Should smoking be considered a pre-existing condition?

That is the opinion of the health exchange boards in Washington, D.C., California, Connecticut, Massachusetts, Rhode Island and Vermont (so far).

Each state (and D.C.) that creates a health insurance exchange under the Affordable Care Act (ACA) has an exchange board that is responsible for establishing certain rules and guidelines. Some definitions in the federal reform law have proved to be ill-defined and open to interpretation, such as “pre-existing condition.”

Most insurers that sell individual health plans charge smokers higher premiums because smokers … Continue reading

Vitamin D – Yes, no or maybe?

The sunshine supplement

Last week I learned that my vitamin D level is slightly below normal. My physician recommended that I take a daily vitamin D supplement of 1000 to 2000 IU.

I didn’t want the test, but what’s done is done. Now I need to decide what the test result means to me, and if I should follow my doctor’s recommendation.

A few years ago, vitamin D was the new wonder supplement. Various studies associated a low vitamin D level with an increased incidence of all kinds of diseases, including multiple sclerosis, rheumatoid arthritis, prostate cancer, breast cancer, … Continue reading

Check and check again

Medical errors happen

The other day I saw my doctor for an annual exam.

This year I was determined to ask my doctor NOT to order a vitamin D level.

I have had my vitamin D level tested for the last three years and it costs me approximately $100 out of pocket. (It is not considered preventive by the Affordable Care Act.)

Earlier this year, the health advocacy group Choosing Wisely recommended against routine screening for Vitamin D level in healthy adults. Well, I am a healthy adult, and my previous vitamin D levels have been normal—albeit at the lower … Continue reading

Look behind the front

The news media recently picked up a report from the Centers for Disease Control (CDC) that stated: “…11 percent of school-age children…have received a medical diagnosis of attention deficit hyperactivity disorder.” Boys are diagnosed twice as often as girls.

Some experts in pediatric psychology and psychiatry are concerned that ADHD is being diagnosed too hastily and treated too recklessly with prescription medications, specifically Ritalin, Adderall and Concerta. Sales of these drugs reached $9 billion in 2012. Overall health care costs related to ADHD are in the tens of billions of dollars—and will increase right along with the diagnoses.

Are there … Continue reading

Welcome spring (and hay fever)!

I love that first warm touch of spring. But the red, itchy eyes and drippy nose I can do without.

In 2011, the Centers for Disease Control (CDC) reported that 16.9 million adults and 6.7 million children were diagnosed with hay fever. Every year, Americans spend billions of dollars on prescription and over-the-counter allergy medications in the quest for relief.

I suffer from hay fever, too, but I am not a fan of most of the available medications. Prescription drugs are expensive, and require a costly visit to the doctor. Over-the-counter drugs (and there are dozens of them!) are pretty … Continue reading

Obamacare: A double whammy for some

A few days ago, more bad news came out about the cost of individual health insurance in 2014. The Society of Actuaries (the financial risk experts that determine insurance costs) reported that next year insurance companies must anticipate paying out at least 32% more in medical claims.

The Affordable Care Act (ACA) will require insurance plans to provide more comprehensive coverage (essential benefits) and cover millions more people with pre-existing conditions. There is considerable doubt about how many young, healthy people and how many small businesses will participate in the insurance exchanges. If they don’t, premiums will rise even … Continue reading

Pass the salt

Two reports last week reminded Americans—again—that we are eating too much salt (sodium), and the media gleefully passed on the news—again—that what we eat is killing us.

Possibly. But it’s not helpful to focus the blame on salt, when it alone is not the problem.

The American Heart Association (AHA) reported that, on average, adults consume 4,000 mg of sodium every day, or about twice what’s recommended. The United States Dietary Association (USDA) recommends no more than 2,300 mg/day (about 1 teaspoon); the AHA advises less than 1,500 mg/day.

In a coordinated analysis, researchers from Harvard Medical School concludedContinue reading

The Z-Pak deception

Several years ago, when my son was in middle school, he developed a nasty sinus infection. He didn’t have a fever, and I suspected it was a viral infection that would run its course unaided. I told him this, but he was unimpressed.

Partly to make him feel better, and partly because I wanted my diagnosis confirmed, I made an appointment for him to see our pediatrician.

I had a good relationship with our pediatrician. We shared the same philosophy of watchful waiting and not rushing to order unnecessary tests and prescribe unnecessary drugs.

Unfortunately, it was his day off. … Continue reading

What is the Quack Miranda Warning?

This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

You have probably seen this warning many times, but perhaps never paused to consider what it meant. Or, maybe you haven’t seen it, because it usually appears in very fine print and is only obvious if you are looking for it.

What is it, what does it mean, and why is it important?

In 1994 congress enacted the Dietary Supplement Health and Education Act (DSHEA), effectively allowing any product under the broad classification of … Continue reading

Surviving the health care jungle

Three years ago, my husband nearly died because of a series of medical mistakes. Although no one was guilty of clear medical malpractice (grossly negligent care resulting in harm), the hospital’s attempts to cut costs, a physician’s careless instructions, and a firewall of inflexible receptionists who refused to let me speak with a doctor led to a 911 call, a trip to the ER, and a 3-day stay in the ICU.

Luckily, he survived. But the resulting medical bills, as you can imagine, were enormous. And completely preventable.

Would it shock you to know that in 1999 the Institute of Continue reading

Man the lifeboats

Under the Affordable Care Act (ACA), small businesses and individuals will be offered “robust” coverage and “affordable” premiums on the soon-to-be-running health insurance exchanges.

By grouping together these two traditionally under-served populations, the risk pool will become large enough (theoretically) to allow everyone (most notably those with pre-existing conditions) access to health insurance, and will help keep premiums affordable (again, theoretically).

But there is a problem: small businesses are jumping ship.

According to the National Review Online, “Small firms and the specialized insurers that serve them may have found the lifeboats (to borrow Texas governor Rick Perry’s comparison of … Continue reading

Equal rights for vision!

For the last 15 years, my family has purchased an individual health insurance policy. Individual plans, as opposed to employer-based insurance, usually don’t cover vision. We could buy a separate vision policy, but in an average year the premiums would cost more than our annual eye exams, glasses and contacts combined.

Even Medicare doesn’t pay for routine eye exams and corrective lenses, except one pair after cataract surgery.

Of course, eye diseases and injuries (your mother always told you not to run with pointy objects, didn’t she?) are covered as medical care.

But I’ve always wondered why screening exams for … Continue reading

It’s about quality, not quantity

I am a child of the 70’s, and I remember the thrill of being able to stay up past my bedtime, on occasion, to watch The Mary Tyler Moore Show. So it was with sadness that I read the recent news that Valerie Harper, aka Mary’s best friend Rhoda, had been diagnosed with a rare and incurable form of brain cancer.

I watched her interviewed on television and was moved by her spirit, her humor, and her eloquence. “While you’re living, LIVE!” she entreats the audience.

In another post about end-of-life stuff, I quoted a doctor saying that … Continue reading

Boning up on calcium

Out of sight, out of mind

The other day I was cleaning out a kitchen cupboard and unearthed an economy-sized bottle of calcium tablets. Oops! I should be taking one or two of those every day.

Or should I?

Everyone knows calcium is necessary for bone health. Most women have been told by their doctors that they need extra calcium after menopause because without estrogen’s help, bones do not absorb it well. Low calcium leads to osteoporosis, which leads to broken bones, which lead to huge health care costs. Oh no!

Too much of a good thing—or the wrong thing

Continue reading

Medicare: No longer the light at the end of the health care tunnel

During the presidential campaign last year, Paul Ryan, the vice-presidential candidate, presented his plan for what we all know is much-needed Medicare reform (too many baby boomers; too little money). Under his plan, seniors would choose a  “Medicare certified” private health insurance plan and, depending on the senior’s income, a percentage of the premium would be subsidized.

His plan sounds a lot like the new health insurance exchanges that are set to begin in 2014, doesn’t it?

Yesterday, an article on the National Review Online caught my attention because the author presented a compelling scenario by which the government could … Continue reading