We would be exposed to huge financial burden that we wouldn’t be prepared to handle.”

Yglesias doesn’t see himself purchasing conventional insurance again, unless significant changes are made. However, the registered Republican likes McCain’s plan to give families a tax credit to use toward the purchase of health insurance..

“That would be a solution I would jump on without any question,” said Yglesias, who plans to vote for McCain.

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TINA LAWRENCE, 48, Toledo, Ohio

Lawrence’s job as a software programmer has taken her to three different universities in the past two years. Each time she switched employers, she also had to switch insurance companies.

That meant spending hours reading the fine print for each plan. One didn’t offer vision coverage. Another raised her copays.

“The plans vary greatly,” Lawrence said. “It can really be a hassle.”

Lawrence’s husband and daughter, a college student with diabetes, also are covered under her plans. Fortunately, she said, she hasn’t experienced any gaps in coverage as she’s moved between jobs, but she’s faced frequent worries about what her newest plan will offer.

Lawrence said she would support a plan that allowed individuals to keep their existing insurance when they switch employers, as long as it meets certain coverage standards. However, she’s wary of any proposals that could cause employers to stop offering insurance.

“With some of the costs that we incur, there’s just no way we could do that,” said Lawrence, a Democrat who is voting for Obama.

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DeLYNN GIBEL, 58, Senecaville, Ohio

It took doctors more than a year to diagnose DeLynn Gibel’s husband with multiple sclerosis.

With no health insurance offered through their jobs, and no money to purchase coverage on their own, the Gibels’ year’s worth of tests and treatments left the family with $30,000 in medical bills.

The only option, Gibel said, was to declare bankruptcy.

“You don’t have enough money to make ends meet on a fixed income,” she said. “You always hear that, but until you actually experience that, it’s completely different.”

Because of his illness, John Gibel is now covered under Medicare. His wife stays home to take care of him.

But the couple is facing a new problem. DeLynn Gibel was recently diagnosed with Type 2 diabetes. The medical bills are starting to pile up again, including a $15,000 bill for a three-day hospital stay.

Gibel, a Republican, is voting for McCain. She hopes health-care reform will be part of the next president’s agenda, but is worried that her needs won’t be a top priority.

“We’re so busy taking care of other places, and other countries and rebuilding for them, that the American people are just lost in the picture somewhere,” Gibel said.

© 2008 The Associated Press

By Don McCanne, M.D., PNHP Senior Health Policy Fellow
Huffington Post
October 10, 2008

John McCain and Barack Obama both recognize that there are serious problems with our health care system, and that the voters want something done about it. They would both use public policies to modify the private health insurance market to accomplish their goals. Although it would seem that their goals are similar, the specifics are quite different because they have started from very dissimilar perceptions of the primary flaws in health care financing.

John McCain believes that employer-sponsored plans and government health programs insulate individuals from the costs of health care, creating an excessive demand for health care. He believes that our financing problems would be solved if we put individuals in charge of purchasing their own health care and health care coverage in a marketplace that controls costs through competition. He does understand that coverage is now too expensive for the majority of us, so he would use government tax credits to help pay for private plans. He would also have the states establish “guarantee access plans” that would insure those who cannot otherwise obtain coverage because of preexisting conditions, though these high-risk pools would be exorbitantly expensive.

Barack Obama believes that the high costs of health care and health care coverage have created a financial burden for individuals and small businesses. He also recognizes that many health plans no longer prevent those with health care needs from facing financial hardship, because of inadequate benefits and excessive cost sharing. He would provide a regulated market of plans of a quality similar to those that federal employees have. Although both Sen. Obama and Sen. McCain recommend systemic reform measures designed to reduce costs, Sen. Obama understands that health plans would still be too expensive, so he would not require everyone to purchase them.

Under Sen. McCain’s proposal, greater numbers would go without insurance simply because health plans would still remain unaffordable even with the tax credits. In a deregulated insurance market, those who obtain coverage and have health care needs would find that affordable plans would no longer provide adequate protection against financial loss. It has been estimated that about 65 million people would be uninsured ten years into his program.

Under Sen. Obama’s proposal, ten years out about 33 million individuals would be without insurance simply because their incomes would be too high to qualify for welfare programs, but too low to be able to pay for private plans.

The problem with both proposals is that they depend on the obsolete model of private health plans. The costs of health care in the United States are much higher than in any other nation. They are so high that the private insurance industry is no longer capable of providing us with insurance products that cover all reasonable essential health care services at a premium that we can afford. Our national health expenditures are now $7900 per person. For a family of four, that’s over $31,000. With a median household income of $50,000, we could never expect to pay the health care tab through private health plans. (An employer-sponsored family plan currently averages $12,600, but we pay much of the difference in direct and indirect taxes for high-cost individuals in Medicare, Medicaid, the VA system, safety-net institutions, and other public programs.)

Our dysfunctional, fragmented system of financing health care through a multitude of private plans and public programs is highly inefficient, inequitable, wasteful, and ineffective in slowing the twin epidemics of uninsurance and underinsurance, while health care costs continue to spiral out of control.

Replacing our current financing system with a single, universal risk pool that is publicly-administered and equitably-funded through public financing would create an administratively-efficient system in which everyone is automatically included, for life.

The $2.4 trillion that we are already spending is more than enough to provide comprehensive services for everyone, providing that we adopt the efficiencies of a single payer system. With our own public, single payer monopsony, we would be able to demand much greater value in our health care purchasing by realigning incentives to improve our primary care infrastructure and to reduce administrative waste and the overuse of non-beneficial high-tech services, leaving more funds for high-tech care that does improve our health outcomes.

Sen. McCain wants each of us to go out and shop for our own health care and health insurance coverage, even if we can’t pay for it. His “you’re on your own” approach rejects the notion of social solidarity, even though all other wealthy nations accept solidarity as a fundamental foundation of a just society.

Sen. Obama has said that if we were starting from scratch, he would recommend adopting a single payer system. He’s right. The current financing system is such a disaster that we really should jettison it and start over with single payer system: a new and improved Medicare that covers every single one of us, at a price that we can afford.

By Josef Woodman
 
The new phenomenon of medical tourism—or international health travel—has received a good deal of wide-eyed attention of late. While one newspaper or blog giddily touts the fun ‘n sun side of treatment abroad, another issues dire Code Blue warnings about filthy hospitals, shady treatment practices, and procedures gone bad. As with most things in life, the truth lies somewhere in between.

In short, I’ve found the term “medical tourism” is something of a misnomer, often leading patients to emphasize the recreational more than the procedural in their quest for medical care abroad. Unlike much of the hype that surrounds contemporary health travel, Patients Beyond Borders focuses more on your health than on your travel preferences. Thus, throughout this book, you won’t see many references to the terms “medical tourism” or “health tourism.” In the same way business travelers don’t normally consider themselves tourists, you’ll begin to think more in terms of medical travel and health travel.

My research, including countless interviews, has convinced me: With diligence, perseverance, and good information, patients considering traveling abroad for treatment do indeed have legitimate, safe choices, not to mention an opportunity to save thousands of dollars over the same treatment in the United States. Hundreds of patients who have returned from successful treatment overseas provide overwhelmingly positive feedback. They persuaded me to write this impartial, scrutinizing guide to becoming an informed international patient. I designed this book to help readers reach their own conclusions about whether and when to seek treatment abroad.

So, why go abroad for medical care? Here are seven reasons.

1. Cost savings.  Most people like to get the most for their dollar. The single biggest reason Americans travel to other countries for medical treatment is the opportunity to save money. Depending upon the country and type of treatment, uninsured and underinsured patients, as well as those seeking elective care, can realize 15 to 85 percent savings over the cost of treatment in the United States. Or, as one successful health traveler put it, “I took out my credit card instead of a second mortgage on my home.” As baby boomers become senior boomers, costs of healthcare and prescriptions are devouring nearly 30 percent of retirement and preretirement incomes. With the word getting out about top-quality treatments at deep discounts overseas, informed patients are finding creative alternatives abroad. The costs listed in this table are for surgery (except as noted), including the hospital stay in a private, single-bed room. Airfare and lodging costs are governed by individual preferences. To compute a ballpark estimate of total costs, add $5,000 to the amounts shown in the table for you and a companion, figuring coach airfare and hotel rooms averaging $150 per night. For example, a hip replacement in Bangkok, Thailand, would cost about $18,000, for an estimated savings of at least $15,000 compared with the U.S. price. The estimates above are for treatments alone. Airfare, hospital stay (if any), and lodging vary considerably. Savings on dentistry become more dramatic when “big mouth-work” is required, involving several teeth or full restorations. Savings of $15,000 or more are common.

2. Better-quality care.  Veteran health travelers know that facilities, instrumentation, and customer service in treatment centers abroad often equal or exceed those found in the United States. Governments of countries such as India and Thailand have poured billions of dollars into improving their healthcare systems, which are now aggressively catering to the international health traveler. VIP waiting lounges, deluxe hospital suites, and staffed recuperation resorts are common amenities, along with free transportation to and from airports, low-cost meal plans for companions, and discounted hotels affiliated with the hospital. Moreover, physicians and staff in treatment centers abroad are often far more accessible than their U.S. counterparts. “My surgeon gave me his cellphone number, and I spoke directly with him at least a dozen times during my stay,” said David P., who traveled to Bangkok for a heart valve replacement.

3. Excluded treatments.  Even the most robust health insurance plans exclude a variety of conditions and treatments. You, the policyholder, must pay these expenses out of pocket. Although health insurance policies vary according to the underwriter and individual, your plan probably excludes a variety of treatments, such as cosmetic surgeries, dental care, vision treatments, reproductive/infertility procedures, certain nonemergency cardiovascular and orthopedic surgeries, weight loss programs, substance abuse rehabilitation, and prosthetics—to name only a few. In addition, many policies place restrictions on prescriptions (some quite expensive), postoperative care, congenital disorders, and pre-existing conditions. Rich or cash-challenged, young or not-so-young, heavily or only lightly insured, folks who get sick or desire a treatment (even one recommended by their physician) often find their insurance won’t cover it. Confronting increasingly expensive choices at home, nearly 40 percent of American health travelers hit the road for elective treatments. In countries such as Costa Rica, Singapore, Dubai, and Thailand, this trend has spawned entire industries, offering excellent treatment and ancillary facilities at costs far lower than U.S. prices.

4. Specialty treatments.  Some procedures and prescriptions are simply not allowed in this country. Either Congress or the Food and Drug Administration has specifically disallowed a certain treatment, or perhaps it’s still in the testing and clinical trials stage or was only recently approved. Such treatments are often offered abroad. One example is an orthopedic procedure known as hip resurfacing, a less expensive alternative to the traditional hip replacement still practiced in the United States. While this procedure has been performed for more than a decade throughout Europe and Asia, it was only recently approved in the United States, and its availability here remains spotty. Hundreds of forward-thinking Americans, many having suffered years of chronic pain, have found relief in India, where hip resurfacing techniques, materials, and instrumentation have been perfected, and the procedure is routine.

5. Shorter waiting periods.  For decades, thousands of Canadian and British subscribers to universal, “free” healthcare plans have endured waits as long as two years for established procedures. “Some of us die before we get to the operating table,” commented one exasperated patient, who journeyed to India for an open-heart procedure. Here in the United States, long waits are a growing problem, particularly among war veterans covered under the Veterans Administration Act, for whom long queues are becoming far too common. Some patients figure it’s better to pay out of pocket to get out of pain or to halt a deteriorating condition than to suffer the anxiety and frustration of waiting for a far-future appointment and other medical uncertainties.

6. More “inpatient friendly.”  As U.S. health insurance companies apply increasing pressure on hospitals to process patients as quickly as possible, outpatient procedures are becoming the norm. Similarly, U.S. hospitals are under huge pressure to move inpatients out of those costly beds as soon as possible. Medical travelers will welcome the flexibility at the best hospitals abroad, where they are often aggressively encouraged to spend extra time in the hospital post-procedure. Patient-to-staff ratios are usually lower abroad, as are hospital-borne infection rates.

7. The lure of the new and different.  Although traveling abroad for medical care can be challenging, many patients welcome the chance to blaze a trail, and they find the creature comforts often offered abroad a welcome relief from the sterile, impersonal hospital environments so often encountered in U.S. treatment centers. For others, simply being in a new and interesting culture lends distraction to an otherwise worrisome, tedious process. And getting away from the myriad obligations of home and professional life can yield healthful effects at a stressful time. What’s more, travel—and particularly international travel—can be a life-changing experience. You might be humbled by the limousine ride from Indira Gandhi International Airport to a hotel in central New Delhi or struck by the simple, elegant graciousness of professionals and ordinary people in Thailand, or wowed by the sheer beauty of the mountain range outside a dental office window in Mexico. As one veteran medical traveler put it, “I brought back far more from this trip than a new set of teeth.”

This article is based on excerpts from the second edition of Patients Beyond Borders (2008), the flagship of a landmark series of consumer guides to international medical travel that have helped thousands of patients plan successful health journeys abroad. Healthy Travel Media, publisher of the guides, has become a global clearinghouse for useful information about medical and wellness travel.

Copyright © 2008 U.S. News & World Report, L.P. All rights reserved.