Just say ‘Whoa!’ to runaway medical costs

The 21st-century American reality is if you get sick, really sick, you’re in for a money nightmare on top of the emotional and physical toll of serious disease. 

Medical costs keep skyrocketing with no sign of easing. Americans spent more than $3 trillion annually on health care in pre-pandemic times, more than any other country on the planet — and we end up with some of the poorest outcomes among our peers in advanced nations.

With the economic disruptions caused by the coronavirus pandemic, public conversations have been dominated as never before by the giant role that health care costs play in our lives. The discussion has become even more painful with recent news articles detailing a shame of the system: medical debt that torments more than 100 million Americans — 41% of all adults — and shoves them relentlessly into economic peril. 

As consumers from coast to coast also are getting slammed by soaring inflation, can regular folks find ways to get the best outcomes for their health care dollars, without reductions in safety or quality?

They can, as the five examples in this newsletter suggest.

It may take a little effort to optimize your spending, avoiding wasteful supplements, triple-checking what your expensive insurance covers, and not only finding good doctors and pharmacists but also getting them to help you with gnarly financial issues that affect your medical care.

Of course, here’s hoping that you and yours stay healthy in the year ahead and beyond, so you do not need to fret about health care costs!

Big Pharma and other profit-seeking purveyors of health-related nostrums have shown the world that Americans love taking pills. Far too many of them.

Consumers can pocket some cash and stop forking out money needlessly on supplements. The evidence of their benefits is slim to none.

Medical scientists long have criticized the federal Food and Drug Administration for failing to corral the booming supplement industry, on which experts estimate consumers spend more than $30 billion annually or about $100 per person. Despite claims manufacturers may make for them, supplements lack rigorous proof of their effectiveness, studies show. This means many of us can clear a kitchen shelf full of pills.

The respected U.S. Preventive Services Task Force, an elite and independent group advising the federal government on screening, testing, and other medical services, has just reexamined more than 80 scientific studies on pills popped to improve users’ health and prevent disease. The group gave a D rating to taking beta carotene (vitamin E) to prevent cancer or heart disease, saying this should not be done. The experts also said, “The current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamin supplements for the prevention of cardiovascular disease or cancer.”

Sure, in specific cases, doctors may advise patients to take supplements to deal with deficiencies or specific health conditions. But even a cursory scan for rigorous evaluations will show the underwhelming evidence for popular supplements — say, for Vitamin D (click here), glucosamine-chondroitin (click here), or melatonin, (click here) for which experts are collecting data on the potential risk to curious kids who swallow their parents’ supplies.

While health insurance can be a major way to protect yourself from bankrupting medical costs, don’t throw away hard-earned dollars on policies that promise a lot but fail to deliver.

The former presidential administration, which never produced its own alternative to the Affordable Care Act that it loathed, did its best, instead, to push dubious alternatives. Health policy experts dubbed them “skinny” plans. The problem with these policies, and the people who hard-sell them in sketchy ways, is that they fail to comply with now-familiar and important ACA requirements. Skinny plans often offer lower monthly premiums. But when patients need them most — due to major injury or illness — they too often find that these policies pay little or nothing. That’s because, for example, they exclude coverage due to preexisting conditions or do not pay for care as required under the ACA. Obamacare plans, for example, pay for certain preventive care and women’s reproductive health, and they eliminate annual and lifetime limits on benefits.

Buyers also should be wary of another kind of ACA-noncompliant coverage — so-called sharing ministries peddled to those of faith. Religious groups, purporting to assist believers with unacceptably high health care costs, have essentially pooled members’ money and created plans to, effectively, self-insure or “share” participant health care costs. But patients with major illnesses and injury have found themselves broke and out in the cold when the plans have declined to cover big medical bills. The sharing ministries, as the Kaiser Health News service has reported, aren’t considered by most states to be insurance and are largely not regulated as such. Do the math: If you and 99 pals pooled $1,000 each for health care, that’s $100,000 — a sum that could be wiped out by one car wreck and the medical care an individual might require. Caveat emptor.

By the way, take time to examine the information package your health insurance coverage sends you annually. Your insurer will never be a best friend. But companies can provide services and coverages that you might overlook and that could save you money. If, for example, you’re on the border about calling your doctor about a non-emergency issue, your insurer may offer telehealth services with a skilled nurse or physician assistant who can advise you. You may find, especially under the ACA, that you’re covered for medical services deemed to be preventive — including blood pressure testing and colonoscopies — and women’s reproductive health care.

Pro tip: Be aware that “routine” tests and screens can turn into a costly cascade of care that can be unnecessary, costly, invasive, and painful.

It can take time and energy to do so. But finding a good primary care doctor (for grownups) and an excellent pediatrician for the kids can benefit patients’ health — and hold down medical expenses — research shows.

Primary care doctors are a critical, undervalued, and badly needed part of our health care system. Every patient should have one, argues the National Academies of Sciences, Engineering, and Medicine. The academies describe themselves as “private, nonprofit institutions that provide expert advice on some of the most pressing challenges facing the nation and world.” As medicine has become expensive, specialized, and fragmented, patients need a primary doctor to provide them with frontline care. They can help steer them through a thicket of options if they have chronic, serious conditions or injuries, the academies found. If patients take the time to find and build a relationship, their primary care doctors — especially if they provide a comprehensive practice — can help them deal with their medical needs without shipping them to an array of specialists, often repeating costly tests and exams in frustrating, invasive fashion. (Patients, especially as they age, may turn increasingly to specialists like cardiologists and turn them into their primary care doctors. This can mean higher costs and less continuity in their care, though, researchers have found.)

“Greater use of primary care is associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality,” according to the nonprofit, independent Primary Care Collective. It is a consortium of medical specialist groups, insurers, pharmaceutical companies, major corporations, patient advocacy organizations, and other parties deeply involved in the health care system.

Simply put, patients find it daunting enough to raise important, private medical concerns with doctors, especially if patients barely know them, rarely see them, and the press of modern practice sharply limits the time spent with patients. This also means it is hard for regular folks to talk to doctors about what can be a major taboo in American life: money and the cost of major health care. Patients should not hesitate to discuss financial worries about their care with their doctors, especially because this has become a hot topic for them, too. Major initiatives involving both have been launched by the American Board of Internal Medicine (ABIM) (click here for more information) and Robert Wood Johnson (click here for information) foundations, as well as by the America’s Essential Hospitals organization (click here for more information) and the American College of Physicians (click here for more information).

U.S. patients tell pollsters that prescription drug prices are out of control.  They express rising concern about drugs’ affordability as the number they must take increases. With politicians stuck on ways to curb medication costs, patients can try to rein in these relentless expenses — with the help of their doctors and pharmacists, advocacy groups like Consumer Reports and AARP say.

It’s important to underscore this point: Prescription drugs are a vital part of many patients’ treatment, and they cannot benefit from them if they don’t take them because they cost too much. This makes drug affordability a major health issue.

Some steps in dealing with drug costs are easier than others. But patients, especially if they have not seen their doctors in a while, can start by gathering up all the pills they take routinely — including supplements and over-the-counter medications — and draw up a list of them or, better, carry the bottles to an appointment. They should ask, politely, whether any drugs can be dropped as unnecessary, and if any need changing because they interact in harmful ways. Seven out of 10 patients who queried about their pill lists had one or more prescriptions eliminated, Consumer Reports found. If you can benefit from a medication and need it only for a short time, your doctor might be able to help you by sharing drug-maker samples she has received from what can otherwise be pesky pharmaceutical salespeople.

Your doctor or pharmacist also can review your prescriptions to see if they can suggest equally effective, less costly alternatives like generics. The federal Food and Drug Administration regulates generics for safety and effectiveness. They typically cost much less, partly because their makers, unlike with branded medications, don’t spend bundles on marketing and advertising. As for the difference in their makeup, the Journal of the American Medical Association has reported this: “Generic drugs are identical to their brand-name comparison drugs in terms of active ingredients, but their inactive ingredients can vary. Inactive ingredients do not affect the chemical activity of a drug and are added during manufacturing for stability and preservation purposes or to achieve a certain consistency, form, color, or taste.” The FDA on its website provides this further information: “In 2004, the average price of a generic prescription drug was $28.74, while the average price of a brand-name prescription drug was $96.01, according to the National Association of Chain Drug Stores.”

Generics, of course, are not always an option, and that can force patients to shop around for the best prices. Consumer Reports says to check with major retailers like Walmart, Costco, grocery chains, and big drug stores like CVS, Rite Aid, and Walgreens. As Consumer Reports found by using “secret” shoppers, a friendly pharmacist can be a savings boon, with “a Rite Aid store near our headquarters in Yonkers, N.Y., … able to get the price of atorvastatin, the generic version of Lipitor, down to just $18 from $300 through a combination of in-store and external discount programs.”

Patients will be surprised to learn that paying cash out of pocket can be cheaper than relying on their health insurance coverage for drugs. They can try online resources, including the popular Good Rx website to scrutinize prescription drug prices and options. Billionaire Mark Cuban is gaining national attention with Cost Plus drugs, his prescription medication startup, which he insists will be as transparent as possible about costs and as affordable as the market allows on costs.

Patients with serious diseases can talk with their specialists about the possibility of participating in clinical trials. Drug makers and investigators, in exchange for vital information they gather from patients in these test programs, often provide novel or innovative medications, substantially underwriting all or part of their costs, as well as giving participants heightened care. Many of the drugs prescribed for advanced cancer care come with crushing costs, contributing to what specialists acknowledge is a “financial toxicity” in treatment. This means the need is huge for patients, their loved ones, and doctors to have frank, sustained discussions about cancer care and its costs.

Hospital costs can be budget-busting, and specific financial tactics can help patients deal with big bills from fancy institutions. Patients can further protect themselves against excessive costs by doing all they can to avoid an important area of hospitals: emergency rooms.

Because of the enormous expertise, gear, and other resources they must keep at the ready, ERs charge some of the highest rates going for medical services. Patients still overwhelm these facilities — yes, because of the pandemic, but also too often with non-emergency needs. This is occurring despite the inconvenience of long waits and being surrounded by the sick and injured. This is occurring even though a key point of Obamacare was to provide the poor, working poor, and middle-class with enough health coverage so they could get affordable care before their health worsened so much they ended up in ERs.

Let’s be clear: certain symptoms and conditions cannot be ignored and do require emergency treatment (click here for more information in another of my newsletters, notably in the section on “Beware and act on these symptoms.”). If you’re seriously ill or injured in a vehicle wreck or in other dire circumstances, ERs can be lifesaving and necessary.

But dealing with other kinds of health conditions early — in a visit to your doctor or a health clinic rather than when they have turned bad —can be a big deal for your well-being and finances. Don’t wait until the middle of the night or during a long weekend or holiday for an illness or injury to go south before seeking medical care. As mentioned above, if you have a good primary care doctor, you can talk with her in advance about dealing with urgent medical needs. Does the practice have after-hours coverage — and how do you access it? Does your doctor advise you to see others in the practice, including possibly an RN or physician assistant —if you are unwell and your regular practitioner can’t see you quickly?

If you’ve got rambunctious or athletic young folks in the house, your doctor or pediatrician, or other trusted parents can steer you to nearby urgent care facilities. These centers typically offer lower-cost care for stitches, sprains, potentially even minor bone breaks — and more conveniently than the ERs of big hospitals or academic medical centers. Those institutions, by the way, own and operate many of the satellite urgent care clinics. Research shows that patients are getting too comfortable and overusing these facilities for non-emergency medical services.

Urgent care and other commercial clinics, notably those in big-chain pharmacies are not a substitute for a strong, sustained relationship with a doctor who can, for example, help you and your loved ones with preventive efforts that keep you healthy and really hold down costs. Think stuff like vaccinations, diet, diagnosing potential illnesses early, and treating troublesome or chronic conditions.