Cost of Medical Care and Tight Budgets in Our Economy

Hey, Great article in the Washington Post today discussing costs of health care and choices people make.  Two multiple sclerosis patients were interviewed and featured within this article which explains why I'm presenting it in full here.  Oh, and btw, one of those MS patients is ME!!


As Budgets Tighten, More People Decide Medical Care Can Wait
By Ceci Connolly and Kendra Marr
Washington Post Staff Writers
Thursday, October 16, 2008; A01

To monitor the multiple sclerosis attacking Ann Pietrangelo's central nervous system, her doctor recommends an annual MRI. Last year, the 49-year-old Winchester, Va., woman had to pay a $3,000 co-payment to get the imaging done.

This year, she's skipping the test. Even with insurance, it's more than her budget can tolerate, especially with the roller coaster on Wall Street devouring her retirement savings.

"I'm doing everything I can to avoid going to the doctor," she said.

From Park Avenue dental offices to the Arlington Free Clinic, the global economic crunch is forcing a growing number of Americans to scale back on medical care. Consumers are attempting their own form of triage, pushing off seemingly less-urgent services in the hope that their financial health will improve. But the danger, say physicians, is that the short-term savings may translate into more severe long-term health implications.

At the extreme are cases such as the Texas woman who went to the hospital complaining of back pain. Physician Doug Curran immediately spotted cancer on the X-ray.

"She'd had a lump in her breast for a while, but things were tight and she said she couldn't get it looked at," he recalled. "We're going to see more of that."

Nationwide, the number of consumers who went without a prescription, tapped into retirement savings to pay for health care or skipped a doctor visit for themselves or a child has risen since last year, according to a survey released this summer by the Rockefeller Foundation and Time magazine. One-quarter of the 2,000 respondents, for example, said they had decided not to see a doctor because of cost in 2008, up from 18 percent the year before. Ten percent said they did not take a child to the doctor for the same reason.

"When the economy is in the situation we have today, people make tough choices," said Kansas Insurance Commissioner Sandy Praeger, who is head of the National Association of Insurance Commissioners. "Things are just not going to get done."

After nearly a decade of steady -- often double-digit -- increases in drug spending, the research company IMS Health this summer recorded the first actual decline. And a survey by the Center for Studying Health System Change found that nearly 20 percent of Americans report having difficulty paying medical bills.

Layoffs, shrinking bank accounts, rising medical prices and widespread anxiety that the economy is likely to worsen are prompting people to split pills, forgo screening tests such as colonoscopies, delay elective procedures such as laser eye surgery and turn to home remedies as cheaper alternatives. Hospitals report that unpaid medical bills are on the rise, pharmacists see a spike in cheaper generics, and demand for low-cost care is climbing.

Falls Church music teacher Lisa Emrich is coping with a dwindling number of piano students by cutting back on physician visits.

"I have too many doctors and specialists who all wish to see me twice a year," said Emrich, who is being treated for multiple sclerosis and arthritis. "Sometimes I might skip one if I'm doing well in that area. . . . When I see my neurologist, I'll ask about my arthritis, which doesn't make much sense. But I try to get as much as possible out of my doctor visits."

For Sandra Harrington, a waitress from Oxon Hill, the trade-off comes in treatment for an infected eye. Her doctor prescribed administering steroid drops twice a day. But as her tips have shrunk, she has decided that applying the $100 medication once a day is all she can afford.

"It's a vicious cycle," she said, explaining that because it is too painful for her eye to be exposed to direct sunlight, she works only night shifts. "People cut back. Then people like me suffer."

In the past month, traffic on the five-year-old advice site JustAnswer.com rose 14 percent. The site, which allows customers to pose a health question and "bid" $9 to $30 for a doctor's or a nurse's response, had nearly 400,000 page views in 30 days, said chief executive and founder Andy Kurtzig. In a telling sign, inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.

At the Arlington Free Clinic, the surge in people seeking care has been overwhelming, said Executive Director Nancy Sanger Pallesen. Last week, the clinic provided free preventive screenings to 19 new patients, but it turned away 27 others, she said.

"Those numbers are higher than what we were seeing just this summer," she said. "Unfortunately, we can't take them all in."

Even free care may not be a good deal for people with limited means. For some, the price of transportation is prohibitive; others fear discovering an illness they do not have the money to treat.

Many are forced to juggle competing medical needs. Pietrangelo must balance the importance of the MRI, which detects brain lesions, and the costly medications that prevent her from relapsing. She pays co-payments of $500 per drug per month. There are no generic alternatives.

"I can't shop around," she said. "My hands are tied."

Most analysts expect the medical crunch to worsen.

"We know from past experience that an economic downturn drives more people to be uninsured," said Len Nichols, director of health policy at the nonprofit, nonpartisan New America Foundation, a think tank. "They lose their jobs, they lose their income and their insurance."

That is what happened to Tim Doss. On Sept. 18, after driving a cement truck for an Indiana company for 10 years, he was laid off.

"They told me, 'As of midnight, your insurance is lapsed,' " he said. Doss, 50, and his wife have illnesses that require medications, regular doctor visits and tests. Creditors have come to their home trying to collect the $3,000 they owe in hospital co-payments from when they did have insurance.

The couple decided that Doss's annual checkup took precedence because he needed it to keep his commercial driver's license. The checkup, plus blood work for a fatty liver and high cholesterol, cost $300. He persuaded his doctor to provide free samples of his liver medicine.

Helen Doss does not plan to get an annual mammogram this year, even though her mother died of breast cancer at age 56. Doss was offered a free stress test at St. Vincent Indianapolis Hospital, but she is afraid it will turn up more problems that she can't take care of.

"I'm just holding off for a year and hoping nothing happens," she said.

Their primary-care physician, Steven Wilk, is devoting more time to helping patients decide what to postpone.

"Folks are asking us to try to limit what we order or pare it down to the bare-bones minimum," he said. "As a doctor, I worry about the risk of missing something at an early stage. It could lead to more serious problems down the road."

In past recessions, health-care spending briefly spiked -- as people raced to doctors before their insurance ran out -- and then fell sharply, according to industry analysts.

"Many times in health care there's a lag of three to six months before it hits really hard," said Donald Fisher, president of the American Medical Group Association, which represents large, multi-specialty providers. "If they have a problem, they get it fixed while they still have health insurance. Then we see a decline in elective procedures, and then we really see a drop-off."

In Plano, Tex., life feels like an endless downward spiral, Victoria Freudiger said, for herself and her husband. Losing jobs meant eliminating health insurance. No insurance meant Thomas Freudiger went to the hospital when he developed pneumonia this summer. That resulted in a $363 bill they couldn't pay. Now their credit is shot.

As the economy crumbled, both started canceling preventive screenings. She hasn't had a pap smear or a mammogram for close to two years; he is overdue for a colonoscopy. They use do-it-yourself dental cement to patch their teeth and put their best face forward in job interviews. And although her doctor prescribed Neurontin for her seizures, Victoria Freudiger tries calming techniques instead of the pills.

"Instead of taking them every day, I wait until I start feeling sick, and then I take them again," she said. "Both of us are suffering mentally, emotionally and physically."

Though the burden is especially heavy for uninsured Americans, even those who have coverage are feeling the pinch as employers shift higher deductibles and co-payments onto employees.

"The reason why health care was immune [to recessions] in the past was because most people were covered under good insurance plans," said Jean Mitchell, a professor of public policy at Georgetown University. Now, "people are realizing, 'Oh my gosh, I have to pay for this out of pocket.' "

In Durango, Colo., Marsha Porter-Norton and her husband, both entrepreneurs in their mid-40s, switched to a high-deductible plan when insurance premiums skyrocketed. Their new catastrophic policy costs $479 a month, but they have to pay the first $6,000 in expenses.

She is supposed to get ultrasounds twice a year to check on the fibroid tumors in her uterus. But the couple's retirement portfolio "has taken a massive hit," and they worry about their jobs, Porter-Norton said. So, for now, she's going to wait on the $500 ultrasound.

"I'm going to take a gamble," she said.

Questions, Answers, and More

Thank you readers for sticking with me. Things are hectic around the homestead and I'm trying to stay above the surface.

I have been, however, doing some writing related to MS topics over at Multiple Sclerosis Central. If you don't already know, I'm a featured writer over there - a "patient expert" - or I'd like to say a "patient advocate." I invite you to read and subscribe to my twice weekly blatherings.

Here are some of the things I wrote recently:

"Pass the Power Please- kthnx" in which a discussion of social communities, forums, and patient empowerment is key.

This fits in perfectly with the presentation and panel discussion of which I will be a participant next Wednesday. I'm still coming up with thoughts to share, so if you have any to add, please do so.

"Need Help Paying Drug Bills? Who ya gonna call?" in which I provide links to sources of financial assistance for MS patients needing help with the DMDs.

"Hey!! Turn Up the Lights and Pass Me Some Color!" in which I discuss the onset of Optic Neuritis 8 years, 7 months ago, pre-dating MS diagnosis considerably.

Also today marks the 3rd anniversary of my final "DEFINITE MULTIPLE SCLEROSIS" diagnosis. Whooohooo. Or is that really a day to celebrate? Not sure.

And...... There's this cool feature over the MS Central where folks can ask questions and folks can answer questions. Kinda like a forum of sorts.

Anybody can ask or answer, but I'll let you in on a little secret, just between you and me.

I actually get a token payment for researching and answering the inquiries. Shhhh... you didn't hear that here. So if you are so inclined, please feel free to help a girl out and ask some MS-related (or not) questions over there.

Ok, enough self-promotion.

I hope that you are having a nice day. :-)

Thump - Zap - Twitch - Jerk

Today is Columbus Day, a federal holiday, a day which I had intended to sleep late and enjoy some quiet time. Perhaps enjoy some time to collect my missing Words.

Instead I awoke to the sound of a jack-hammer outside my window - thump thump thump.
Seemingly at my headboard - thump thump thump.

I reach for my glasses - thump thump thump.

Look out the window - thump thump thump.

See my neighbor talk to a man in her driveway.
Thump thump thump thump thump thump.

The jack-hammer was being wielded to demolish the driveway - thump thump thump.
Piece by piece, small cracks are made in the surface of the hardtop - thump thump thump.

I curl up in my favorite recliner and begin to make my daily rounds of many blogs.
Thump thump thump thump thump thump.

An hour goes by - thump thump thump. Another hour - thump thump thump.
The sound seems to trigger a spastic muscle on my torso - jerk.

The muscle pulls my ribcage to the right, subtle on the outside, distinct on the inside.
Thump thump thump - Twitch - thump thump thump.

Somehow the relentless noise of the hammer causes electrical circuits to misfire.
Thump thump thump - Zap - Twitch - thump thump thump.

Then a muscle in front of my left shoulder decides to join the action.
Thump thump thump - Zap - Jerk - thump thump thump.

Where have those words gone? The voice in my head is drowned out.
Thump thump thump - Zap - thump thump thump.

What was I trying to read, think, say, comprehend...?
Thump thump - Twitch - thump thump - Jerk - thump thump.

Then after about six hours, the thumping stops. The cloud begins to lift.
My brain suddenly clears and the thoughts return - Twitch.

What a blessing and relief - finally I could think and could read.
Maybe even get around to some writing - Jerk.

However, it was time for music cheerleader duty.
Thump.

That was my day until about an hour ago.

Zap.

Words???

more animals

Carnival of MS Bloggers #21

Welcome to the Carnival of MS Bloggers, a bi-weekly compendium of thoughts and experiences shared by those living with multiple sclerosis.

Daily OM 
by Herrad

You may jump to conclusions today when interacting with others,

especially if you are assessing your exchanges from an emotional or biased point of view.

Perhaps you are feeling suspicious of other people's motives

or are making assumptions about how you're being received.

If this is the case for you today, it may be because your mind

is busy referencing the past and compelling you to get stuck in projections.

Consider focusing your attention on the present moment instead.

Paying attention to what's really happening, rather than getting mired in mind chatter,

can help you to think clearly and rationally so you can form appropriate conclusions.

Staying present allows us to process information rationally

during our interactions with people.

Being in the moment frees us of the mind's tendency

to dip into the past or jump ahead into an unknown future.

We can listen attentively and take what we see and hear for what it is in its own context.

The objectivity this affords us allows us to come to more pertinent conclusions.

We can also respond to what's in front of us rather than

react from past experiences, our fears, or conditioning.

Stay present and absorb what is happening to you right now,

and you will be able to honestly assess your situation

and draw more accurate conclusions.

In a post which made me laugh outloud, Mandi of Anatomy of Restlessness shares  
An open letter to Acme Syringe.

Dear Acme Syringe Company:

I am writing to tell you that I have used your syringes for years, and I would like to ask you for a syringe sponsorship. I believe that I have excellent qualifications, and I will be a good representative of your company. A far better representative than the folks who abuse your syringes and use them multiple times to inject illegal substances. Attached is my syringe resume:

Allergies
One round of allergy shots 1x a week for 3 years
One round of 2 allergy shots 2x a week for another 3 years
4 skin tests, with about 60 needle pricks each (back and forearms)

Multiple Sclerosis (this is where it gets exciting)
Innumerable blood draws
almost 25 days of infusion with Solu-Medrol and IVIG
spinal tap (this one requires several little needles for numbing and a few BIG needles for drawing cerebro-spinal fluid)
injections of interferon every other day forever and ever
B12 shot

Thyroid
biopsy with several needles
more blood draw

Diabetes
I don't have diabetes, but I would definitely use your syringes if I were to get it.

Thank you so much for your time to consider my request. Please feel free to contact me with any questions or comments.

Sincerely,
Mandi

ps: I can definitely get you lots of photos of me wearing a sports bra in extreme locations using your syringes.

Hey - DID YOU KNOW MONTEL WILLAMS HAS THAT? asks Bald Ben.

Would the real Bald Ben please stand up......

I never much thought of myself as a "blog person". Sitting here writing some sort of blather about myself for others to read never really seemed of much interest to me. Then my wife got pregnant. One might ask, "Hmm, how does your wife getting pregnant lead you to blogging? I would think you would have a lot more to think about?"

Your question would be a good one, albeit a little short sided, but a good one nonetheless.
You see, my wife wasn't only pregnant with one baby, but she was pregnant with two babies! Yep twins. This as I have been known to say is proof there is a God and he has a very dark and wicked sense of humor.

Picture it: It's a lovely day in heaven. Large white billowy clouds, soft harp music in the air, well manicured lawns, you know....heaven. Standing by the pearly white gates, God, calls all his buddies around, "Buddha, Moses, Vishnu, Jesus get over here." As they gather they realize that God has got a real rip snorter and He can barely hold back his laughter.
Now, God has been known to tell a good yuke from time to time, (i.e.=2 0floods, pestilence, duck billed platypus) but if he already can't contain himself this has got to be good. "Wait till you see this," almost bursting in hilarity, "See that Bald guy down there?"
"Yeah" They reply choir like.

God bellows out," allakazam!"

ZAP!

Bald Ben's got MS.

God is rolling. He almost starts a thunder storm he is laughing so hard.

The other deities look at each other a bit confused. You see, Buddha never understood this whole incurable disease bit. He's more of a knock, knock joke guy.

Knock, knock…
Who's there?
Buddha.
Buddha who?
Don't cry, it's just me the Enlightened One…..

And Moses was still trying to figure out how the Jews, after thousands of years of persecution, were supposed to be the chosen people. Jesus, being the savior and all, meekly taps God on his great big omnipresent shoulder and says, "Dad, ummm, that wasn't really that funny." God, still laughing, eyes his eternal Son and says, "Wait for it, wait for it...."

Another allakazam!

ZAP! Bald Ben is now the father of twin boys. All the deities break down in uncontrollable laughter at the great cosmic joke that was just played on the poor kid who lost his hair when he was 16. If you listen real close, you can still hear their eternal mirth.

But I digress, I started the family blog (It's linked to on the left20there. Two babies, one Bald guy, and a woman who can't tell the difference: a love story.) Simply because I was feeling a bit lazy and antisocial. "Hold the phone," I hear you say, "Lazy and Antisocial? Blogging can be a tough hobbie, and it ostensibly connects you to thousands of people at one time."

Ahh, you are right. If done with a little bit of heart and elbow grease blogging can be a full time job. However I am not looking for anything permanent thanks, just a little part time thing on the side will do just fine. The laziness and antisocial behavior came out of the fact that I didn't feel like having to call every person we knew with every detail of every doctor appointment, answering the same questions ad nauseum. Oddly enough despite the blog, I had to call every person we knew with every detail of every doctor appointment, answering the same questions ad nauseum.

However something odd happened along the way,

"Did you step in Dog poop?"

For the answer to this question AND MUCH MORE, visit Bald Ben who says, "...I will not hide. I am Bald Ben. My view points, my thoughts, my opinions are all free for the taking. I stand behind what I say, that's why I say it. Otherwise this would all be a colossal waste of time."

This concludes the 21st edition of the Carnival.

The next Carnival of MS Bloggers will be hosted here on October 23, 2008. Please remember to submit a post (via email) from your blog of which you are particularly proud, or which you simply want to share, by noon on Tuesday, October 21, 2008.

Thank you.

Comments for this post.

Fact Check the Presidential Debate

Here is just a little fact checking in relationship to last night's Presidential Debate.  I apologize in advance for those persons not interested in politics.  This seems very important to me lately.  This is from the Washington Post.

ABOUT THE FACT CHECKER
"Comment is free, but facts are sacred." -- C.P. Scott, editor Manchester Guardian, 1921

Our goal is to shed as much light as possible on controversial claims and counter-claims involving important national issues and the records of the various presidential candidates. 

LIVE FACT CHECK
Second Presidential Debate: Nashville

Computers
10:01 p.m.
Obama claimed that the government had invented the computer in order to encourage scientists to communicate. He probably meant the Internet. The personal computer was invented by Apple and other private companies. IBM pioneered the mechanical punch card tabulating machines which formed the basis for the large mainframe computers.
--Michael Dobbs


Taxes
9:57 p.m.
Once again, McCain said that Obama raised taxes 94 times. This came up in the vice presidential debate, and it is a bogus charge.

Fact check.org, a non-partisan watchdog, has analyzed the charge.

Of the 94, 23 of those votes were indeed votes against proposed tax cuts. Eleven of them were increases on families earning over $1 million to help fund programs such as Head Start and school nutrition. And 53 were on non-binding budget resolutions that foresaw allowing tax cuts to expire as scheduled. Such out-year projections are meaningless, since non-binding budgets are passed each year.
Fact.check.org ruled the claim misleading.
--Glenn Kessler


Health Care
9:46 p.m.
In outlining his tax policy, John McCain boasted that he would give all American families a $5,000 tax credit to allow them to go out and buy their own health insurance. This is true but it is only part of the story. The other part, which McCain rarely mentions on the campaign trail, is that the Republican candidate has also proposed taxing employer-provided health benefits, which will wipe out most of extra income from the tax credit.
--Michael Dobbs


Oil
9:43 p.m.
Sen. McCain talked about the U.S sending "$700 billion, some of it to countries that don't like us very much." And he said, "My friends, some of this $700 billion ends up in the hands of terrorists organizations." He's talking about the U.S. imports of oil, for which the U.S. consumers send money to the countries that produce the oil.

In fact, according to the Energy Information Administration, which bills itself as offering the "official energy statistics from the U.S. government," the top producer of crude oil for import into the U.S. is Canada, not exactly a country that doesn't like us. The second largest is Saudia Arabia, another ally. And then Mexico, also a key ally.

But McCain is right that the list also includes countries like Venezuela, whose leader, Hugo Chavez, can accurately be proclaimed to be "no friend" of the U.S. And the list includes Nigeria, Iraq, Angola, Brazil, Algeria, Ecuador, Russa, Colombia, Azerbaijan, Kuwait and Chad.

It is not possible to know how much of the money that flows into some of those countries ends up in the hands of terrorists organizations.
--Michael D. Shear


Boeing Contract
9:33 p.m.
McCain took credit for his crusade to block a new contract for Boeing for a new fleet of midair refueling tankers. He said he saved taxpayers more than $6 billion while launching a Senate probe that found cozy relations between Pentagon officials and Boeing executives.

But the GAO found significant problems in the rebidding of the new contract, which had awarded the contract to a partnership between Northrup Grumman and the European firm EADS.

"This shows how a sort of naive crusade for good government can actually backfire," Loren Thompson, of the Lexington Institute, a defense think tank, told Newsweek.
--Glenn Kessler


Earmarks
9:28 p.m.
McCain continues to make an issue out of earmarks, which are only a small part of the overall federal budget. The big ticket items are entitlement programs, such as Medicare and Medicaid, and defense spending, which together represent much of the federal budget; earmarks are just $16 billion out of a more than a $2 trillion budget.
--Glenn Kessler


Fannie Mae and Freddie Mac
9:24 p.m.
Sen. McCain claimed that Sen. Obama was the second-highest recipient of money from Fannie Mae and Freddie Mac "in history." In fact, according to the OpenSecrets.Org site, which tracks political contributions, Obama was third among senators in receiving contributions from the two mortgage giants during the period of 1989 to 2008.

Having received $105,849, he falls behind Sen. John Kerry (D-Mass.) and Sen. Christoper Dodd (D-Conn.) in third place, not second. And it's unclear where McCain bases his claim that Obama is second "in history" since the sites that track these contributions don't use that kind of duration.
--Michael D. Shear