NPR


We all know the facts and the figures. About 46 to 47 million Americans are uninsured and with the economic recession not yet over, several more are expected to join the ranks.

The Congress is still debating over a national health care reform which no one knows will lead to what consequences. So, given the current state of affairs, the big question still looms – Who takes care of you when something major comes up? Or, worse yet, What happens if you are aging, start having health problems and no insurance wants to cover you even if you are willing to purchase the most expensive catastrophic policy?

NPR recently ran the story of a 58-year old uninsured American who landed himself into exactly this sort of a situation. Read on…

Fernando Arriola spends his days keeping track of four or five construction projects, and his nights praying for good health. The New Orleans home builder is one of the 46 million people in this country who don’t have health insurance.

Four years ago Arriola, 58, bought a friend’s contracting business, just as New Orleans was starting to rebuild after Hurricane Katrina. He named it New Beginnings Enterprises.

“It was a new beginning for me; it was a new beginning for the city; it was a new beginning for a lot of people we were working with,” he says.

And business has been good. He does mostly residential work, like the quaint mother-in-law cottage in the Garden District where his crew is laying tile and putting on the finishing touches.

Making A Living, But Not Enough For Insurance

Arriola makes about $50,000 a year and says he enjoys working for himself. But what he’s missing is the comprehensive health coverage he had at his former job as a sales manager.

Ever since he’s been self-employed, Arriola has been on a health insurance roller coaster. Initially, he bought a standard policy with a $1,000 deductible to cover his family. Then, when business slowed down and money got tight, he decided to temporarily drop the coverage. When he tried to reinstate it, he could only afford a catastrophic plan.

“I was paying $900 a month for a $5,000 deductible that would cover nothing until I hit that $5,000. So I was paying in essence $15,000 before I had one penny covered. And that was too expensive,” Arriola says.

So he dropped that coverage, only to have second thoughts. And when he tried to get it back, he was denied even the expensive catastrophic policy. Arriola doesn’t know exactly why, but he acknowledges that he and his wife both have high blood pressure and are approaching 60.

“Insurance is nothing more than just a business. And they try to limit their liabilities. So where there’s an older person, they don’t want to cover it,” he says.

Aging Without Coverage

Maria Arriola doesn’t think it’s fair that after years of paying for coverage and not having many claims, now, when they are starting to have health problems, they can’t get insurance.

“There’s nothing you can do about that. As you get older things don’t work so well, so…” she says.

The Arriolas did buy a policy for their two daughters, ages 22 and 16. But Fernando and Maria are uninsured. They pay for doctor visits and prescriptions out of pocket.

If something major comes up, Arriola says he would leave the country for medical services. Arriola is a naturalized citizen and has lived in New Orleans since 1970. But last year, he traveled to his native Guatemala for arthroscopic knee surgery. It cost him less than $1,000.

“Over here [it] would cost me thousands. They have just as good of doctors as they have over here. Most of them graduated from here,” he says.

Not Waiting For Congress To Fix

As for the debate on Capitol Hill over health care reform, Arriola takes a businessman’s approach to the issue: Open up the marketplace, he says, and create a national playing field so consumers will have more options.

But he does not have faith that Congress will come up with a fix because of partisan politics. So, in the meantime, he’s working to do something locally as a member of the board of directors for the New Orleans Faith and Health Alliance. The group is trying to start a health clinic in unused classroom space at a midcity church. Patients would pay based on their income.

“The purpose is to be able to provide the working uninsured medical services. There is definitely a need. I’m a perfect example of it,” Arriola says.

The alliance hopes to start providing care this fall. Arriola plans to sign up. In the meantime, he prays that nothing serious happens. The way the system works now, he says, he’d have to experience a major calamity to get coverage.

“I would have to go into the hospital, I would have to lose my house, I will have to lose all my savings, lose everything for the government to be able to help me. So 40 years of work, 40 years of struggle has to come to nothing. I have to be totally destitute in order for me to be able to get some help.”

Arriola says he doesn’t want anybody to give him anything. He just wants to be able to afford health insurance.

“There has to be a way,” he says.
Source: NPR

For low cost high quality surgery abroad or discount medical services in the United States, call Healthbase at 1-617-418-3436.

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Almost all of us have been to the doctor at some point or the other in our lives. One of the common things you would have noted in your meetings with your doctor is him scribbling down notes. But, have you wondered what he writes in such notes? Do you think you should be allowed to see those notes? And, are you prepared to see what your doctor might have written about your meeting and your physiological and psychological conditions?

A lot of what’s in that note is objective stuff about your blood pressure, weight and blood count. But often your doctor puts down subjective impressions.

Did you seem down? Anxious? Angry? Drinking too much? Not so mentally sharp? Physicians also may speculate about a tentative diagnosis – maybe a scary one – they haven’t shared with you.

What do you think doctors would feel about letting patients see their notes? As you would guess, there are mixed opinions. Some feel comfortable while others don’t. It ranges from ‘Well, transparency is here, this will be good for patients, they’ll be more actively involved in their care, this is a terrific idea,‘ to ‘This is the worst thing I’ve ever heard of.

Doctors’ notes are not really secret anyway. Other doctors see them. Insurance companies and lawyers do. And under a 1996 federal law called the Health Insurance Portability and Accountability Act, or HIPAA, patients have every right to see their complete medical records. But as Dr. Tom Delbanco of Harvard Medical School (HMS) puts it, “You can get it but we do everything in the world to make sure you don’t get it. The medical record has traditionally been viewed by the medical establishment as something that they own. They think: ‘It’s my private notes. This is my stuff.'”

Check out below for some other kinds of opinions that different doctors share:

  • “Information should be accessible, but that will mean more work for doctors who may need to explain their notes to patients.”
  • “My hope is that it will be a method of communicating with patients, so patients can see what we’re thinking, where our head is, what our plans are, why we’re suggesting what we do.”
  • “We may be less candid. We may not as accurately describe the mood of the patient, the tenor of the encounter, for fear that we may get someone perhaps already a little angry during the encounter – more so after they log on and read the note that I just finished.”
  • “Physicians are scared of this kind of thing. But the big, broad directions are clear. Which is: Patients have to be at the center of their care more and more. That doesn’t mean patients call the shots. But patients really have to be a team member. To be a team member, they’ve got to see the playbook. And doctors will have to learn to be respectful in the way they write their notes in some situation.”
  • “If there’s some delicate problem, doctors shouldn’t dodge that topic, and patients should be prepared to see some things which may be a little painful for them to confront too.”

Your doctor’s reservations to this idea are understandable:

  • It will be more work for them, because patients will call up wanting to know what something means, or demanding corrections.
  • It might lead to more lawsuits.
  • It might scare the hell out of patients.

Source: Adapted from the NPR story – “Doctors Don’t Agree On Letting Patients See Notes” by Richard Knox

For affordable and quality medical care in the United States, check out domestic medical tourism. For surgery abroad, check out medical tourism.

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An excellent story appeared yesterday on NPR that talked about the Federal Employees Health Benefits Program or FEHBP – the health insurance program that insures 8 million federal workers, retirees and their families, and members of Congress. Below is the story of a 13-year old daughter of a federal employee who feels blessed to have the FEHBP coverage to pay for the costs of managing her Type 1 diabetes. Do you think other insurance programs in the country should model themselves after FEHBP?

“This is what keeps me alive,” says 13-year-old Toni Bethea, as she picks a tiny glass bottle off the kitchen counter of her home in Washington, D.C. The clear liquid inside is insulin. Toni has Type 1 diabetes.

“Your health is obviously not anything that you should play around with,” says Toni, a high-school freshman. She’s pretty, smiling and stylish — from her bangs angled across her forehead to her sparkly red fingernails.

“You should take it very seriously and when you have a chronic illness like what I have and other kids have, it’s very important that we take care of ourselves because there’s a lot of preventable stuff that can happen to us.”

It helps that her mother, Rhonda Dorsey, has good insurance, which she gets as a federal employee. She’s covered by the Federal Employees Health Benefits Program, or FEHBP. It insures 8 million federal workers, retirees and their families — and members of Congress. That federal health insurance program has been held up — by the president, lawmakers and other players in the health care debate — as a model of the kind of good insurance that should be available to all Americans.

Dorsey and others who are covered under FEHBP do report high levels of satisfaction, but it’s not some kind of super insurance. It’s pretty much like most insurance people get through their jobs. Federal workers, too, sometimes complain about the rising costs of their premiums and co-payments and about the hassles of getting care.

The Option To Choose

Toni was five years old when she was first diagnosed with diabetes — as long as she can remember. “At five, I really didn’t know what was going on, but I remember having my mother and my grandfather holding me down to give me shots and prick my fingers. And I was scared, I was confused, and it wasn’t a good time.”

In those early, stressful days of her daughter’s illness, Rhonda belonged to a traditional HMO through FEHBP. She’d take Toni to see an endocrinologist, an eye doctor and one specialist after another. “I’d always have to get a referral. And sometimes I would forget and I’d get to the doctor’s office and it would be a mess. And so I’d be very apologetic and we’d have to call the pediatrician’s office, and it just was a waste of time in my opinion.”

There were limits, too, on the supplies she needed to manage Toni’s diabetes. Sometimes a prescription refill for needles or testing strips would be denied.

So Rhonda switched insurance companies. Her new plan allows her to keep taking her daughter back to the specialists who know her best. “I have the standard plan which means that I pay a little bit more up front,” she explains. “My deductible is a little bit higher, but I don’t have to deal with the referrals. I can go to any doctor.”

Federal employees get a lot of choice. That’s what makes the Federal Employees Health Benefits Program stand out compared to other insurance. In the Washington, D.C. area, there are at least 16 health plans to choose from. Across the nation, according to a new report by the Kaiser Family Foundation and the Health Research & Educational Trust, most companies offer only one health plan to their employees, and just one percent of companies offer three or more.

The federal Office of Personnel Management conducts annual negotiations with each health plan to set benefits and rates. That has allowed it to claim some success in constraining cost growth. But last year Blue Cross and Blue Shield — which covers about 60 percent of FEHBP enrollees — increased the premium for its standard option by 13 percent. As a result, the average for all federal plans went up 7 percent. The year before, the annual premium increase was just 2.1 percent.

Toni’s Life Depends On It

For Dorsey, an information specialist at the Nuclear Regulatory Commission, her insurance through FEHBP has been central to keeping Toni healthy. “In order to live a healthy life with Type 1 diabetes or any kind of chronic illness,” she says, “it’s so important to have good insurance. And I tell Toni all the time how blessed we are because we’ve met a lot of people who don’t have insurance at all.”

Still, even with good insurance, it’s expensive to manage diabetes. Toni pricks her calloused fingertips several times a day to check her blood sugar levels. Rhonda pays a little more than $200 a month for supplies.

Toni wears an insulin pump — it’s the size of a cell phone and it’s pink. “It had to be pink,” Toni says with a laugh. Adds her mother, “Pink is definitely her style.” The first pump cost $5,000. Insurance paid all but $500.

Toni knows she’s fortunate. This summer, she went to a summer camp for kids with diabetes. And she saw what kids do when they don’t have good health insurance. “At camp they provide you with supplies, but I’ve seen kids who have saved their needles and taken them with them,” she says. “Even though you weren’t like supposed to, they would kind of sneak them just to make sure they would have something when they got back home.”

Toni and Rhonda know that when people don’t have good insurance, they’re so desperate they will even reuse a needle. “It gets dull. And so it really hurts. But you have to have insulin, just like I said,” Rhonda says. “I mean, without insulin, Toni would die. So you, take the pain in order to live.”

Toni listens to her mother and adds, “I do feel very grateful for all that I have, because that could be me.”

Source: NPR, by Joseph Shapiro

For those without health insurance or poor health coverage, there is medical tourism (as well as domestic medical tourism) to help them afford the costs of major medical care. Read more about these on Healthbase.

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