Health "Coverage" That Could Really Cost You

A friend was hit by a car while riding his bike in the twisty streets of Harvard Square. He was wearing a helmet during the crash, but the impact was severe enough to land him briefly in a coma.

When he came to in the hospital, the first words out of his mouth weren't "What happened?" or "Where am I?" but rather these: "Oh NO! I'm not insured!"

He was so upset that he tried to leave the hospital, concussion and all. Nurses had to sedate him (sadly, further boosting his bill).

I don't want to put myself or my family in that kind of situation. But my work contract is wrapping up, and I need insurance for at least 3 months. COBRA will run $392 a month—ouch. Yet it would be $700 monthly to add just little ole me to my husband's school district-sponsored insurance policy (which we aren't even allowed to do until September's open-enrollment period, which determines coverage for October). While that's ridiculously steep, at least our kids are covered "for free."

So, I'm shopping for an individual plan. And I'm finding out why so many young people either can’t afford or decide to forgo insurance coverage, as this MSNBC article points out.

Mostly, I want to be able to get refills on my asthma inhaler and allergy medicine (breathing is nice!), and I also don't want to bankrupt my family should I be hit by a car or blow my knee out while jogging.

While it's been disputed, one study indicates that as many as half of personal bankruptcies are related to medical bills, even though many of these folks have insurance. They went broke after finding it doesn't cover chemo, surgery, or other pricey procedures, or they had co-pays and co-insurance and deductible bills that added up, and up. So there's no way I'm skipping out on finding a plan.

Well, after some web surfing, I found a nice high-deductible policy from Regence that would run just $71 a month.

Cheap!

But penny wise, pound foolish.

Because in the future, if I were to be insured under another policy after Regence, I'd have to wait 9 months (!!) to have any of my asthma or allergy-related doctor visits or prescriptions covered. That's the mandatory "pre-existing condition waiting period" that bites you if you've been insured under a paltry "catastrophic" plan, due to recent changes in Washington State law. Other states have implemented similar measures, in the interest of preventing residents from being under-insured.

But the policy I was about to buy sure didn't look like a catastrophic plan--you know, the ones that cover you if you were hit by a car, but still make you pay an arm and a leg if you get strep throat. But sure enough, I found that any policy with a deductible is $1,750 or more is considered catastrophic coverage. 



This 9-month waiting period wasn't spelled out to me on the application form (at least, not anywhere that wasn't in inscrutable legalese, in a font bigger than size 7.5). I only found out because I had to call a customer service representative with a question on when the application was due for Sept. 1 coverage. He mentioned it offhand, like it was no big deal that only two of the policies offered on their site would let anyone avoid that extended waiting period.

And … a basic non-catastrophic policy would bump the fee to $276 a month. And oh, only 2 of the 7 individual plans on their site were non-catastrophic. I also needed to fill out a 33-page questionnaire on my health history.

Good thing I have a month to work on that! The co-insurance, strict preferred provider limitations, and annoyingly difficult-to-navigate provider directory seemed like no big deals after eyeing it. But the whole wool-being-pulled-over-the-eyes element made me want to certainly consider a number of other companies; at least the state offers a handy insurance-shopper's guide for doing so.

Sheesh. That COBRA policy is looking like a bargain, if only to keep my blood pressure down. (If yours is high, you may want to avoid this BusinessWeek story on insurance companies as monopolies.)

While I'm grateful that legislation passed by President Obama partially subsidizes COBRA payments (which would bring my monthly bill to $360 or so), I have to say that the universal coverage proposal, "rationing" and all, is looking better and better by the minute. I don't want any "Oh NO! I'm not insured!" moments in my future.

Boycott a Book, Save the U.S. Healthcare System

Ok, so there's a bit of hyperbole there, but What to Expect When You're Expecting needs to go away. It's been sitting for scores upon scores of weeks at or near the top of the New York Times bestselling advice titles. Every Sunday, there it is, making me apoplectic.

It should be called Culture of Fear: Pregnancy Edition, and if you ask me, it's very much responsible for keeping health-care costs in our country skyrocketing.

I've been writing for Fit Pregnancy magazine for nearly 10 years, including book reviews, and I'm a trained labor doula. I've also had two children born with the help of midwives. But I think it's a shame this book has more than 13 million copies in print. What to Expect is guaranteed to give any pregnant woman reason to worry unnecessarily.

Worrying and anxiety lead to increased adrenaline; adrenaline is capable of preventing or stopping labor, as it interferes with labor hormones including oxytocin. Penny Simkin, a physical therapist, author, longtime childbirth educator, and international lecturer on labor an birth--voted a "living legend" by Seattle magazine--recommends to the couples in her class that they avoid the book. One of my midwives implicated it in our country's asininely high c-section rate, which is over 31% and up to 40% in some communities. (The World Health Organization says it shouldn't be any higher than 15%.)

I give the book props for redesigning its cover for the 10th anniversary edition; no longer does a contemplative mom-to-be sit in a rocking chair, daydreaming in a schlumpy outfit. But the book's contents are downright frightening. Even its web site lists 67 potential symptoms or concerns of pregnancy. Sixty-seven!! For crying out loud. And the book's index is even more of a fright. Pregnancy is work enough; women don't need to be haunted by the names of rare genetic diseases with a 0.02% chance of occurrence.

A better option for pregnancy advice? The Thinking Woman's Guide to a Better Birth, by Henci Goer. The Thinking Woman's Guide focuses on evidence-based obstetrics and midwifery care. Evidence-based medicine is something President Obama keeps mentioning in his health-care reform talks. What to Expect reinforces our culture's distrust of the female body, assuming that the baby and mom are not healthy until proven otherwise, which encourages women to take every (expensive) prenatal test available "just in case." Midwifery--and just about every other pregnancy title out there--takes a more optimistic approach, recommending tests only if symptoms warrant.

A cesarean section--which fearful women can request without medical reason--costs up to $20,000. My kids' homebirths cost about $3,000 each--and included house calls for a week afterwards to check on the babies' growth.

Here are some dizzying stats, according to childbirth.org: "The Public Health Citizen's Research Group estimates that over one-half the cesareans performed in 1987 were unnecessary and resulted in 25,000 serious infections, 1.1 million extra hospital days and a cost of over $1 billion."

Seems to me that's a billion dollars that could be better spent on preventive care, or put toward caring for the under- or uninsured.

The Power of a Misleading Headline

Meow, I'm going to get catty here.

You'd think that yesterday was a slow news day or something. I guess the report on how the H1N1 (swine) flu virus resembles the 1918 Spanish flu virus wasn't significant enough to warrant much coverage or analysis (that may be the topic of another blog post!). You see, this headline hit the top of Yahoo's Most Popular page, and prompted more than 20,000 people to e-mail it to a friend:

Cats Do Control Humans, Study Finds

Twenty thousand people--a small town's worth!--were intrigued enough by this story to pass it on. The header sure makes it sound like the basis for a sci-fi movie, doesn't it? Personally, it made me envision a bunch of zombie-like people under a spell, shuffling to the grocery store for fresh salmon, per the request of their anthropomorphic felines, who greeted them upon their return with a "Mrrrow. What took you so long?" (Ok, watching Michael Jackson's "Thriller" video may have influenced my imagination a bit. But still.)

The headline nagged at me. The story sounded vaguely familiar. Hmm, I thought, thinking of how I had noticed at work just the day before that another study had come out about cat/human interactions. But that one had the much more mundane headline of "How Cats Get Food Bowl Filled." Zzzzz.

Could it be a coincidence that there was yet another story out on cat research so soon? Or, were they the same story, but with dramatically different headlines--one of which that was written to "pimp for clicks," or grab the attention of readers, despite not being very newsworthy?

Sadly, the latter was the case. The Yahoo headline sure souped up the story to sound more interesting than it really was. The research, published in Current Biology, essentially stated that cats change the tone of their purrs or meows to communicate different needs.

In a purr-fect world, news outlets would pay more attention to news that truly affects people, and not waste the public's time with overwrought headlines for stories on inconsequential topics.

Photo of kitten by Ian Britton, courtesy of freefoto.com.

Psst, Hey, Buddy, How Much for a Blog Post?

The New York Times reports this week on payola and product reviews on blog posts. While not entirely shocking, it discusses how some more popular bloggers, such as Colleen Padilla of classhymommy.com, are sent free products from companies hoping for positive reviews. "If she does not like a product, she simply doesn't post anything about it," the times writes of Padilla, whose site receives 60,000 visitors a month.

So... ClassyMommy doesn't give its readers the full picture. Sure, the Web site is helpful to parents, but it's sort of lying by omission, no? If a product doesn't pass muster, why is that so? What about products that aren't safe, and therefore get panned? And do its readers know that Padilla's reviews of Healthy Choice TV dinners are essentially sponsorships?

The NYT goes on to explain that the Federal Trade Commission is investigating this pay-for-play arrangement in blogs nationally, citing that consumers have a write to know.

I agree; I'm of the school that says free food always tastes better. And I admit to reluctantly, if briefly, engaging in undisclosed pay-for-play myself, when I was a staff book reviewer for Amazon. The company was under enormous pressure to become profitable in those days, and a book publisher had the bright idea of asking to pay Amazon to prominently feature certain titles for a certain length of time--known as "cooperative marketing" in the book business.

We soon learned that just about EVERY book publisher was willing to fork over cash in exchange for a review and a placement on the site, with homepage placements at a premium, and spots on other book sections--such as health, which I covered--going for a few thousand less.

Amazon's marketing managers went along with the offer, but not without an uproar from the book reviewers. We countered that our readers' trust would be tarnished, that it was a penny wise and pound foolish approach to revenue generation.

In fact, one editor was so peeved, she faxed a reporter friend at the New York Times, who promptly wrote a page-1 story about the situation. The PR emergency that followed was a low point for many of us, career-wise, but the upshot was that management agreed to designate paid placements as such.

But one of the marketers who disagreed with this disclosure countered with this: The books that are so attractively arranged on tables in the aisles of Barnes & Noble are placed there through co-op marketing money as well. Same with the cereal that's on sale at the end of the grocery-store aisles. Shouldn't ALL stores disclose this to their customers? Or are the customers too happy to stumble upon titles and products that they like to care that they're essentially being advertised to, without their knowledge?

Photo of falling coins by Ian Britton, courtesy of freefoto.com.