Post-Insurance Costs Aren't the Only Things Rising

In the previous two posts, I show that out of pocket costs are rising given the increasing prevalence of high deductible insurance plans.  That means that even though you have insurance, you are going to be paying for your own care until you reach the deductible.
Here is a picture showing that out-of-pocket costs are also rising at the point of insurance purchase.  When people buy health insurance in the US, much of the cost is often picked up by their employer.  It’s still the person’s money, of course.  Money is fungible, and the employer “contribution” is, ultimately, coming out of people’s take home pay.  But it doesn’t FEEL like it costs money, because we employees never pay those bills.  We only pay a portion of our insurance premiums.
Well the absolute dollar value of that portion has been growing quickly, as shown by this picture, once again from the Kaiser Family Foundation:

A more than doubling of people’s contribution to their insurance, in only 10 years. Hard to deny that health care costs are taking a toll!
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More on High Deductible Insurance Plans

In my previous post, I showed a powerful picture (from the Kaiser Family Foundation) of the growth in high deductible insurance plans.  Here is another picture from that same report, showing that the high end of these high ends is getting really high.

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Higher Health Insurance Deductibles, Smaller Wallets

With health care costs rising, employers (and insurance companies) are increasingly asking consumers (aka “patients”) to have more “skin in the game”—to pay more out of pocket for their medical care.  The Kaiser Family Foundation has a nice report on trends in health insurance deductibles.  This picture shows the rise in these deductibles.  That means: you pay a lot of money before insurance kicks in.  All the more reason that we physicians need to talk, more openly, with our patients about the cost of care.

What the World Got Wrong About Lance Armstrong and Oscar Pistorius

Lance Armstrong cheated and bullied. These are not shocking revelations. Oscar Pistorius had a history of altercations with his girlfriend and is now accused of murder. More shocking, by far, but hardly the first athlete to be accused of such wrong doing.
Should we be so thoroughly shocked to find out the Armstrong and Pistorius are deeply flawed? Remember: the same traits that make people successful as elite athletes—obsessive focus, unrelenting ambition—can also make them rotten human beings.
Yet, we suppressed thoughts of Armstrong ‘s jerkiness because he is a cancer survivor. And we didn’t focus on Pistorius’s previous bad behavior because he is a double amputee. And in this manner, we made our big mistake… (Read more and view comments at Forbes)

Informed Consent 1950s Style

In her deservedly best-selling book, The Immortal Life of Henrietta Lacks, Rebecca Skloot reproduces the language of Lacks’s informed consent document when she was about to undergoing her cancer surgery at Johns Hopkins in 1951:

   I hereby give consent to the staff of the Johns Hopkins Hospital to    perform any operative procedures and under any anesthetic either local    or general that they may deem necessary in the proper surgical care and    treatment of _______________.

Talk about giving doctors leeway!
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Why I Sometimes Feel Like an Eisenhower Republican

As Jim Newton pointed out several times in his book on the White House Years, Eisenhower valued balancing the budget.  Sometimes that meant controlling social welfare spending.  But it also meant trying to restrain military spending and foregoing tax cuts, even when his Vice President, Richard Nixon, was running for Presidency and needed a lift in the polls.
Then there is this great quote from Ike:

“There can be no enduring peace for any nation while other nations suffer privation, oppression, and a sense of injustice and despair. In our modern world, it is madness to suppose that there could be an island of tranquility and prosperity in a sea of wretchedness and frustration.”

Amen!
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Why the Healthy You Doesn't Understand the Sick You

In a recent blog post, David Berreby writes about some work that George Loewenstein and I have done on people’s inability to predict how illness or disability will make them feel, and what this inability means for things like “pain and suffering” awards from juries.  Thought you might find the blog interesting. Here is the link.
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Are You Smarter than a Radiologist?

Notice anything unusual about this CT scan?

On the upper right side is an image of a gorilla. According to a new study, 83% of radiologists missed this image.
They had been looking through a series of scans, looking for “pulmonary nodules”—growths in the lung, in other words. The early scans included such nodes, and the radiologists were expert at finding them.  This picture, in fact, includes a node near the lower left margin of the lung. That little white circle. But because they had nodes on their mind, the radiologists were not thinking about finding other types of images. They especially weren’t thinking about finding gorillas!
The moral of this story: When we look at the world, we often see what we are looking to see. Our attention is limited. So when we look for “nodes”, we might miss other even glaring parts of our field of vision.
Even physicians are prey to invisible gorillas!
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When "Express Care" means "Oh My Gosh, That's Expensive!" Care

See this Fayetteville Observer story about a disturbing new type of doctor’s office, called an express care center. And in the process of reading the article, you’ll see my take on the relevance of gas stations for understanding our insane health care system.
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Hear My Discussion with Joe and Terry Graedon on People's Pharmacy

Here is a link to a podcast of my recent appearance on People’s Pharmacy, an NPR show that hopefully reaches you where you live.  (If it doesn’t, you should ask your radio station to pick it up. It is a great show.)  In this podcast, Joe and Terry lead me on a wide ranging conversation, mainly but not exclusively about Critical Decisions.
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