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Bills, Bills, Bills: Readers And Tweeters Offer Solace, Solutions And Scoldings

Readers And Tweeters: Are Millennials Killing The Primary Care Doctor?

Letters to the Editor is a periodic function. We welcome all feedback and can publish a variety. We edit for size and readability and require full names.

2018 was a busy yr for KHN, harvesting greater than 1,200 medical payments submitted by readers for consideration in our “Bill of the Month” franchise, an investigative partnership with NPR. These month-to-month dives into sufferers’ cumbersome payments proceed to spawn tales — in addition to proposed modifications to well being care coverage by legislators.

Sen. Bernie Sanders (I-Vt.) glommed on to the despair of an Arizona couple consumed by well being care debt (“Insured But Still In Debt: 5 Jobs Pulling In $100K A Year No Match For Medical Bills,” Dec. 28).

Nobody ought to need to work 120 hours every week or 5 jobs to have the ability to get the well being care they want. We’d like a well being care system that places individuals earlier than income. We’d like a Medicare for all, single-payer system.

— Bernie Sanders (@BernieSanders) December 27, 2018

In response to the August “Bill of the Month” function a few schoolteacher’s $109,000 coronary heart assault, Rep. Lloyd Doggett (D-Texas) tweeted: “When I heard Drew’s story — an Austin teacher saddled with a $100k surprise bill after surgery — I reached out to him to share my concern. We discussed my End Surprise Billing Act legislation, which would end this predatory practice.”

Once I heard Drew’s story—an Austin instructor saddled with a $100okay shock invoice after surgical procedure—I reached out to him to share my concern. We mentioned my Finish Shock Billing Act laws, which might finish this predatory follow.

— Lloyd Doggett (@RepLloydDoggett) September 1, 2018

Sanders additionally shared that story on Fb, saying: “Our health care system makes absolutely no sense. If you don’t have health insurance, you probably can’t afford to get the care you need. And if you DO have health insurance, in many cases you STILL won’t be able to afford the care you need, on top of paying a monthly premium.”

Outrageous medical payments proved one thing readers might relate to, as they reviewed our end-of-the-year roundup, Yr One Of KHN’s ‘Bill Of The Month’: A Kaleidoscope Of Monetary Challenges” (Dec. 21).

Message right here – do not get sick! @UTSWIMchief by way of @khnews

— David Johnson (@dhjutsw1) January 7, 2019

— Dr. David Johnson, Dallas

Plaudits For ‘Bill Of The Month’ Collection

Thanks for publishing these tales. You’re doing a public service. I work in well being providers analysis and know that the costs charged by producers, hospitals and different suppliers are arbitrary. The extra residents are knowledgeable about this, the extra energy we now have to vary how a lot well being care prices on this nation.

— Beth Egan, Minneapolis

Sufferers ought to look rigorously in any respect their hospital payments – estimates are that half have errors: exams scheduled however not and charged, medicines not taken., consults by docs who by no means noticed you. Caveat emptor!

— Edward Hoffer MD (@EdwardHoffer1) December 26, 2018

— Dr. Edward Hoffer, Boston

‘Bill Of The Month’: Recourse For Wounded Skier

Plainly the surgeon and the system producer ought to have paid for Sarah Witter’s second surgical procedure (“After Her Skiing Accident, An Uphill Battle Over Snowballing Bills,” Dec. 18). If she really adopted protocol for her rehab, they need to have owned as much as their mistake or to a poor manufacturing method. Virtually 10 years in the past, I had an higher gastrointestinal collection carried out to watch my non-Hodgkin’s lymphoma. Because of the biopsies, I skilled vital bleeding (the physician stated that he had carried out this process a number of occasions when the affected person was nonetheless on blood thinners, which I used to be). After I used to be admitted to the emergency room and acquired 4 models of blood, they repeated the process — and charged me for all of it. Thankfully, after threatening a lawsuit towards the hospital and the physician, they lastly paid for the emergency room and working expenses.

There nonetheless could also be some aid for Ms. Witter: There are corporations who audit hospital payments and receives a commission in the event that they discover financial savings. When the insurance coverage firm refused to pay the hospital, they need to have referred her to an organization that audits hospital payments.

— Dan Kass, chief shopper of HealthCare Purchasing Community, Mission, Kan.

On Twitter, readers minced no phrases:

Nicely, what do you anticipate from a small piece of metallic that prices $9,706? No marvel it broke.Invoice Of The Month: $43,208 For Repeat Surgical procedure To Exchange Damaged Medical Gadget

— Bernie Good (@CBGood23) December 18, 2018

— Bernie Good, Pittsburgh

That is unconscionable. We’d like #SinglePayer now! No one ought to should battle with insurance coverage corporations or foot the invoice for a second surgical procedure as a consequence of system failure. Invoice Of The Month: $43,208 For Repeat Surgical procedure To Substitute Damaged Medical System

— Judy Melinek M.D. (@drjudymelinek) December 18, 2018

— Dr. Judy Melinek, San Francisco

A Dose Of Fantasy-Busting

Julie Appleby’s story “Short-Term Health Plans Hold Savings for Consumers, Profits For Brokers and Insurers” (Dec. 21) perpetuates a standard misunderstanding that incentives for insurance coverage brokers favor promoting short-term over Reasonably priced Care Act plans.

By evaluating a month-to-month fee price of 20 % for short-term plans and a flat greenback quantity for ACA insurance policies, the article mistakenly means that fee earnings on short-term plans are persistently greater than people who adjust to the ACA. However the premise misses the essential proven fact that the lifetime worth of a plan — not the month-to-month fee fee — determines insurance coverage agent commissions. Brief-term plans are each inexpensive and held by the client for a shorter time period than ACA plans. At eHealth, an ACA plan generates twice the income as every short-term coverage.

Most insurance coverage brokers advocate for shoppers to decide on an ACA plan first, if they will afford it, as a result of the protection is way extra complete. Sadly, many People have been priced out of the ACA market and short-term insurance policies might symbolize one of the best viable medical insurance protection at a worth they will afford. Others miss the open-enrollment interval and, with out different choices, face a yr with no insurance coverage protection in any respect. The duty of an excellent insurance coverage agent is to assist all People achieve entry to the insurance coverage coverage best suited for his or her particular person medical and monetary wants. To do something much less just isn’t in the most effective curiosity of shoppers or to the long-term success of insurance coverage brokers.

— Scott Flanders, CEO of eHealth, Santa Clara, Calif.

Unhappy Twist On Knee Replacements

It’s true that docs don’t all the time inform you the truth of knee replacements upfront (“Up To A Third Of Knee Replacements Pack Pain And Regret,” Dec. 25). I needed to have my proper knee changed twice. I had a metallic allergy to the primary implant, which I came upon the onerous approach.

Sufferers ought to be examined for metallic allergic reactions earlier than surgical procedure. I’m so sorry I ever had my knee changed — it hurts worse now than it did earlier than the surgical procedure. I might not have my different knee changed until I couldn’t stroll. I used to be informed my knee can be nice till after my second surgical procedure, when my surgeon warned me my knee might all the time trigger me ache. That may have been good to know earlier than my first surgical procedure.

— Lesa Lawrence, Dallas

Often we do not hear the draw back of those procedures. However this proportion appears means too excessive. #meddevice #hipsnknees

— Greg Mays (@hips_n_knees) December 26, 2018

— Greg Mays, Nashville, Tenn.

With out knocking complete knee arthroplasty, or TKA, a New Yorker wonders whether or not we’re shifting in the best course.

TKA undoubtedly has room for enchancment however no knowledge I do know that the robotics arms race now underway will assist. Up To A Third Of Knee Replacements Pack Ache And Remorse by way of @khnews

— wendy diller (@Wendydiller) December 28, 2018

— Wendy Diller, New York Metropolis

Doing The Math On Biologics

The article “Why The U.S. Remains The World’s Most Expensive Market For ‘Biologic’ Drugs” (Dec. 20) talked about that Cosentyx prices about $15,000 in Europe versus virtually $65,000 in america. Whether it is true that somebody can buy a three-month provide for private use in Europe — and if a three-month provide, correctly dealt with, has a shelf life larger than three months — it appears attainable for Susie to go to Italy or someplace in Europe each three months for an estimated value of $6,000 a yr or much less (with tickets bought prematurely). Including to her journey prices the $15,000 annual value of the drug, which conveniently may be self-injected, she might nonetheless make out much better than paying $65,000 a yr within the States. Only a thought.

— Abette Jones-Bey, Blue Bell, Pa.

A tweeter provided one rationalization for the pricing disparity:

(Reply? The Pharma lobbyists spend an entire lot on congress individuals.) Why The U.S. Stays The Most Costly Market For ‘Biologic’ Medicine In The World

— Elizabeth Henry (@HenryLeerhenry) December 19, 2018

— Elizabeth Henry, Olathe, Kan.

Signal-Up Season’s Unsung Heroes

Your article on navigators (“Short On Federal Funding, Obamacare Enrollment Navigators Switch Tactics,” Nov. 30) uncared for to say the group of execs greatest suited to assist shoppers choose applicable well being protection: licensed insurance coverage brokers and brokers. Brokers and brokers sometimes have extra coaching and expertise than navigators. They’re licensed by the states through which they work. The bulk have been in enterprise for greater than 10 years.

Brokers and brokers additionally work with their shoppers year-round, not simply in the course of the six-week open-enrollment interval. A survey carried out by the Kaiser Household Basis discovered that greater than 70 % of brokers spend “most” or “a lot of” their time explaining protection to their shoppers.  It’s no marvel that almost 84 % of adults who labored with brokers and brokers when purchasing for trade protection discovered them useful — greater than some other group providing help.

— Janet Trautwein, CEO of the Nationwide Affiliation of Well being Underwriters (NAHU), Washington, D.C.

It has nothing to do with the excessive value of premiums!!!! Hey – Navigators it isn’t you! Brief On Federal Funding, Obamacare Enrollment Navigators Change Techniques by way of @khnews

— HAFA (@TheNolanGroup) December 5, 2018

— B. Ronnell Nolan, president and CEO of Well being Brokers for America, Baton Rouge, La.

Entrepreneurs Caught In The Center

I fall into the state of affairs described in Steven Findlay’s article “Health Insurance Costs Crushing Many People Who Don’t Get Federal Subsidies” (Dec. 14).

In the event you take a look at the standard prices for a household incomes greater than $100,400 a yr who don’t qualify for subsidies, the price is large. Our present premiums for an ACA-compliant coverage are about $1,400 a month with a mixed $13,000 deductible for my spouse and me (we’re self-employed). In case you have a “bad year” — say, a automotive accident the place you’re each hospitalized — your bills bounce to an estimated $29,800, or almost 30 % of your revenue. This appears to be the technique of the medical insurance corporations, whereby they need well being care pricing to be a hard and fast quantity of complete revenue. The best way they get there’s via lack of transparency.

After Supreme Courtroom Chief Justice John Roberts forged the deciding vote across the constitutionality of the ACA “tax” for being uninsured, I left a terrific company job and have since began a number of corporations and created jobs just because getting medical insurance by means of the ACA appeared sure. I’m now within the place the place I’m questioning if I’ll need to cease my entrepreneurial actions and discover a company gig once more with insurance coverage. I think I’m not alone on this.

The continued ambiguity round it will have a stifling impact on individuals like us who’re taking the danger to start out companies and create jobs.

— Mick Garrett, Fort Collins, Colo.

“The financial challenge for people […] has come into much sharper focus during the past year, as insurance premiums have spiked.”

Hmm… Really feel like I stated one thing like this may occur on the first point out of ACA. Love elements of ACA, however…

— Clayton Mowrer (@claytonmowrer) December 18, 2018

— Clayton Mowrer, Kansas Metropolis, Mo.

Band-Assist Fixes To ACA Are Like Salt To The Wound

“Ask Emily” columnist Emily Bazar gives a worthy answer which will work for various people and ought to be explored by these whose family revenue is barely above 400 % the federal poverty degree (FPL) (“Without Obamacare Penalty, Think It’ll Be Nice To Drop Your Plan? Better Think Twice,” Dec. 5). However there’s a break-even level which will make this answer undoable. Since FPL is a nationwide measure, with simply two states receiving an exception (Alaska and Hawaii) to the revenue ceiling, for anybody who resides in a state with a excessive value of dwelling, such changes to take-home pay can adversely influence their potential to afford different requirements of life.

Value of dwelling can range extensively by state or ZIP code, but the revenue ceiling for ACA subsidies is about on the nationwide degree. Insurance coverage premiums may additionally range amongst counties and even ZIP codes inside a state. Some name this market-based pricing or pricing based mostly on an space’s potential to pay (larger common incomes equate to larger premium costs). Nonetheless others name it price-gouging. But once more, the revenue ceiling is about on the nationwide degree.

I welcome any and all concepts that may permit extra people to acquire medical insurance (which, by the best way, doesn’t assure well being care protection). Modifications must be made to the regulation to degree the enjoying subject for shoppers. Till all shoppers have entry to protection on the similar worth, with the identical degree of subsidy be it authorities or employer, then we really are placing band-aids on a coronary heart assault. Till your age, marital standing, place the place you reside and measurement of your employer not hinder your potential to afford medical insurance protection, there’ll proceed to be these unnoticed and in danger.

Sadly, our elected representatives at each the state and nationwide degree have little abdomen to face and repair the glitches and inequities within the ACA. Their solely treatment, which comes within the type of a tax on the uninsured, has taken the ACA from an answer meant to convey medical insurance to all People to a coverage that depends on those that can’t afford medical insurance and are excluded from the advantages of the ACA to fund it. Now that’s ironic.

— Susan Frangione, Rockville, Md.

Hectoring individuals to purchase one thing they can not afford is not simply silly – it is a type of shaming and mockery. In fact individuals need medical insurance – however they’d like to purchase meals and shelter first.

— Rob Levine (@roblevine82) December 5, 2018

— Rob Levine, Minneapolis

What’s Actually Hurting ACA Enrollment

I can inform you the actual cause many People gave up on enrolling in an Obamacare plan this yr (“Need Health Insurance? The Deadline Is Dec. 15,” Dec. 10).

I had a reasonably good medical insurance plan underneath the Reasonably priced Care Act in 2014-15. In 2015, my revenue modified, and I used to be eligible for Medicaid underneath Illinois’ enlargement of that federal-state program. Nevertheless, in July 2018, Medicaid decided that I not certified. I went on-line to the ACA market to attempt to discover an ACA plan I might afford. To my shock, the plans out there in 2014 have been not out there. The 2 dozen plans out there in my space are usually not best. Some present low protection. Some are from carriers that the majority of my physician teams don’t settle for. Even some “gold”-level plans have extraordinarily excessive copays. Although my premium in 2018 didn’t improve a lot, it was offset by excessive hospital copays and burdensome deductible and coinsurance obligations. Prescription copays have been percentage-based, not a greenback quantity, which made it costlier to pay for prescriptions.

That is all hurting many People in my revenue bracket. The drop in enrollment in ACA plans is as a result of nobody can afford most of those low-level protection plans within the ACA market. And virtually all of the ACA plans have restricted entry to suppliers, particularly specialists, making getting medical remedy close by troublesome. The ACA has been modified and tweaked in order that many People not can afford to purchase any of the plans with out going into debt if a critical sickness arises.

— Lena Conway, Naperville, Ailing.