Health Care for the Unemployed

Appended to a note about how much she enjoyed my book, a friend asks:

I'd be very interested in any thoughts you have about getting healthcare to the unemployed and uninsured. Do you have some?

If she means, "Do you have any thoughts about large structural changes in the delivery of health care that decouple it from employment and insurance status?" then the answer is yes. However in addition to being the topic of my next book, these thoughts by definition have no chance of actually helping any of the unemployed and uninsured -- two groups that frequently overlap, of course -- right this minute. If, on the other hand, she means "Do you have any thoughts about getting health care to the unemployed and uninsured this very minute?" then the answer is also yes. Furthermore, they fit into a blog post.

I'd like to make it clear at the outset that I'm not discussing primarily charity care. There are several local clinics and resources available that provide care at reduced rates. The thoughts I have are about making medical care more affordable by thinking outside the box and off the grid.

Medical Care

First, find a good family physician you can work with. By this I mean someone whose opinions and abilities you respect, and whose advice you will follow. The well-trained family doctor can care for 90% or more of the problems you may have, and can do so far more economically than the collection of specialists most people in this country have come to equate with "the best medical care in the world". You do not need an annual visit to a dermatologist/gynecologist/urologist/cardiologist to check your moles/pap/prostate/blood pressure, even though they may tell you that you do. This will also spare you from undergoing expensive, unnecessary testing: annual stress tests and echocardiograms do nothing for stable coronary disease; once you've had three normal annual paps, the frequency can be decreased to every 3-5 years; and so on.

Tell your family physician about your uninsured status. Plan to pay for your medical care, preferably at the time of service. Rates are often substantially less than you think they will be. My regular fees work out to about $200 per hour (ie, $50 for a 15-minute chronic care visit; $100 for a half-hour physical, etc.) Most doctors near me would probably charge about the same, or accept that amount upon negotiation.

Drugs

We are living in the golden age of generics. There are really surprisingly few patients who absolutely require expensive brand-name drugs. In addition to WalMart's $4 generics ($10 for 90 days), Target and Genuardis have almost identical lists. Many other pharmacy chains (Giant, Rite Aid, and others) will match prices, but you have to ask. Costco usually has the best prices. By law, you do not need to be a Costco member to use the pharmacy.

Labs

Laboratory studies are among the most overpriced components of medical care. The markups between what labs charge patients and their actual costs are truly sickening. I know this because their charge to me as a physician client is a fraction of the direct patient charge. By charging only a small markup for myself, patients end up paying less than half of what they would be charged by the lab. Additionally, there are assistance programs available. Then again, a qualified, thoughtful family physician (like me) will limit lab testing by doing only those tests absolutely necessary for appropriate diagnosis and treatment.

Imaging

There is a free-standing radiology center near me that offers fantastic service, and completely transparent pricing. If you call them up and say, "I don't have insurance. How much is a chest x-ray?" they will say "That will be $62." (Actually, a rep stopped by the other day and told me the price for a chest x-ray had actually decreased.) If you need to schedule an MRI, they will say, "Can you come over this afternoon?" Again, competent family physicians (like me) will only order imaging studies if they are absolutely necessary to diagnose and treat you appropriately.

Immunizations

Every county has a public health department that includes immunization clinics for adults and children. Some are free; some charge (VERY reasonable rates; I purchase vaccines and I know what they cost). Pride should not be an issue: this is not charity. You pay for it with your taxes. (Montgomery; Chester; others easily googled.)

(Hospital Care)

This could be a project for venture capital: a cash-only, insurance-free hospital with transparent pricing. In the meantime (apologies for continually tooting my own horn), a qualified family physician ought to be able to keep you out of the hospital, and especially the Emergency Department. Aside from major motor vehicle accidents and complex trauma, a good family doc can take care of many things for which you may think you need an ER. Call first.

Other Ways to Save Money on Health Care

I would be remiss if I did not include a discussion of things NOT to spend money on when funds for health care are limited.

Supplements & Vitamins

Stop purchasing and consuming assorted vitamins and supplements. Things like CoQ10, antioxidants of all descriptions, and substances purported to "support" any aspect of your health should be avoided completely. They are completely unnecessary for your physical health, and downright hazardous to your financial health. All essential nutrients are readily available in high-quality food. Use the money you save to increase your consumption of vegetables, fruits, and fish.

Most Over-the-Counter Medications

Stick to generic acetaminophen (Tylenol), ibuprofen (Advil, Motrin) and naproxen (Aleve) for pain and fever. Just about everything else is useless. Cold meds like decongestants, antihistamines, cough suppressants, etc. have been shown not to work in children under 4. Originally, they were banned under age 2. That age is going to keep creeping up until it is finally recognized that they don't do squat. Saline nose drops/sprays/neti pots work best for stuffy noses. Use plain honey for cough. (Locally produced honey can help with allergies, too.)

When you get sick, you really do need to rest, increase your fluid intake, and be patient; not "a patient" (noun), but "patient" (adjective). Wait it out at least a week. Almost all minor illnesses will be improving by then.

Avoid Chiropractors

Intelligent chiropractors recognize that they are providing a form of physical therapy. The ones who still believe there is a vital force flowing from your brain to your spinal cord and out to the rest of your body, and that all illness comes from spinal subluxations disrupting these vital forces, are dangerous pre-scientific quacks who are nevertheless persuasive and effective at separating you from your benjamins. Save your money.

Avoid "Alternative," "Complementary" and "Integrative" Medicine

The more accurate term for all these modalities is "quackery". Acupuncture, homeopathy, reiki, therapeutic touch, and all kinds of other so-called "CAM" practices are collections of pseudoscientific nonsense that have been well studied (with your tax dollars, thank you very much) and shown scientifically not to work. Their practitioners are compassionate and persuasive, but their ultimate interest is their pocketbook and not your health. When you win the lottery and have more money than you know what to do with, feel free to waste it as you please. But if you're unemployed, uninsured, and/or worried about how to pay for healthcare, it is unconscionable to throw your money away on these services.

Drop the Gym Membership

Get out and walk, either outside in fair weather or inside in foul. Thirty minutes a day, a little too fast to comfortably have a conversation if you happen to be walking with someone else, is all you need for metabolic fitness.

Quit Smoking

Now is the perfect time. Cold turkey is the most effective, as well as the cheapest way to go. At $5.00 per pack, one pack per day is $35/week, $150/month, $1,825/year. That should easily cover a year's worth of routine medical care out-of-pocket.

Quit/Cut Down on Drinking

Alcohol isn't cheap, and it isn't particularly good for you either. Decreasing or eliminating it will do you no harm at all. While on the subject of liquid refreshment, the latest nutritional recommendations for drinks for children are "nothing but milk and water." Given that soda and most fruit juices are nothing but sugar water packed with empty calories, that's pretty sound advice for adults too. "Water" means from the tap, by the way. Your taxes go to make sure that it's absolutely perfect. Bottled water is a waste of money.

Stay Healthy with the Basics

They're called "basic" for a reason:

• Get plenty of sleep
• Eat well
• Exercise regularly

Nothing sexy, exciting, or expensive about any of it.