<p>I am also sorry to hear about ML’s situation and the stress. It underscores everything on this thread about how difficult it is for so many. The info that’s out is incomplete. It seems there will still be private health exchanges.</p>
<p>For anyone interested in preventative care issues, there are tons of sources and many discussions, including one that’s continuing in the NYT about the validity of drug testing trials. There are a host of issues with most studies and I don’t mean the source of funding - i.e., the drug company or other interested party. Most are too small to generate sufficient “power” to know a) if the effect is real and b) if this is the actual effect. Those are different issues, with the former asking if there is an effect and the latter asking if it is this effect or some other one. </p>
<p>The current system has huge problems with efficacy of treatments. For example, anyone remember the arguments about mammograms for women under the age of x? Without a family history, the tests generate too many false positives (and actually cause some cancers over time because it is exposure to radiation). Turns out lots of procedures, including some stents and other highly used and fairly expensive devices and procedures, aren’t more effective than something cheaper … and in some cases aren’t effective at all versus chance. </p>
<p>I don’t mean to get political here but one thing I’ve not understood is the resistance to more examination of treatments to find out if they work. I understood it in the context of falsely labeling “death panels” because that was a way to undermine passage of the ACA. But extremely tough opposition to efficacy testing - including attempts to outright ban comparative testing - has really watered down the ACA’s ability to address these issues. </p>
<p>False positives are a huge concern. As testing becomes more sensitive, it doesn’t generally get better at determining truth; it just becomes more sensitive. That means more false readings, not better ones. (This is not always true, but it’s a real problem.) Think of bomb or drug residue: if they can pick up more stuff, you think that’s great and we’ll be better protected from bombers, but it means any exposure in any way to any little bit identifies you or you falsely. </p>
<p>False positives go with “false” procedures, devices and drugs because these things are approved - devices and procedures have much easier approval than drugs - based on statistical evidence of efficacy. That evidence is often wrong, particularly when judging whether there is any actual benefit. Our system has become one where we put stuff out there and see … which can mean many billions of waste and often actually worse outcomes. To be clear, to take an example, I’m not talking about cleanliness issues like at compounding facilities for spinal injections - which has been killing people with mold contamination - but about the efficacy of the process itself. That particular procedure has very little to show as a benefit but people are desperate for relief and other people get paid for doing it so all the incentives line up for making this procedure an industry that seems more to be taking advantage of desperation - and now killing - rather than doing measurable good. This is only one of many examples.</p>
<p>"“But if you are on the private market, there is nothing better. If there were, there wouldn’t be a need for the exchanges in the first place.”</p>
<p>There is no better insurance on the private market? For example, if you are a family in Washington state, paying over 19K for only 70% coverage, there’s nothing better? Two words…Group Health.</p>
<p>I’m not against the ACA at all. I want people to have coverage at reasonable rates, I don’t mind paying more taxes for it, and I like some of the aspects of it. But if this is what the policies cost, and the only people who are going to go on it are going to get crazy subsidized by the federal government…it seems obvious that this is a massive money transfer from our tax dollars to insurance companies, to overcharge us. Apparently in all the excitement about how wonderful this is going to be, this isn’t important.</p>
<p>I should invest in the health insurers.</p>
<p>Mainelonghorn, that is terrible. Is there anything retroactive in these plans that can help you?</p>
<p><a href=“https://www.wship.org/Docs/Non-MC%202013%20Rates.pdf[/url]”>https://www.wship.org/Docs/Non-MC%202013%20Rates.pdf</a></p>
<p>I don’t think I can express how foolish it is to “expect” medical science to be perfect. Nor how wrong it is to transfer <em>all</em> responsibility to a doc or team of docs. I’ll skip the ease of researching some conditions on your own. You can at the very least ask if a test is medically necessary or just a “look further.” </p>
<p>This isn’t black/white, all or nothing. You can’t say, don’t have a test because it “may” generate a false positive. Or this is the one source of high expenses for medical care. Plus “false positive” is a loaded phrase and, I think, edges into emotional, not rational. “Oh, Gawd, I was so frightened and it turned out to be nothing. Dumb doc, what’s he trying to pull?” </p>
<p>I don’t know what kind of medical care you all experience. Just how poor it really is.</p>
<p>Busdriver: who is paying 19k? That came up on a chart for WA, with a footnote that final prices are pending. On a chart about the public exchange for people of low and moderate incomes. NOT a chart reflecting mandatory cost changes applicable to all.</p>
<p>Lookingforward, I thought that was supposed to be an accurate estimate of cost of the silver plan to a family making 115K. I would be very happy if that was incorrect, and fully acknowledge that I accepted the information presented without investigation, which is always a bad idea. I really hope that we don’t go broke enriching the insurers.</p>
<p>Can somebody explain these great group plan rates in Washington?</p>
<p><a href=“https://www.wship.org/Docs/Non-MC%202013%20Rates.pdf[/url]”>https://www.wship.org/Docs/Non-MC%202013%20Rates.pdf</a></p>
<p>
</p>
<p>After reading that medical care is the third leading cause of death in the US (JAMA study), I generally try to avoid or delay care as much as I feel is possible.</p>
<p>
</p>
<p>Not really. It is common terminology in every school of public health, particularly in epidemiology and biostatistics. Heck, my D was even tested on false positives in her upper division college stats class last year (non-health care-related, General Stats for Research).</p>
<p>The term ‘false positives’ is also used by the US Preventive Services Task Force:</p>
<p><a href=“http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostateart.htm[/url]”>http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostateart.htm</a></p>
<p>Below is an example of how prevention has been costly over the past two decades:</p>
<p>
</p>
<p><a href=“http://www.kaiserhealthnews.org/stories/2013/june/02/psa-test-guidelines-prostate-cancer.aspx[/url]”>http://www.kaiserhealthnews.org/stories/2013/june/02/psa-test-guidelines-prostate-cancer.aspx</a></p>
<p>dstark, I’m looking.
BD, the footnote said pending final rates. I don’t expect final will be that off. My point is, we’re trying to read the costs for higher income folks on a chart that is part of a rollout of rates for low and moderate income people. At a certain point, it’s not cost feasible for the 115k guy to use the “public” exchange. Not that he’s locked into it.</p>
<p>But, honestly, I am still looking for confirmation of the range of decision choices everyone will have, Everything I see is geared to this low/mod group.</p>
<p>Haha, life is the leading cause of death. Probability of death is 100%. Bay, can you link the study? Does it say problematic “medical care?”</p>
<p>I know false positives exist and can be factored. Certain tests are even more likely to generate them than others. A smart doc- and smart patients- wrap their arms around that and what one would do next. False negatives are also an issue.</p>
<p>I think busdriver11 should explain these rates to us because she is the one who brought this up.</p>
<p>Looks to me somebody my age could pay close to 20,000 a year…</p>
<p><a href=“https://www.wship.org/Docs/Non-MC%202013%20Rates.pdf[/url]”>https://www.wship.org/Docs/Non-MC%202013%20Rates.pdf</a></p>
<p>I’d love to look into it, dstark, though my shuttle leaves for the airport in 10 minutes, I’ll type quick. WSHIP is: “The Washington State Health Insurance Pool (WSHIP) is an independent, non-profit health plan created by the Washington State Legislature. We offer individual health insurance coverage to state residents rejected for coverage due to medical reasons.”</p>
<p>So basically it is the state pool for people with pre-conditions, the uninsurables, who can’t get coverage elsewhere. I’d expect their rates to be high. I’m sure that ACA will offer them a better deal, as it should. When I mentioned “Group Health”, I was talking about about GHC, Group Health Cooperative, a popular non-profit in Washington, that offers very comprehensive services for a decent price.</p>
<p>Lookingforward said:
"I don’t think I can express how foolish it is to “expect” medical science to be perfect. Nor how wrong it is to transfer <em>all</em> responsibility to a doc or team of docs. I’ll skip the ease of researching some conditions on your own. You can at the very least ask if a test is medically necessary or just a “look further.” "</p>
<p>I will add a few things. First: If you have a medical zebra (as in “if you hear hooves, think horses, not zebras”), learn all you can about your disease. I had a chondrosarcoma removed (successfully) seven years ago (it’s a very rare bone cancer–about 800 adults a year in the US, and two-thirds of them are men over 70, which I am not), and I have yet to find a doctor (other my oncologist) who knows more than I do. The last one I saw said “I’m glad you’re so knowledgeable about this. It really helps.”</p>
<p>Second: always ask “would the results of that test change the treatment?” As in “I think you have pneumonia, let’s do a chest x-ray to be sure.” “Would that change your choice of treatment?” “No, I’d give you antibiotics either way.” “Then can we wait and do the chest x-ray if the antibiotics don’t help?”</p>
<p>Ok…so I know that coverage can’t be denied because of a preexisting condition…but does this mean that the health insurance provider must COVER the preexisting condition? And if the person currently has coverage that excludes the preexisting, will the carrier need to cover it?</p>
<p>dmd, I do worry about folks who really can’t absorb the details, so can’t make decisions. And best wishes.</p>
<p>Thumper, aiui, current carriers will need to meet the “essential” requirements and that can mean revising plans. In theory, they can’t leave your plan not covering pre-existing. Plan can lose grandfathered status if they don’t.</p>
<p>sure." “Would that change your choice of treatment?” “No, I’d give you antibiotics either way.” “Then can we wait and do the chest x-ray if the antibiotics don’t help?”</p>
<p>I am running into this with my 85 year old dad. I like what is written here.</p>
<p>Here you go, lookingforward: <a href=“404 message”>404 message;
<p>And no, it doesn’t say deaths from “problematic” care, just regular old “iatrogenic” care.</p>
<p>Bay, will look at it. But the general conflict is that CDC, 2010 data for leading causes of death includes 1.5 mil from heart, cancer, respiratory, stroke and accidents- versus Starfield discussing 250,000 from medical care. Number too high, yes.</p>
<p>One interesting thing my doc once said: about how one has to distinguish among the disease itself, how long it has done its damage, and collateral factors, including the disease’s impact on other physical operation, plus age, SES, prior care, etc. And then the choices of treatment, based on all factors.</p>
<p>And, if there were perfect understanding and perfect cures, of course all this would be easier.</p>
<p>LF,
Here a nice overview of the various studies, if you are interested: [How</a> Common Are Medical Mistakes? - RightDiagnosis.com](<a href=“Healthgrades Health Library”>Healthgrades Health Library)</p>
<p>This one in particular caught my eye:
</p>