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Thinking About Health
Think twice before buying drugs that may not be effective PDF Print E-mail
Written by Wauneta Breeze   
Thursday, 26 March 2015 17:53

Editor’s Note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association, the South Dakota Newspaper Association and the Hoosier (IN) State Press Association.


By Trudy Lieberman

Rural Health News Service

 

Word has just come from Express Scripts, the big pharmacy benefit manager, that per capita drug spending in the U.S. increased more than 6 percent last year. When  high prices for specialty drugs like the hepatitis C medicine Sovaldi is factored in, the increase is even greater. There are more expensive specialty drugs in the pipeline, and prices of traditional drugs especially generics are rising too. We know that if we’ve refilled any prescriptions.

The National Coalition on Health Care, a group of businesses, healthcare providers, consumer groups and faith-based organizations, has warned, “getting these prices under control is imperative. All the new therapies won’t do much to improve health if Americans can’t afford them.” We know that, too.

And that brings up what we might not know. What can we as patients do to be better consumers of medicines and help lower our own spending for costly drugs.  And since flu season will be with us for a bit longer, the drug Tamiflu came to mind.

Obviously hundreds of drugs improve health and save lives, but many others are more questionable, and the benefits are less clear. Tamiflu may be one of them.

Throughout this flu season the media citing recommendations from the Centers for Disease Control and Prevention (CDC) suggested people take the drug.  In fact CDC  Director Tom Frieden told journalists at a press conference when this year’s flu season began that if he or a member of his family got the flu or a flu-like illness, “I would get them or me treated with Tamiflu as quickly as possible.” Much of the press reported uncritically on that advice.

But what’s the evidence that the drug, which generates millions of dollars in sales each year, actually does any good?  Larry Sasich who is a founder and publisher of www.patientdrugnews.com Patient Drug News, which offers unbiased clear information about the use and safety of medicines based on scientific evidence, says  “for almost 15 years the FDA has said the drug is minimally effective in shortening the number of days you have flu symptoms, and there’s no convincing evidence it prevents serious bacterial complications of the flu.”

Sasich cited the FDA’s 1999 professional product label written for doctors and pharmacists which notes that taking the drug may result in a 1.3 day reduction in symptoms for adults and adolescents who already have the flu and a one day reduction for people over 65. (That result was not statistically significant.) For people who didn’t have the flu but were exposed to someone who had it, the drug taken once daily for 42 days reduced flu cases from 5 percent to 1 percent.

In 2000 the FDA changed the product label to indicate that although serious bacterial infections may begin with flu-like symptoms or may occur as complications “TAMIFLU has not been shown to prevent such complications.” That finding still stands. Consumers can find it on a website called DailyMed, at http://dailymed.nlm.nih.gov/dailymed/index.cfm, a service of the National Library of Medicine. The website lists more than 70,000 drugs and is the official provider of FDA labeling information which anyone taking medicines should consult.

The FDA and the CDC seem to be telling Americans different stories about Tamiflu. Sasich told me the difference appears to be the quality of the evidence each agency has used to make its warnings and recommendations. The FDA has used randomized controlled trials, the gold standard for scientific work. The CDC has used observational studies, often considered less reliable, in formulating its advice.

Sasich says he favors the FDA recommendation, and believes consumers should think hard about spending their money on a drug that doesn’t prevent influenza and minimally reduces symptoms of the flu. Tamiflu isn’t cheap. The website www.goodrx.com shows prices generally in the $133 to $143 range. The retail price at my local pharmacy is $152 for 10 75-milligram tablets.

Whether you buy the drug at the first sign of a sniffle comes down to whether you want to plunk down more than $100 for a marginally useful remedy especially if you are still in the deductible period of your insurance policy and paying out-of-pocket. We may not be able to change the way the drug industry prices its products, but we can examine the evidence and make an informed choice to take a drug that doesn’t help much.

We want to hear about your experiences with the high cost of medicines. Write to Trudy at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


TRUDY LIEBERMAN is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement. She is also a fellow at

the Center for Advancing Health where she blogs about health.

 
Long-term care insurance may provide little assurance PDF Print E-mail
Written by Wauneta Breeze   
Thursday, 05 March 2015 18:28


Editor’s Note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association, the South Dakota Newspaper Association and the Hoosier (IN) State Press Association.


By Trudy Lieberman

Rural Health News Service

The U.S. has no national policy to pay for long-term care-—no payment system for nursing home, home care or dozens of other services many people need as they age. And almost as bad, there has been little public discussion about this looming crisis in American healthcare. You’d think it might surface as an election issue in the coming presidential campaign, but it hasn’t so far.

Last Dec. 31, the youngest of the 76 million Baby Boomers turned 50, and the time when many will start needing long-term care services is only two decades away. The need is already here for older Boomers who are moving into their 70s when the infirmities that come with growing older often show up.

When a loved one needs care many families eventually turn to Medicaid, the jointly funded federal and state program that pays the medical bills for the poor. But it also pays for nursing home stays for middle class families.

Medicaid pays for nearly half of all long-term care, and families who have no resources or run out of money turn to it as a last resort. Medicaid pays after someone needing care first spends all of his, her or their income and almost all assets on care. They must make themselves “poor” to qualify, a demeaning and frustrating process. This often leaves the spouse at home with very little to live on.

Often they have no choice. The annual cost of a nursing home private room averages about $84,000 in Nebraska, South Dakota, Colorado, Wyoming, California, Indiana and Illinois, the seven states participating in the Rural Health News Service partnership.

Home care can also cost $40,000 to $50,000 a year depending on how much and what type of care is needed.

Despite a tax deduction for premiums and lots of media hype, long-term care insurance has yet to catch on. Policies are expensive. It’s not uncommon for a couple to pay $10,000 to $12,000 a year for two policies. Those buying at younger ages may pay less, but unless they’ve purchased inflation protection—a costly add-on–an individual or couple can still be unprotected. As nursing home costs escalate—they averaged $40,000 a year in the 1990s–the benefit bought years ago covers much less.

Insurance companies also carefully check an applicant’s health. If you have conditions like Parkinson’s disease or diabetes, you may not get a policy even if you can pay for it. Insurers don’t want people with illnesses that will land them in a nursing home or require lots of home care. This kind of insurance doesn’t work like Obamacare plans which must cover everyone whether they are sick or well.

Policies have also been around long enough now to gauge how well companies pay claims. Trying to snag customers, many insurers priced their policies too low when they first offered them. Now they are raising prices as consumers file costly claims. Some companies have tried not to pay claims at all, leaving policyholders stranded.

Because of the large out-of-pocket costs for policies and uncertainties about paying claims 20 or 30 years later, long-term care insurance has never gone mainstream, and while some people are glad they were covered when they needed care, it’s not the solution for financing long-term care for everyone who will eventually need it.

Last week, another one of those over-simplified advice stories showed up in the New York Times with financial advisers telling people to shop around for rates and consider buying a policy with fewer benefits to make coverage more affordable, a move that kind of defeats the purpose of having the insurance in the first place.

Journalist Jane Gross, a former Times reporter and author of “A Bittersweet Sweet Season: Caring for Our Aging Parents–and Ourselves,” shot back in a letter to the editor summing up the problem this way: “When it comes to long-term care, the elderly, and families struggling to care for them, are being ignored by the government and by the private sector.”

Paul Kleyman who directs the Ethnic Elders Newsbeat at New America Media is as fierce an advocate for better long-term care financing as anyone I know. He told me even though families have been hit hard nationally by the lack of long-term care protection, it’s been difficult to fight politically for better ways to finance care.

This is something that affects the middle class, a voting block politicians covet. But unless there’s a collective voice raising the cry about the hardships aging people face, long-term care won’t even be a whisper in next year’s election.

We’d like to hear about your experiences paying for long-term care.  Write to Trudy at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


TRUDY LIEBERMAN is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement. She is also a fellow at the Center for Advancing Health where she blogs about health.

 
Shopping for healthcare isn’t like buying computers PDF Print E-mail
Written by Wauneta Breeze   
Thursday, 26 February 2015 04:02


Editor’s Note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association, the South Dakota Newspaper Association and the Hoosier (IN) State Press Association.


By Trudy Lieberman

Imagine a world where you could shop for medical procedures the way you shop for computers.  Most likely, price is near the top of your list when you’re looking for a new computer. Not so when the “product” is a hip replacement or an MRI. Generally, what the procedure costs is largely irrelevant. And doctors will make the decision about where the surgery will take place.

For years health policy researchers as well as some employers have tried to build a case for changing the way Americans buy medical services. Their goal is to use competition to force doctors and hospitals to lower their prices. The theory is that if zillions of women avoid mammography centers that charge high prices, those prices will drop. Consumers will vote with their feet.

It’s the kind of medical cost containment that health policy expert Kieke Okma calls “aspirational” cost containment rather than tougher controls that would be obtained through government negotiation with providers.

And while price transparency—the  opportunity to easily see what various doctors and hospitals will charge—has become the holy grail of cost containment, we’ve yet to construct a healthcare market that’s as transparent as the market for computers and other consumer goods.

I’ve argued that healthcare is not like buying computers or canned peaches. Are you really going to say, “Hey doc. I can’t afford the hospital you use. I’m taking my surgery somewhere else?” In medicine you need to trust your physician. Relationships and confidence may be as important to effective healing as price.

Then there’s the matter of quality. How do you know the surgeon who performs a cut-rate hip replacement will do a good job?  But then, how do you know that a high-priced surgeon will do a good job? That’s the problem. There aren’t reliable quality measures to go along with the prices, and it may be a long time before there are.

This new day of insurance with high deductibles, high copays and coinsurance might be nudging patients to look at price more carefully or at least ask about it.  One of those who thinks so is Jeanne Pinder, the president and CEO of http://clearhealthcosts.com/. Clear Health Costs, a start-up that uses New York City journalism students to gather prices for some 30 medical and dental procedures that patients can actually shop for—MRIs, cardio stress tests, teeth cleanings and colonoscopies.

“Healthcare is the last big remaining opaque market place. It’s what real estate, airline tickets and cars used to be before transparency and technology transformed them,” Pinder told me last week. The variation in prices can be “mindboggling.” In California her group found that charges for a colonoscopy ranged from $1,200 to $7,240. Researchers found similar ranges for many other procedures.

I checked out the prices for teeth cleanings from dental offices within a five-mile radius in my zip code and found I could be charged as little as $75 or as much as $299, useful information if I needed a cleaning and was willing to switch from my regular dentist.

In addition, Pinder’s site tells visitors what Medicare pays for a procedure, which is usually much less than commercial insurers pay. The site records prices for only eight metropolitan areas, but she says, “If you’re in Boise, we give you the Medicare rate that will at least give you something to hold onto.”

So if you’re in Boise, Omaha, Denver, Ft. Wayne or any place else, how should you use price information that’s available from Pinder’s site and other similar services?

If patients are on the hook for more than $6,000 before insurance pays—that’s the case with Obamacare policies for individuals—knowing what a procedure costs and that there can be huge variation in out-of-pocket costs may prompt them to check several places before having a colonoscopy or an eye exam.

Knowing what Medicare pays gives a benchmark to use in evaluating the prices you find. If the prices are super high like the $7,000 colonoscopy, the Medicare rate can be a starting point for determining whether a $7,000 or a $2,000 procedure is more reasonable.

Still, it’s hard to evaluate costs for the big-ticket stuff, and it will probably always be impossible to compare prices when you face an emergency.

When you have chest pains and you’re in the back of an ambulance, the last thing you’ll be doing is consulting a website or comparing costs.

We’d like to hear about your experiences in learning about the price of your care. Write to Trudy at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


TRUDY LIEBERMAN is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement. She is also a fellow at the Center for Advancing Health where she blogs about health.