Healthcare insurance and retirement - again!

[NW-Bound]

I suffered from kidney stones for years without knowing what it was. Then, one day when in my 40s I was passing a lot of blood and the pain was a lot worse. In the ER, with X-ray, they confirmed the cause, and sent me home to seek long-term medical help. I was relieved that the intense pain was caused by stones and not something worse. I went to a urologist, who gave me a sieve to try to catch the stone. And as luck had it, I happened to pass it while at home and not at work, and was able to catch it.

Back to the urologist for analysis of the stone. The stone was the common calcium oxalate type. He prescribed Allopurinol, and said it would be for life. He also said I should drink more water. He added that in the desert, due to sweating, one may not have enough fluid for the kidney to work, hence one must be more careful to have sufficient water intake.

Water and drug? Is water alone enough? I decided to go with just more water. No more trouble, and I have not been back to see him since. Occasionally, I would forget, and my kidneys promptly produce painful stones to remind me. Arghh!

 

[samclem]

Very true. I was amazed at how many medications I didn't need. All of them! Just by changing my diet and walking.

I've noticed that some close friends just keep taking more and more prescription drugs. When a new complaint occurs, the doctor (well, generally a PA) just adds on another drug.
1) It seems like there's never a subtraction. The docs seldom say "it's been a few years, let's see what happens if we taper off or stop your prescription for XX." That might require more testing and appointments, it's easier just to have the patient keep taking the meds.
2) I'm not convinced that anyone is tracking subtle interactions between the meds. I know pharmacists are supposed to look for drug interactions, and maybe there's an automated way that they get notified when there's a potential big problem. But I'm also virtually certain that the drugs interact in more subtle ways, and nobody among the phalanx of specialists seen by some patients is checking on that.

 

[explanade]

I am concerned about Medicare too, though it will be 5 more years till I get there.

Instead of talking about cutting benefits or raising taxes, how about reducing costs and using the same money more efficiently? We already spend more than other countries. Maybe we just need to spend it differently than we do now?

Easier said than done.

These "costs" are the incomes for a lot of people -- doctors, hospitals, drug companies, medical equipment cos, etc.

 

[pb4uski]

I've noticed that some close friends just keep taking more and more prescription drugs. When a new complaint occurs, the doctor (well, generally a PA) just adds on another drug. ...

A good friend has been on a cancer drug for many years and has had a lot of ups and downs. Recently, he maxed out the time he could take on that drug... they prescribed him another drug and it made him feel lousy so he has recently stopped taking drugs all together.

Totally different guy in terms of look and attitude. He looks better, feels better and is putting on weight. Now they are just assessing whether there are any adverse effects happening from not taking the cancer drugs. None so far, so we are keeping our fingers crossed.

 

[Sarah S]

Samclem these days both the pharmacist and the preacriber have computerized systems that will flag known drug interactions that are graded by severity. The problems often arise when the patient uses more than one pharmacy and more than one provider and forgets to mention a new medication. My specialist's office has the medication list verified by the patient three times ( on paper, by the medical assistant and by the nurse) but not everyone is that diligent

 

[NW-Bound]

Easier said than done.

These "costs" are the incomes for a lot of people -- doctors, hospitals, drug companies, medical equipment cos, etc.

It is of course difficult. But the public awareness must be raised. We've got to start somewhere.

Right now, if someone raises the question of whether some drugs or procedures really work, people cry out loud that their benefits get cut, and that they are denied treatments.

 

[NW-Bound]

Samclem these days both the pharmacist and the preacriber have computerized systems that will flag known drug interactions that are graded by severity. The problems often arise when the patient uses more than one pharmacy and more than one provider and forgets to mention a new medication. My specialist's office has the medication list verified by the patient three times ( on paper, by the medical assistant and by the nurse) but not everyone is that diligent

My nephew, a pharmacist, told us of doctors prescribing medicine with the wrong dosage, among other mistakes. He took it as his job to catch errors that could harm patients. He is the head pharmacist at a hospital in NY.

 

[NW-Bound]

I've noticed that some close friends just keep taking more and more prescription drugs. When a new complaint occurs, the doctor (well, generally a PA) just adds on another drug.
1) It seems like there's never a subtraction. The docs seldom say "it's been a few years, let's see what happens if we taper off or stop your prescription for XX." That might require more testing and appointments, it's easier just to have the patient keep taking the meds.
2) I'm not convinced that anyone is tracking subtle interactions between the meds. I know pharmacists are supposed to look for drug interactions, and maybe there's an automated way that they get notified when there's a potential big problem. But I'm also virtually certain that the drugs interact in more subtle ways, and nobody among the phalanx of specialists seen by some patients is checking on that.

My mother-in-law developed some mysterious allergy. We never knew what food she ate to cause her face to be swollen occasionally. Her doctor or rather his PA could not tell what it was. And of course we knew allergy can be extremely difficult to track down. So, she tracked what she ate, and could not tell what food it was.

She's in her 90s, and of course takes a few prescription drugs. When the above nephew visited us, and we told him about it, he asked to see the medication list. One look, and he said the culprit was most likely Lisinopril, a very common medicine for high-blood pressure.

Yep, that was it. When MIL asked to be switched to another hypertension drug, the problem was immediately gone. MIL had been taking Lisinopril for decades, and there was no reason to expect her to develop a reaction to it. Her doctor did not know, but my nephew saw it right away.

 

[Walt34]

I am a layman, but have read that some of these fancy new and expensive drugs are not that great. Why are the prices so high then if they are not effectual? Is it simply because desperate patients want them at any cost, if the drugs give them a glimmer of hope?

I think it is not that simple, that the drug "works or does not work". Maybe it works some of the time for most people or some people, or does not work for most people but does for a few. If you are among those few then it matters a very great deal.

During the last year of her life an aunt that DW was very close to was on an experimental drug for leukemia that cost $10,000 a month. I have no idea who paid for it and they certainly didn't have that kind of money. Whether the drug helped or the cancer simply went into remission on it's own we don't know. But if you or someone you care about has leukemia, then you certainly want that option on the table.

 

[explanade]

It is of course difficult. But the public awareness must be raised. We've got to start somewhere.

Right now, if someone raises the question of whether some drugs or procedures really work, people cry out loud that their benefits get cut, and that they are denied treatments.

You're talking about cutting or eliminating the incomes of a lot of people.

They're going to fight that, including lobbying the govt. to keep things the way they are.

 

[Senator]

Yeah, I have Delta dental through VADIP myself (cheaper than my work plan for the coverage provided).

The one thing to note that some people may not know is that the "cost" we're talking about is only for VA provided (or referred) care. They won't pay for you to go see any doctor of your choosing in general, it's either through the VA, their referrals, or the Choice program (if you qualify). The exception is emergent care received in an ER or similar (though the VA has been fighting that and trying not to pay if you have any outside insurance, but have been losing with their argument in courts recently).

That can be a significant downside in some areas and for some people who really want to see a particular doctor/specialist etc.

100% correct. If you use the VA care, it's VA or nothing. I decided to skip private market insurance as the VA might not cover emergency care. I could be stuck for not only the premiums, but a large deductible too. That is one major stipulation of the VA covering emergency care, if you have any other way to pay for it with other insurance.

 

[travelover]

You're talking about cutting or eliminating the incomes of a lot of people.

They're going to fight that, including lobbying the govt. to keep things the way they are.

Absolutely true. It always happens and the more entrenched they are and the more money they have the harder it is to get reform.

 

[Bir48die]

I suffered from kidney stones for years without knowing what it was. Then, one day when in my 40s I was passing a lot of blood and the pain was a lot worse. In the ER, with X-ray, they confirmed the cause, and sent me home to seek long-term medical help. I was relieved that the intense pain was caused by stones and not something worse. I went to a urologist, who gave me a sieve to try to catch the stone. And as luck had it, I happened to pass it while at home and not at work, and was able to catch it.

Back to the urologist for analysis of the stone. The stone was the common calcium oxalate type. He prescribed Allopurinol, and said it would be for life. He also said I should drink more water. He added that in the desert, due to sweating, one may not have enough fluid for the kidney to work, hence one must be more careful to have sufficient water intake.

Water and drug? Is water alone enough? I decided to go with just more water. No more trouble, and I have not been back to see him since. Occasionally, I would forget, and my kidneys promptly produce painful stones to remind me. Arghh!

Be careful and watch your numbers. I had the same stones. Later in life had horrible gout attacks. I am a sweater also and very active. Sometimes there is just an inability for the kidneys to catch up. I'm on Allopurinol for life and drink crazy amounts of water and other fluids every day. Small price to pay for no more attacks.

 

[daylatedollarshort]

Absolutely true. It always happens and the more entrenched they are and the more money they have the harder it is to get reform.

The link below from Forbes has a chart on the most profitable industries in 2016. The only industry more profitable than investment advisers is pharma:

Forbes: The Most Profitable Industries for 2016
http://www.forbes.com/sites/liyanch...t-profitable-industries-in-2016/#269bc97b7a8b

The top four are:
Pharma: Generic - 30%
Investment Managers - 29.1%
Tobacco - 27.2%
Pharma: Major - 25.5%

"If you drill down....healthcare, tech and finance still stand out. Biotech, generic and major pharmaceutical companies rank among top 10 – same with major banks and investment managers. The only specific industry category on top 10 outside of the 3 most profitable sectors is tobacco, with 27% net margin projected for 2016."

 

[Katsmeow]

Bmcgonig

Thanks for the link, but I take some issue with some of your interpretation of the plan.

On people already on Medicare (and possibly near it) being able to keep traditional Medicare -- That is true that it says that. But, what others analyzing this have pointed out is that the premium support would apply to those keeping traditional Medicare. The premium support would be based upon the charges of all the plans in the region -- both stripped down networks and traditional Medicare. So, yes, let's say I was on traditional Medicare then and opted to keep it. I could. BUT, the premium support payment almost certainly would not cover the cost of traditional Medicare. So, I might have the option of either accepting a private insurer with very narrow networks (an HMO) or have traditional Medicare at far, far higher costs.

Now on the issue of supplemental policies - His plan doesn't do away with them. It puts an annual out of pocket maximum on spending by the patient (that is good), but requires the patient to pay the deductibles and co-payment. The deductibles are about $1400 (currently) and then he wants you to have pay a 20% copayment.

Now, that is probably OK for my husband and me (although something to consider in the budget) depending on the size of the OOP. Is it $5000 per person? $7500 ? $10000?

For many people that is a huge hardship. My mother gets about $15000 in Social Security and has a little other income. An additional $5000 a year for her would be a quarter of her income! Huge, huge increase in cost.

Yes, people should have skin in the game -- but she really can't reduce her health care expenditures. She is diabetic with kidney disease. She can't really just decide not to treat those things unless she wants to die.




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[NW-Bound]

I think it is not that simple, that the drug "works or does not work". Maybe it works some of the time for most people or some people, or does not work for most people but does for a few. If you are among those few then it matters a very great deal.

During the last year of her life an aunt that DW was very close to was on an experimental drug for leukemia that cost $10,000 a month. I have no idea who paid for it and they certainly didn't have that kind of money. Whether the drug helped or the cancer simply went into remission on it's own we don't know. But if you or someone you care about has leukemia, then you certainly want that option on the table.

There are indeed some drugs that really work. For example, Gilead's drug for Hepatitis C, an anti-virus drug and not cancer drug, is really wonderful, from what I read. It truly cures people, not just buying them a few more months of life. The drug is expensive, but compared to a liver transplant, it's godsent.

I have posted what doctors at Sloan-Kettering said about the ineffectual drugs. One can search the Web for it, if interested. These cancer drugs also have terrible side effects.

 

[NW-Bound]

Be careful and watch your numbers. I had the same stones. Later in life had horrible gout attacks. I am a sweater also and very active. Sometimes there is just an inability for the kidneys to catch up. I'm on Allopurinol for life and drink crazy amounts of water and other fluids every day. Small price to pay for no more attacks.

I do not have uric stones. I don't think Allopurinol really helps with oxalate stones. I am not averse to taking drugs, and will take them if truly necessary.

PS. I do not remember what my blood test said about uric acid, but it was normal.

 

[Pilot2013]

It's kind of interesting that a lot of folks here seem to have strong opinion about "unscrupulous" methods for getting healthcare on the cheap or for free (not paying and taking, for example, bankruptcy). But those same people don't feel that "taking action to get the BIGGEST subsidy" (basically, having a bunch of other people pay for a large chunk of their healthcare costs) is unscrupulous.

Interesting thought process....

 

[Big_Hitter]

It's kind of interesting that a lot of folks here seem to have strong opinion about "unscrupulous" methods for getting healthcare on the cheap or for free (not paying and taking, for example, bankruptcy). But those same people don't feel that "taking action to get the BIGGEST subsidy" (basically, having a bunch of other people pay for a large chunk of their healthcare costs) is unscrupulous.

Interesting thought process....

not really; bankruptcy or stiffing a provider is not paying your debts. managing magi to get a subsidy is just playing by the rules

completely different

 

[Walt34]

not really; bankruptcy or stiffing a provider is not paying your debts. managing magi to get a subsidy is just playing by the rules

completely different

I have to agree. It's no different than managing your finances/investments to pay the lowest possible amount of taxes. The govt. wrote the rules, people are expected to manage their affairs to pay the lowest legally available amount.

 

[NW-Bound]

When the rules cut out almost $20K of subsidy if your income goes from $64,000 to $64,100 people do "weird" things to take away that extra $100 of income.

It's actually $19.5K where I live.

So, one has to blame the rules, not the people. The rules are crazy. The people act rationally.

 

[Big_Hitter]

When the rules cut out almost $20K of subsidy if your income goes from $64K to $64,100 people do "weird" things to take away that extra $100.

gotta draw the line somewhere...

 

[daylatedollarshort]

Yes, people should have skin in the game -- but she really can't reduce her health care expenditures. She is diabetic with kidney disease. She can't really just decide not to treat those things unless she wants to die.

I wonder if there are any data to really support the issue of not having skin in the game as being a major component for high healthcare costs. If I didn't have to pay to go to movies I might see more movies or if I had the Olive Garden unlimited pasta pass I might go there more than I do now but rarely have I had the urge to have an unnecessary pelvic exam or colonoscopy just because my insurance would pay for it. Unless someone has a mental illness who goes to the doctor more than they really need to? People who like waiting rooms and blood tests and have nothing better to do?

As far as price shopping I'd love to do that with medical services like I do with everything else but without being able to compare prices from one doctors' network or hospital to the next I don't think most healthcare customers have a way to do that.

 

[bmcgonig]

Bmcgonig

Thanks for the link, but I take some issue with some of your interpretation of the plan.

On people already on Medicare (and possibly near it) being able to keep traditional Medicare -- That is true that it says that. But, what others analyzing this have pointed out is that the premium support would apply to those keeping traditional Medicare. The premium support would be based upon the charges of all the plans in the region -- both stripped down networks and traditional Medicare. So, yes, let's say I was on traditional Medicare then and opted to keep it. I could. BUT, the premium support payment almost certainly would not cover the cost of traditional Medicare. So, I might have the option of either accepting a private insurer with very narrow networks (an HMO) or have traditional Medicare at far, far higher costs.

Now on the issue of supplemental policies - His plan doesn't do away with them. It puts an annual out of pocket maximum on spending by the patient (that is good), but requires the patient to pay the deductibles and co-payment. The deductibles are about $1400 (currently) and then he wants you to have pay a 20% copayment.

Now, that is probably OK for my husband and me (although something to consider in the budget) depending on the size of the OOP. Is it $5000 per person? $7500 ? $10000?

For many people that is a huge hardship. My mother gets about $15000 in Social Security and has a little other income. An additional $5000 a year for her would be a quarter of her income! Huge, huge increase in cost.

Yes, people should have skin in the game -- but she really can't reduce her health care expenditures. She is diabetic with kidney disease. She can't really just decide not to treat those things unless she wants to die.




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Thanks for expounding on that Kats. I'll look into it more. Very difficult to see how they could change Medicare like that for people who are already retired and on fixed income.

 

[Pilot2013]

Well, I saw someone proposing that my HI benefit be taxed because I am "lucky enough" to work for a mega corp and have HI benefits. Why should I get a massive tax increase, to pay a subsidy for someone that decided to ER? Unscrupulous is in the eye of the person who is getting screwed.