At Monticello Community Surgery Center we are fighting for health care reform. In second part, that means explaining the current system so informed stake holders can make good decisions, starting right at home. See Part 1 for a discussion of cost-sharing plans, direct primary care and the importance of price transparency. This is Part 2. There is a conclusion in Part 3.
Costs are going up.
Way, way up. Why? What can we do? Many insurance plans have become prohibitively expensive, especially in the individual market. Last week the Washington Post reported that individual market prices are higher in the greater Charlottesville area than anywhere else in the country. The government recently stopped subsidy payments to insurance companies. United, Anthem and Aetna largely pulled out of Virginia. Optima is now the only participating ACA provider in the area. Premiums for plans have skyrocketed 300% for many.
Reports of annual premiums over $48,000 are common– and that’s before any benefits are paid. It’s not just individual plans that are seeing big increases. Most employee sponsored plans are again seeing double digit increases. Based on what we’ve seen from Washington, we cannot assume a solution will be coming in the near term. To say the least, it is a very difficult, stressful situation without a lot of easy answers.
4. Be Smart about Prescription Drugs. Shop around for prescription drug pricing. No one place always has the best price. In fact, prices fluctuate widely and seemingly without reason. GoodRx is a nice tool for this. They have an app for your phone that you can use to quickly check local prescription drug prices. Many generic drugs are $4 a month, while others in the same class are $150.
The best solution — when you are with your doctor, use the app in real time to check the prices of the drugs s/he is prescribing for you. Usually, there are affordable and equivalent alternatives. If the drug you need is e
xpensive without a more reasonable alternative, use the app to find the best price locally or consider an online pharmacy. Online Canadian pharmacies have amazing prices, but are of questionable legality. MailMyPrescriptions.com and other US based pharmacies have prices that will almost always beat any brick and mortar pharmacy.
5. Political Engagement. One thing that all parties can agree on, is that the current course of health policy cannot be sustained. Talk to elected representatives and demand change. If you are so inclined, run for office. There is much we can change that will help. If companies are forced to publicly reveal what they charge, the pushback on high priced vendors and pharmacies will force prices to inevitably fall. Some measures, like requiring pricing and contracting transparency, can be done at the state or even local level. We have to start demanding accountability.
Inaction and apathy allows for additional legislation that harms the average American. In other words, Congress is still working hard to make it worse. For instance, Democrats and Republicans just voted overwhelmingly to renew the FDA generic drug approval program. It was lobbied for and suggested the by drug companies. This has led to 1000-6000% increases in the price of generic drugs over the last 10 years. Few protested this action, though it will cost us billions. This type of action is happening every day in Washington DC, where the voices of ordinary citizens have been replaced by those of high-priced lobbyists.
Our trust in the government, health systems, drug companies and insurance groups to manage this issue has failed. They haven’t been doing what’s
best for us. Instead they have succumbed to the special interests of the pharmaceutical industry, third-party payers and others. They net billions in profits while wage growth and household income stagnate under the weight of ballooning health care costs. No mainstream politicians in either party are talking about real reform.
Congress refuses to consider any real cost containment measures. These include meaningful deregulation, government negotiation of drug costs, drug re-importation, mandated price and contract transparency. The repeal of monopoly-maintaining Certificate of Public Need programs would disrupt the government sponsored industry consolidation the drives up prices. and laws and dozens of other measure that could stop the abuse. No loud voices are yet clamoring for the creation of a free market that could save healthcare. Now is the time for us to speak up.
6.Stay Healthy. We know you know this. And we don’t mean to be flippant, but it’s important to be remember. Eating good food and exercising makes a difference. Regular activity is more effective than antidepressants for depression and anxiety. Good sleep hygiene can help cure migraines. A plant based diet and an active lifestyle can reverse heart disease better than stents, drugs and cardiac rehab. Regular physical activity prevents some cancers and wards off dementia. Dozens of chronic conditions have been clearly proven to improve with exercise, even arthritis! Stay active, eat fresh food– which means as much plant-based nutrition as you and family can tolerate. Take a regular vacation and celebrate life. Engage with your loved ones, spend time with family. Time spent on mental health pays big dividends in maintaining physical health.
7. Consider Other Ways to Insure. While employers may not see the huge rate hike that the individuals in the ACA market did, most have been handed solid double digit premium increases for years. This can lead companies to either reduce the amount of coverage provided or increase the financial burden of the employee. For many small companies, the strain can be too much. Do you pay a lot in premiums but don’t get much in benefits? What would five years’ worth of your insurance premiums look like growing in the bank? Depending on the health status of you and/or employees, age and tolerance for risk, self-funding might make sense. Self-funded insurance means rather than spending tens of thousands to an insurance company for benefits that may never be utilized, essentially the money is put into a savings account to pay expenses.
Small and medium groups can band together to form a captive, which purchase together a large health plan that priced better than the ACA plans. Small businesses and even individuals can in some cases incorporate and be given access to other health plans outside of the individual market which may have more favorable terms. Incorporation can allow you to access tax-preferred self-funded adjuncts too, like Health Savings Accounts (HSAs). HSAs have several tax advantages and if one is available to you, consider maximizing its benefits by fully funding it. Both the contributions and the interest in HSAs that are invested are tax free, subject to certain limits. Such changes should be undertaken with good professional advice and not from brief blog posts, however. Locally, LD&B is a local insurance and financial services firm that has long history of helping clients reduce health costs and is currently innovating with real cost-saving payment methods, such as self-funding, bundled-pricing and direct contracting.
That’s it for part two. We’ll finish this series in Part 3 with some of our most important tips, including how to approach the big health care conglomerates.