Why We Need to Preserve Medicare

Over the last few months I've experienced a few issues with my "cognitive" abilities. To be blunt, I have started to forget things. That is, my short term memory isn't working as well as it used to. There was a time when I could remember telephone numbers almost instantly (I used to brag I carried my Rolodex around in my head) but lately I have had to start documenting every appointment or engagement or I would forget them (thanks to my cell phone's calendar feature that didn't prove to be too much of an issue -- unless I entered the wrong date).

More disturbing is my inability to recall long term memories. I found in conversations with family and friends that when they mentioned something important that had happened to me I often discovered I had no recollection of the event they mentioned, or my recollection was sketchy, lacked many details and often was at odds with theirs.

I also struggle to concentrate or focus on anything involving intellectual effort, and have difficulty remembering words or phrases that had previously always been at the tip of my tongue. My vocabulary was shrinking and this is embarrassing to me (though online dictionaries and thesauruses are a godsend in this respect when I write), a former lawyer who graduated 4th in my law school class and practiced law at a high level until my auto-immune disorder forced me into an early retirement.

Reluctantly, I finally informed my primary care physician and he ordered and MRI (Magnetic Resonance Imaging) scan of my brain. Usually the insurance we have doesn't approve payment for an MRI for most problems (preferring to pay for regular x-rays or CT scans) but I guess when you exhibit signs of cognitive difficulties they bite the bullet and approve payment. Fortunately, my insurance covers 80% of approved procedures (after we meet our yearly family deductible of $2,800, which we have done). I suspect he ordered the exam to see if I have any signs of a brain disorder such as early onset Alzheimer's Disease, or from structural damage resulting from the four serious concussions I have suffered in my lifetime in which I lost consciousness and suffered retrograde amnesia.

The MRI exam itself is not much to speak of, unless you suffer from claustrophobia, which I do not. It lasted about an hour (they did scans with and without contrast dye) and I just closed my eyes and meditated. An MRI machine makes a variety of loud, atonal sounds. The technicians give you ear plugs which are moderately helpful, but after a while I just pretended that I was listening to an atonal symphony by Schoenberg.

As I said, there's nothing much to the procedure but the cost. MRI exams cost far more than most medical imaging procedures. Only a Positron Emission Tomography or PET scan is comparable in cost. Here's a a chart giving various price ranges for MRI scans across the country:

 

Testing Facility Location Price
Orlando, FL $2,229
Dallas, TX - MRI Testing Facility A $3,624
Dallas, TX - MRI Testing Facility B $2,172
San Diego, CA $2,826
Salt Lake City, UT $1,694
Detroit, MI $3,461
New York, NY - MRI Testing Facility A $1,785
New York, NY - MRI Testing Facility B $2,199
Raleigh, NC $3,001
Omaha, NE $2,502

So these are not cheap exams. However they can be terribly important for certain people especially those who may have undetected cancers. Christina Applegate went on CNN last year to extol the benefits of her MRI exam, one which she claimed saved her life:

 

Breast cancer survivor, and mother-to-be, Christina Applegate sat down with CNN’s Chief Medical Correspondent, Dr. Sanjay Gupta, to discuss her battle against cancer and how early detection may have saved her life. Applegate’s foundation, Right Action for Women, provides advanced screening and genetic testing to women at high risk for breast Cancer.

DR. SANJAY GUPTA: If you hadn’t received the MRI at that point, do you have any idea what would have happened to you?

CHRISTINA APPLEGATE: They probably would have found the cancer on my next mammogram a year later, where it would have been a much bigger tumor, and could have been a much worse scenario. So, it saved my life. It would have been a whole other year before I went in again for my next mammogram.

GUPTA: Most women, as you said, don’t know about MRIs with respect to screening for breast cancer.

APPLEGATE: Well it’s not talked about and I also think that you know, there’s also been a lot of talk that there’s all these false positives with MRIs but there are false positives with any kind of screening. Same with mammography – there is also a lot of false positives. They are not perfect science, unfortunately. But they’re learning more and more now that it’s, it’s an incredible way to screen for early detection.

GUPTA: One of the things I hear all the time as a doctor is that you doctors order too many tests – you’re ordering tests for everything. What do you say to people who say look we’re a culture of over-testing as it is?

APPLEGATE: Well, it’s just a really good test. I mean, I can’t stress enough, it saved my life. There’s no if, and, or but about it. I had just had a mammogram. There was nothing on it. This [breast cancer] was something that if found at a stage that was curable, instead of at a stage where it’s not. I don’t care what anyone says about that – I know that to be the truth.I also unfortunately know that, you know, the MRI screenings are incredibly expensive and a lot of insurance companies don’t cover that – um, which is why I started my foundation, because it just really – it’d upset me so much that, you know, these women were opting to not have this really valuable screening, because of money, and because we’re not taking care of these women who are high risk. So that’s um, one of the things that really got me when I was going through all of this.

GUPTA: Should insurance companies be hearing what you have to say, I mean, ultimately?

APPLEGATE: Absolutely. This should be a part of it. You know, I mean, we, you know, MRIs should be in tandem with mammography – that’s just what I truly believe. But until then, with right action for women, we’re going to provide financial aid to these women. Um, we’re also going to have, you know, education on women who have the genetic mutation, and what they’re options are. At that point, we’ve assembled an incredible group of doctors and nutritionists, and what not, who are on there to kind of guide everyone through the process.

And there's the rub. People with insurance may not have an MRI scan approved when it is appropriate because their health care insurance will not approve payment for it. And then, there are many people without insurance, employed or unemployed, who simply can't afford the cost of an MRI. Do a Google search with the terms "Can't afford cost MRI" and you will find many links to forums and patients discussing the financial difficulty they have paying for an MRI even when their doctor says they should have one. And this is the case with many expensive procedures that might detect a potentially fatal disease but for which the patient can't pay the cost.

Indeed, The New York Times ran an article last March authored by a physician about how the cost of these procedures and the failure of insurance companies to pay for them when ordered, or the fact that a patient is uninsured, is affecting patient care and the doctor patient relationship:

 

... I met a woman, a freelance photographer in her early 40s. She ... began asking me questions related to her own health. When she showed me a picture of herself ... I realized why. This gaunt woman had lost almost 20 pounds in the month since the photo had been taken and, despite efforts to stop the weight loss, was still losing more.

I urged her to see a specialist to undergo testing, perhaps even a colonoscopy; but she brushed aside my suggestions, preferring instead to ask for my professional opinion on foods that might help her gain weight and treatments she could obtain over the counter.

... The woman had no health insurance. Even if she wanted to follow my advice, she couldn’t afford it. [...]

“The doctor may say, ‘Here are your prescriptions, and make sure you get the M.R.I.,' ” said Dr. Cary P. Gross, another of the rally’s organizers and an associate professor of medicine at the Yale School of Medicine. “But the patient is thinking, ‘I can’t get all of these medications, and I can’t afford the M.R.I.’ ”

These limitations become the silent and discomforting third party in every clinical interaction. Patients may hesitate to divulge which recommendations they have eschewed because of cost concerns; doctors may feel trapped into giving suboptimal care because of insurance limitations; and both may feel uneasy bringing up the subject of money. [...]

Nonetheless, as I watched President Obama sign the health care bill last Tuesday, I remembered the woman from the wedding. And I remembered the far too many patients from my past who stopped or cut back on medications because they couldn’t afford them, who had to be discharged early from the hospital because their insurance wouldn’t cover longer stays, or who struggled — and died from — chronic diseases because they had no health insurance.

The health care reform bill that was signed by the President last year is far from perfect. However, eventually it will provide health insurance for most people. It prevents insurance companies from excluding pre-existing conditions when you change your insurance for whatever reason. It must be protected.

Yet even this modicum of reform is threatened by Republicans in the House and Senate. They ran on repealing the health care reform act and the House Republicans voted to repeal health care reform. House Republicans also plan to attack various individual elements of the health care reform act, such as their plan to eliminate funding for state run insurance exchanges that would provide competition to existing insurance companies that now hold a virtual monopoly on heal care coverage in most communities:

 

Republicans in the U.S. Congress are launching a fresh attack on the healthcare law by targeting grants to states for creating insurance exchanges, just as congressional budget analysts said on Thursday setting up the marketplaces may be delayed.

Next week, the U.S. House of Representatives is expected to take up a bill that would repeal funding for $1.9 billion in grants for establishing exchanges where individuals can purchase health insurance. [...]

The Republican-controlled House voted to repeal the law this year. But with Senate Democrats standing in the way of full repeal, House Republicans are now working on bills to try to undo the law bit by bit.

Two weeks ago, the House passed a bill that would yank money for a prevention and public health fund. A bill repealing grants for operating school-based health centers also could come to the House floor as early as next week.

The CBO, which estimates the costs of legislation, said blocking state grants for exchanges would reduce the U.S. deficit by about $14 billion from 2012 through 2021.

Rescinding the funds, though, would not eliminate the exchanges. Instead, it would shift much of the responsibility for creating the marketplaces to the federal government, which could in turn push up U.S. costs, CBO said, although it did not estimate the size of those obligations.

Even worse, under the budget proposal by Rep. Paul Ryan (R), they voted to eliminate Medicare for everyone under the age of 55, and turn it into a "voucher program" where you will be given a modest sum with which buy your own health insurance when you reach the retirement age. Health insurance that I guarantee will be worthless since without an exclusion for pre-existing conditions, or group rates, most people won't be able to afford health insurance that would come close to adequately covering the medical problems that the majority of seniors face.

I can afford the 20% cost of the MRI I had today. But if Republicans have their way, in the future I won't be able to obtain insurance that would cover any procedure that might detect potentially fatal illnesses that would prolong my life. Not unless I win the lottery that is.

There's been a lot of "meta" blog posts at Dkos lately that have stated the case for or against approving of President Obama. Frankly I tend to avoid those diaries. Not that I don't have my opinions on Obama and his presidency (I do, and many of them are not favorable), but I find pie fights over whether Obama is a good or bad President essentially a waste of time. To use the President's own words, "We do not have time for this kind of silliness."

Obama will be the Democratic candidate for President. Any hope we have of resisting a Republican takeover of government and the outright elimination of health care reform and Medicare so wealthy people can receive more tax benefits and insurance companies can squeeze more money from people like me and most of you will require a massive effort on the part of all Democrats, those who like him and those who do not.

Otherwise, many will die early deaths and suffer great misery from chronic illnesses and diseases, deaths and suffering that only having a Democrat in the White House provides us with any hope to prevent.

I hope the results from my MRI are helpful, whatever they show. I also hope this won't be the last time I am allowed to have an MRI and other "expensive procedures" because my health care insurance won't approve payment for them, payment that I likely won't be able to afford to pay myself in the future if the Republicans succeed in their class warfare.

Booman Tribune / By Steven D.

Posted at April 29, 2011, 5:40am