Category: medical

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medical

The gym is my friend

Wow, going to the gym really makes a big difference for me. One thing that my diagnosis does for me is that it explains how exercise doesn’t have the same effect on me as everyone else. everyone always says, “I love working out, I feel so energized afterwards.” I felt like crap, like my soul is leaking out of me. Exercising really take it out of me, I don’t feel like doing much of anything for an hour or two afterwards. I might even fall asleep.

So it’s tempting for me to not go, it really is. Here’s the problem, when I don’t go, I pay the price. I have found out that if I don’t go for a couple of days, I get real stiff, the spasticity in my legs is pretty bad. Still no pain, but wow, they lock up good. If I go to the gym, I’m much looser. Of course, that first day back is pretty rough. Stretching doesn’t seem to help all that much, but the activity does.

I’d like to say that I’ve found this out with a controlled scientific approach, but I can’t. It’s mostly about how lazy I get. But it truly is pay now or pay later. I hope I can maintain this through the heat of summer because people with MS typically don’t do well with the heat. AC and an exercise bike are all I need to stay on course, and I suppose a little reminder from my legs once in a while would help too.

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medical

Adult stem cells or why I hate the FDA

One of the more promising treatments for MS (among a slew of other conditions) is the use of adult stem cells. Unfortunately, here in the US, the media and various groups are obsessed with embryonic stem cells. Those have a lot of promise as a therapeutic method, but they are really controversial. I’m really uncomfortable with them, and I think I would decline to be treated with them. In addition to the controversy, there is the little problem of how to use them. In theory, they have a lot of promise because they could become darn near any type of cell that is needed. The problem is that they tend to create tumors. It makes sense since those cells are all about growing…

So while everyone talks about embryonic stem cells, there really aren’t any treatments available using them. While the US was arguing abut those, the rest of the world went on to researching adult stem cells. These are cells that are taken from the patient’s own body. As such, there is no controversy in using them. The cells have a variety of different sources including fat cells, bone marrow, blood, skin, and even menstrual blood! The stuff is taken out of the patient, the stem cells are separated from the host tissues, they are made to grow into more and more cells, and then they are injected back into the patient wherever they need them.

This technique is successfully being used all over the world to treat the symptoms of many different afflictions like MS, cerebral palsy, congestive heart failure, broken bones, and many more. In most cases the stem cell treatments aren’t “cures” but they do alleviate many symptoms and help people regain function. In addition, since it is the patients’ own cells being used, there are no side effects to speak of.

So why is it that people can go to Israel, China, Costa Rica, The Philippines, Argentina, and many other places to get these treatments but we can’t get them here? Many Americans assume that all of those countries have inferior medical systems and are unable to do quality medicine. That just isn’t true. The way many people think, they assume that all of those people live in mud huts and have never read a book. They have hospitals and many of those countries have very successful medical tourism industries. The reason they are successful is because they are able to offer good treatment at much lower prices in a timely fashion. Their reputations depend on good service.

No, the reason we don’t have those treatments available isn’t because of the backwardness of those other countries, it is because of the weird incentives the government has set up for these treatments. You see, the FDA has declared that adult stem cells are “drugs” and therefore are subject to all of the regulations that go along with that title. Put another way, the FDA believes that they have jurisdiction over how you can use your own cells on your own body.

It costs fortunes to get a drug approved at the FDA. Here’s the kicker, the drug companies do not have any incentive to research how people can use their own cells, so they don’t do any. Clinics, hospitals, and doctors stand to gain tremendously if these procedures become normal here. The trouble is that any given clinic would be unable to recoup the money needed to jump through all of the hoops at the FDA because once it is approved, anyone would be able to do it.

Some people would say that the government should foot the bill for this research in order to solve the problem. It would be much easier, much less expensive, and much faster if the FDA would simply reclassify the use of adult stem cells as a procedure instead of a drug.

If you’d like to see what is going on with adult stem cells these days, check out RSCI. He has a lot of information about adult stem cell use and lots of links to different types of conditions that are currently being treated with them. Adult Stem Cell Therapy is also a good place to go to talk with people that have had the procedure done. Adult stem cells are the future, and in other countries, the future is now. I hope beyond hope that this will happen in this country soon, and that the prices will follow a Lasik-type trajectory.

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medical

MS treatments

As you might imagine, I’ve been looking into what kind of treatments are available for MS. There are two different fronts when it comes to treating MS. There are things to treat the symptoms and then there are things that try to prevent relapses. Most of the effort and most of what is out there for MS patients is in the latter category.

I have problems with those types of things for several reasons. The shots that are used to prevent relapses are hideously expensive and have various side effects. Very frequently, they stop working or don’t work for a particular person. I’ve also wondered how you would know if they work at all. I mean, it’s easy to tell when they aren’t working, but it isn’t possible to know if they are. All of this is a bit moot since I don’t seem to have the relapsing type, those shots won’t work for me.

When it comes to treating the effects of MS there is very little that modern medicine has to offer. There are some anti-spaticity drugs and pain killers and that’s about it. There are some things that anecdotally have some effects. Things like acupuncture, diet, and yoga have their adherents. Another option is marijuana. There are many people that swear that it helps with pain, spasticity, and some even claim that it prevents relapses. Along with those positives, there are very few side effects and it is cheap! It’s really easy to grow too. The one downside is that it is illegal in most places.

Sigh.

The good news is that there is a lot of promise with the new field of stem cell research. More on that in the next post.

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medical

I have MS

I was diagnosed with MS this last friday. In one sense, it is a relief. I now at least have an idea of what to expect and can put a name to what has been causing me all of these troubles. Of course, it always sucks getting a diagnosis like this…

On the bright side, if I’m going to have MS, now is a pretty good time to have it. Research is finally making some serious progress (more about that in the next post) and it looks like treatments are available now overseas and will hopefully be here within a couple of years. In the meantime, I really am not in all that bad a shape. I can get around, I have no pain, and I have nothing that will prevent me from getting a new job. I’ll need to be sitting down with the new one, but still…

I was pretty much anticipating this, so it didn’t come as a big shock. I’m doing OK right now and I think that within a few years I’ll get some treatment. I don’t know if that is going to be in this country or not, but I’ll cross that bridge when I get there.

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medical

The latest test results… and a decision to be made.

Well, the results came back from my spinal tap and they showed the presence of proteins that are markers of MS. It doesn’t mean that I have MS, but it is consistent with MS. In addition, I still only have the one lesion as opposed to the 9 they usually look for in an MS diagnosis.

My doctor has recommended that I start treatments for MS. These treatments don’t do anything for my current symptoms, but they are supposed to help in slowing down the progression of the disease. They consist in getting shots either every day or every other day and have a variety of side effects.

I have several reservations about these treatments. First of all, it still isn’t clear that I do have MS or that I will get MS in the future. Right now, I have a single lesion on the spine. Usually, they want to see 9 before giving a diagnosis of MS. It isn’t clear that my symptoms will get worse without treatment.

Now if the treatment just involved taking a pill or two with minimal side effects, or offered some hope of getting better, I’d go for it right away. But daily shots with the possibility of “flu-like symptoms” don’t make me jump for joy. Oh, and I’ve been reading about people’s $1200 a month copay for them too, that also makes me happy.

I’m also not sure how we’d know if they are working. I mean sure, if there’s a flare up, we’d know they weren’t, but in the meantime, there’s no telling. I’m going in tomorrow for a meeting, I’ll discuss my reservations and wee what he has to say. I gotta be frank, I’m leaning towards not starting those treatments….

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economics free market medical

Another rant on medical costs

I’m getting another blast of medical bill nuttiness. Where to start…

As you may know, my insurance company has been denying all claims. I’m not going to get into that here, the upshot is that I’m getting the bills. I have had some success with negotiating lower prices at some places, my neurologist’s included. A big part of this negotiation involves me whipping out a credit card and actually paying the bill. Getting paid right away is a big incentive, at least to some people…

I needed a spinal tap, so naturally I was worried about the price. I knew that I could work with the neurologist’s but they made it clear that they lab costs were out of their hands. OK, maybe if I contact the lab and work out something before the test, I can work a good price. Hoo boy. I called my neurologist’s office to find out what lab they are using. I then called the lab. They directed me to another number for billing questions and then they sent me back to the lab. At that time, I was only trying to get a price. It turns out that the person I needed to speak to had already left.

So I went and got my spinal tap the next day, and at the lab I told them that my insurance wasn’t going to cover it. I asked if they had a discount for prepayment. They said they used to, but they stopped doing that on April 1. They did say I could pay for a third and then fill out a form to see if Riverside medical would be willing to forgive the rest. Um, OK. Can’t you do something now, I would prefer to pay now. They would do that only if I paid the entire cost. They would not move an inch.

I got a similar run around with some of the other doctor’s offices I dealt with from Riverside Medical. When I call to the office, they say they do not handle the billing. When I call, they are not willing to lower the price at all even though they were willing to accept my insurance company’s much lower payment. It was common practice for my mother (an orthopedic surgeon) to charge a much lower rate, usually the medicare rate, when the patient didn’t have insurance. So what’s going on?

What my neurologist’s office and my mother’s previous office had in common is that they did their own billing. All of the other people I have dealt with have others do the billing. Why does that matter? It matters because when I deal with people at the other offices, they don’t care if I pay or not. It isn’t their job to collect, their job is to do the paperwork properly. As a matter of fact, they have been conditioned to not get involved in the money aspects of the business, it is uncomfortable and messy. They insulate themselves to the point that they have no idea what things cost.

The problem is that the prices that are charged are set with the idea that the insurance companies will pay a fraction of that. If you do not have insurance, you are stuck with a much larger bill than the insurance companies would get. This isn’t necessarily a problem, reasonable people can quickly come to an agreement based on what the insurance company or the government pays for any given procedure. The key is that the other side has to be interested in getting paid, they have to be willing to make a deal. The companies that do not handle their own billing and the billing companies that do it for them are not interested. They just want to do their job. If you pay, you go into one slot, if you don’t pay, you go into the other…

All of this has had the perverse effect of making it attractive for the medical claim to go into collections. You see, the collection agent is paid based on their ability to get money. They have every incentive to get money, so they have every incentive to wheel and deal on the price. They would be ecstatic to get half of the bill paid. They take their cut, and the rest goes to the medical company. It’s their own stupidity and the incentives set up by their structure that prevent them from getting that money in the first place.

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medical

The worst things about my spinal tap…

… were getting up early, having to lie around for half an hour after the procedure, and of course the money. The procedure itself was really no big deal, no bigger than any other getting stuck with a needle procedure. Hopefully, I will have some results later this week.

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economics medical

I have an MRI appointment! and more on health costs

At long last I am going to have an MRI. My doctor wasn’t getting anywhere with the insurance company, so he wanted to arrange another visit to get a more particular differential to present to them. Of course, that meant that there was going to be another charge for a visit, plus probably more lab work etc. There wasn’t much difference between what the insurance company was going to pay (if they agreed to it) and what I’d pay out of pocket in the first place. When you added another doctor’s visit just to get the insurance to cover it, I was going to end up paying more. So I said screw it and scheduled one.

Just google for “low price MRI” and you’ll pull up a bunch of sites to help you find a good price. It turns out that AZ and Vegas have some of the lowest prices. At $350 for an MRI without contrast, it might make sense to fly out there to get one if you need a bunch done.

Mine cost me $800 because I needed one with and without contrast. That’s still pretty good, and still the same or less than using my doctor’s usual place with my insurance. It pays to shop around! Now if only the insurance companies would pick up on this we might get somewhere on prices…

Here’s a website and blog fighting the fight for lower cost medical care. It’s called Out of Pocket, and I hope many more pop up like it!

Categories
economics medical

How to keep healthcare costs down

My medical issues have been very illuminating. I need some MRIs and the insurance company is balking at paying for them. There’s a chance that they may come around, but an even better one that they won’t. But I need those MRIs, so what do I do? Like anything else I might buy, I’m shopping around.

I asked the regular place my doctor uses for MRIs what they charge for a single one. It is a hair under $3000. Ouch! Independent labs look like they are charging anywhere between $2000 and $2500 but I’m not sure that my insurance will be accepted at those places. That’s a little better but still… I have an insurance plan that pays 80% while I have a 20% copay. I’m going to ignore the deductible just to make the calculations easier. So, if my insurance does “pay” for the MRI, I would be out 20% or $3000, that equals $600.

What a lot of people don’t know is that if you pay up front, you can get big discounts. My doctor’s regular place will give you a 20% discount. That’s not bad, but there are much better deals to be had. With a little looking around, you should be able to find a place that will do an MRI and have a radiologist read it for you for $650 (without contrast stuff being injected into you, that’s extra), maybe even less depending where you are.

Of course that got me thinking. It is well known that insurance companies only pay a small percentage of whatever bills they get from medical establishments, but the copay is determined by the full amount. I assume that the $650 that the companies charge for cash payments is pretty close to what they end up getting paid when they jump through all of the insurance company hoops. In other words, all of those “hoops” cost the office money to process and there is a the issue of waiting for the payment to come through. After you subtract those costs the office probably clears $650 even though the insurance company eventually cuts them a check for something closer to $1000.

In any event, I know that $650 is a lot less then thousands of dollars. Why doesn’t my insurance company allow me to negotiate the best rate I can, pay for it, and then reimburse me. Let’s look at the typical dealings. I go to the MRI place and get one done. They charge $3000 to my insurance company and get some proportion of that. I’m thinking it’s going to be in the $800 to $1000 range, but I’m just guessing. I then have to pay a $600 copay. How about this alternative universe, I go to the MRI place and negotiate a price of $650 if I pay up front. I then submit that claim to my insurance company and they reimburse me my 20% copay of $130. The insurance company pays a total of $520.

What just happened? The total cost of the procedure and the work involved has just dropped. It’s true, I have to do a little more legwork and I have to wait to be reimbursed, but my total cost has gone down, the insurance company’s payments have gone down, and the provider gets their money much quicker.

If this model became popular, you can bet that competition would drive down the prices, just like it does for everything else. Making the consumer initially bear the entire cost of the procedure is a sure fire way to lower the overall cost of medicine. I know, there are some problems with this when you start to talk about really big things, but as a basic framework, it is a good model. One of the primary reasons that healthcare is so expensive is because consumers are so insulated from the costs. Consumers are likely to order every test and procedure without once considering the cost. That will make the price creep up no matter what kind of service we’re talking about.

Health insurance is so weird, if it were more like home insurance, everything would be much less expensive. It may seem counter intuitive to people, but paying up front would mean lower prices, insulating ourselves from the pricing mechanism is not in our best interests.

Categories
free market medical

Shopping for medical care

For those of you not in the loop, I’ve been going to different appointments trying to figure what’s wrong with me. I have what I think is a good doctor and he’s being very methodical. The sad thing is that I wasn’t overly worried about what was going on until I went to a doctor and then found out how serious it could be.

We’ve gotten the really nasty diagnoses out of the way, not without a little sweating though. I don’t have ALS or cancer… The next big thing to rule out is MS (I’m thinking positive), but to do that I need some MRIs done.

I found out tonight that my insurance is denying all of my claims so far so I have no reason to think that they’ll pay for my MRIs. That’s a bit of a problem because they are pretty expensive. I’ll find out on monday, but I’m willing to bet that the price is between $1500 and $2500 each, and I need two.

It turns out that there are places that have discounts if you pay up front. And I’m talking about some serious discounts, I can go up to northern Virginia and get an MRI (with a radiologist reading) for $630 each. Yeah, it’s a three hour drive, but what the hell, it’s worth the savings!

I am going to call up the place that is scheduled to do mine on tuesday and see if I can’t negotiate a better price and use this other location as their competition. It’s worth a shot. If they can get close, I’ll do it here instead of driving. We’ll see just how much of a business it really is and how willing they are to move their price in order to avoid the complications and hassle of insurance.

Even if they don’t budge, I’m happy that there are alternatives. That’s the way it should be, competition is good for us!!!

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