When Medicare disclosed average charges from thousands of U.S. hospitals for 100 common procedures last week, only one hospital was near the top in every category: Cedars-Sinai Medical Center in Los Angeles.

Be it a cardiac stent, a . . . → Read More: Cedars-Sinai Tops Lists for Hospital Pricing]]> Not sure if this is a list that any hospital wants to be at the top of:

When Medicare disclosed average charges from thousands of U.S. hospitals for 100 common procedures last week, only one hospital was near the top in every category: Cedars-Sinai Medical Center in Los Angeles.

Be it a cardiac stent, a hip replacement or a pacemaker, Cedars-Sinai’s list prices for these routine treatments ranked among the top 5% in the country.

For example, the average charge at Cedars-Sinai for gallbladder surgery with complications was $153,302 in 2011 compared with the U.S. median charge of $42,380, government data show. That figure ranked second nationally.

Cedars-Sinai stands out for steep pricing

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Wes Brain was uninsured last winter when a tonsillectomy showed signs of throat cancer. He qualified for the high-risk Oregon Medical Insurance Pool, which the state has administered through Regence BlueCross BlueShield.

But gaining access to that insurance soon proved . . . → Read More: Is a Single-Payer System Still on the Table?]]> Just a reminder that some folks are still trying to keep the single-payer dream alive:

Wes Brain was uninsured last winter when a tonsillectomy showed signs of throat cancer. He qualified for the high-risk Oregon Medical Insurance Pool, which the state has administered through Regence BlueCross BlueShield.

But gaining access to that insurance soon proved a big obstacle for the Ashland resident, when Regence erroneously told him he hadn’t submitted his driver’s license.

“Denial and delay, denial and delay are the way these insurance companies work. They make money this way,” Brain vented to the House Health Committee on Tuesday. He had previously lost his daughter after a nine-year struggle with leukemia while contending with insurance companies over access to necessary healthcare services.

Eventually, his policy was approved. He paid $2400 — three month’s premium. His doctor ordered a PET scan for March 1. But then Regence came back and told him no, he’d have to wait until March 1 to even begin authorization.

His clock was ticking. His throat cancer could be spreading.

Single-Payer Activists Keep Dream of Universal Healthcare Alive

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Well, Kaiser Health News . . . → Read More: The Oregon Medicaid Lottery, a Winner’s Story]]> There’s been a lot of talk about the so-called Oregon Experiment. Oregon conducts an annual lottery for a few precious spots in its state Medicaid program. Recently, a group of researchers looked into the program, as a look as to whether an expanded Medicaid makes any difference to people’s health.

Well, Kaiser Health News has one lottery participant’s story:

After winning the lottery, Mary Carson, 55, was accepted into the Oregon Health Plan, the state’s Medicaid program, in 2011. She and her partner live with her three children. They earn about $1,000 a month by making and selling replicas of historic battle knives used in the Civil War and the two World Wars, doing odd jobs and providing respite care for people with cancer. Her comments on a popular blog about some of her own experiences on Medicaid have garnered some attention.

Kaiser Health News interviewed Carson by phone this week. The following is an edited transcript of the interview.

Q: Where did you go for health care before you won the Oregon lottery?

A: There was a low-income clinic that would see people without health insurance, so that’s where I was going when I had no health insurance. They would see people for $25 a visit, so that was enough to keep my prescriptions filled. I have high blood pressure and depression so I need three or four different medicines. I’ve gone to some of the clinics for people with no insurance: a giant group of people in a basketball court, trying to get their tumors looked at. It was just so depressing and doesn’t seem very American and seems wrong.

Q: How did lacking insurance affect your medical care?

A: At one point I needed some cortisone for my asthma and they wanted to do a complete heart work-up to make sure that my troubled breathing wasn’t congestive heart failure. You’re always telling them, “No, no, no, this is the only thing I want.” It’s like trying to buy the burger with no fries at McDonalds. You have this resistance all the time, because doctors and nurses look at you with these big soft eyes and say, “But it would be so important to know your level of cardiac health, I’m really concerned. I’m sure the doctor there will work out something and make payment arrangements.” And it sounds so good and you do it and it never works out. The discount isn’t there or you fill out something wrong and all of a sudden you have a $300 bill in collections. So you have to make sure none of that happens to you.

Q: When you went on Medicaid and could afford blood tests, what did you learn?

A: I found out I have really low Vitamin D levels, that my cholesterol isn’t really good, but it’s not really bad. There are things I need to change in my eating and exercise. My blood sugar, I’m pre-diabetic, just on the edge of needing diabetes medication, so I need to watch what I eat. It’s hard to eat really healthy when you’re on food stamps because you get $3 a day for groceries and you’re not going to get a whole lot of lean meat and vegetables for $3 a day.

Q: How has your health changed since you went on Medicaid?

A: Over the course of nine months or a year I was able to drop two different blood pressure medicines, which is nice because they had side effects I didn’t like. So I’m down to half a pill of one of the medicines and my blood pressure is still stable. For about a five-year period I thought my thyroid medicine was too low and I couldn’t afford the doctor visit to have the lab slip to have the labs read to get a new prescription. That whole procedure is about $300 so I just stayed with the same medicine. With Oregon Health Plan I was able to go back to the doctor and when she said wanted check my thyroid levels I could say, “Yes, I’ll go to the lab and get that done.” They were low again. I was able to get that increased and that made a big difference in how much energy I had and how much better I felt.

Oregon’s Medicaid Lottery: A Participant’s View

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Approximately 100,000 women undergo mastectomies each year, according to Decision Researches, a Burlington, Massachusetts industry analysis group, and the popularity of the procedure has grown. Rates of double mastectomies more than doubled . . . → Read More: Double Mastectomies, Numbers Rise and So Do Costs]]> If Angelina Jolie’s recent announcement about her decision to have a double mastectomy has made you think about the procedure, you’re not alone:

Approximately 100,000 women undergo mastectomies each year, according to Decision Researches, a Burlington, Massachusetts industry analysis group, and the popularity of the procedure has grown. Rates of double mastectomies more than doubled from 1.8 percent to 4.5 percent of women diagnosed with early-stage cancer between 1998 and 2003, according to a study in the Journal of Clinical Oncology. Dr. Kelly Hunt, a surgeon at Houston’s MD Anderson Cancer Center, tells CNN that she’s seen the rates of having both breasts removed increase dramatically in the past few years at the center.

But not everyone who chooses the procedure is as high risk for cancer as Angelina Jolie.

In a report last year by UK’s Independent Breast Screening Review, researchers estimated that there were around three cases of overtreatment for every death prevented from mammogram screening. Another study in Norway found that in screening 2,500 women 50 to 69 years of age, one death was prevented and 6 to 10 women were over-diagnosed.

The surgery is extremely invasive – and expensive. “The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film,” Jolie wrote in The New York Times. Costs for the full procedure – including breast reconstruction – can range from $15,000 to $50,000, depending on the location and the type of surgery. Insurance providers are not required to cover preventative mastectomies, though many do. The test alone for BRCA gene mutations can cost over $3,000. The test will be covered as preventative care under the Affordable Care Act if the patient can prove they have a family history of breast cancer.

Double Mastectomies Are Rising, Along with the Costs

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On Tuesday, Angelina Jolie drew headlines with her announcement that she has undergone a preventative double mastectomy. As she wrote in the pages of The New York Times, . . . → Read More: The Breast Cancer Gene Breakdown]]> Bruce Watson has a great breakdown of some of the cost issues involved in making decisions like Angelina Jolie’s to have a preventative double mastectomy:

On Tuesday, Angelina Jolie drew headlines with her announcement that she has undergone a preventative double mastectomy. As she wrote in the pages of The New York Times, a blood test revealed that she carries a damaged BRCA1 gene — a defect that greatly increases the odds of a woman getting breast cancer. Facing what she said was an 87 percent chance of developing the disease, she decided to undergo a prophylactic double mastectomy, an operation that reduced her risk to 5 percent.

Jolie’s decision to have a prophylactic mastectomy before any sign of the cancer had manifested, and her willingness to openly discuss it, is shedding fresh light on breast cancer — as well as on the very real problems with how the American medical community deals with this disease. Every step in Jolie’s process — from the tests that uncovered her faulty gene, to the operations she underwent to protect against it, to the post-surgery reconstruction — highlights shortcomings in the American health care system, and inequities in the care that most Americans receive.

To put it another way, when it comes to breast cancer care, your health may often be trumped by your finances: even if your best bet is to follow in Jolie’s footsteps, you might not be able to afford the screening, care and surgery that may have saved her life.

Breast Cancer Gene: Why Most Women Can’t Do What Angelina Jolie Did

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Cancer patients are at much greater risk of bankruptcy than people without cancer, according to a large new study. And while the new health care . . . → Read More: Cancer Patients Much More Likely to Declare Bankruptcy, Even When Insured]]> If you’ve ever wondered what’s at stake in staying healthy, a group of researchers in Washington can now tell you: it can be the difference between solvency and financial disaster:

Cancer patients are at much greater risk of bankruptcy than people without cancer, according to a large new study. And while the new health care law promises insurance coverage to more than 30 million Americans who lack it now, the high cost of cancer care can push many patients, especially younger women, into financial trouble, experts say.

“We need to look into why this happening and see if there is something we as a society can do to reduce that risk,” says Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research in Seattle and lead author of the study published Wednesday in the journal Health Affairs.

Ramsey and his colleagues matched 197,840 adults from a western Washington cancer registry with an equal number of cancer-free adults by age, zip code and sex. They then determined who had filed for bankruptcy, using court records.

The researchers found that 4,408 of those diagnosed with cancer between 1995 and 2009 had filed for bankruptcy, compared to 2,291 of those without cancer. Overall, cancer patients were 2.5 times as likely as others to file for bankruptcy.

Cancer increases bankruptcy risk, even for insured

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Many small-business owners worry that a new tax on insurance providers in the health-care law will mean higher premiums for them, undermining the law’s capacity to lower their health-care costs.

Starting next year, the federal government will charge a new fee on . . . → Read More: Obamacare: How Much Will It Cost Small Business Owners?]]> If you’re a small business owner, this news may not be a surprise:

Many small-business owners worry that a new tax on insurance providers in the health-care law will mean higher premiums for them, undermining the law’s capacity to lower their health-care costs.

Starting next year, the federal government will charge a new fee on health insurance firms based on the plans they sell to individuals and companies, known as the fully insured market. Meanwhile, the provision exempts health-insurance plans that are set up and operated by businesses themselves (the self-insured market).

Revenue from the tax will help pay for the health-care overhaul, which is expected to extend coverage to millions of uninsured or underinsured Americans.

Health insurance tax ‘scares the daylights’ out of some small-business owners

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Have you been tested for the breast cancer gene? Tell us about it in our discussion forum!

. . . → Read More: Angelina Jolie: How Much Can Testing and a Mastectomy Cost?]]>

Have you been tested for the breast cancer gene? Tell us about it in our discussion forum!