PUMPING IRONY: The Price Is Not Right

I count myself and My Lovely Wife among the fortunate seniors who don’t lose much sleep over the cost of healthcare. I wish I could say that our vast wealth insulates us from such distress, but that would be a gross exaggeration. For the better part of the past 40 years, we’ve simply done all we could to avoid conventional doctors.

We each cough up $170.10 every month for our Medicare Advantage plan, but we tend to view this simply as insurance against some catastrophic health disaster rather than a reason to regularly dip our toes into the murky waters of the American healthcare system. You’ll find no prescription drugs in our medicine cabinet or appointments for health screenings on our calendars. Annual physicals? Not so much.

Our aversion to conventional medicine means we’ve had to reach into our pockets over the years to pay the homeopaths, naturopaths, massage therapists, and acupuncturists who have provided services to us and our kids, but those costs are minuscule when compared with the bills we’ve received on those rare occasions when we were forced to seek out an MD. Last spring, for instance, I had to call an ambulance to dispatch MLW to a nearby emergency room when we couldn’t stanch her nosebleed. (She’d been taking double doses of turmeric for her bum knee and realized later the supplement also functioned as a blood thinner.) The damage on that occasion came to a few thousand bucks, offering us a glimpse of what most seniors deal with on a regular basis.

A couple of recent polls have brought this issue into sharper relief: According to the results of a survey released last week by Medicare Plans Patient Resource Center, a consulting agency for seniors, cost concerns are rising among the Medicare set because of the unprecedented 14.5 percent increase in Part B premiums that went into effect earlier this year. Surveying 1,250 recipients, pollsters found that one in five Medicare beneficiaries spend half of their monthly income on healthcare premiums, deductions, and prescription drugs. That explains why about six in 10 said they would have difficulty paying for healthcare services in 2022. And about half of the respondents said they would likely be forced to forgo some treatment because of its cost.

A broader survey by Gallup-West Health Institute, published in December, reported that nearly a third (30 percent) of Americans polled said they had skipped needed medical care in the previous three months because of the cost. And a little more than half (51 percent) of the respondents said the cost of healthcare adds stress to their lives.

“Americans have reached their breaking point,” says West Health CEO Shelley Lyford. “Between March and October, the percentage of people reporting trouble paying for healthcare, skipping treatments, and not filling their prescriptions spiked to their highest levels since the pandemic began, exacerbating another public-health threat born out of cost rather than illness.”

The mechanism behind these rising costs is all too familiar to practitioners but mostly hidden from their patients. Despite a lot of talk from policymakers about promoting high-value care, healthcare companies understand that it’s volume rather than value that generates revenue. That’s why some 80 percent of primary-care physicians are paid based on the number of procedures they perform; among specialists, that number rises to more than 90 percent.

That’s what RAND Corporation researchers discovered after analyzing the payment structures for practitioners at 31 physician organizations affiliated with 22 health systems. The results were published in JAMA Health Forum.

“Despite growth in value-based programs and the need to improve value in healthcare, physician compensation arrangements in health systems do not currently emphasize value,” notes lead study author Rachel Reid, MD. “The payment systems that are most often in place are designed to maximize health-system revenue by incentivizing providers within the system to deliver more services.”

Meanwhile, those practitioners who advise their patients struggling with chronic conditions how to manage their illnesses with diet, exercise, stress management, and other lifestyle approaches regularly find themselves penalized by insurance companies. A survey of 1,286 practitioners conducted last fall by the American College of Lifestyle Medicine found that only one in five (18 percent) were reimbursed for all their services. About one in four (27 percent) reported some payments, and more than half (55 percent) said they’d never been paid.

The message to these practitioners from the insurance industry was pretty clear: Ramp up the invasive procedures. A diet-focused weight-management program, for example, was not covered, while the insurer approved a pricier surgical procedure to achieve the same goal. Several practitioners reported receiving warning letters from insurers after lifestyle-based programs had allowed their patients to wean themselves from prescription drugs.

All this despite a growing consensus that chronic ailments are best managed — and often resolved — through lifestyle changes. “If optimal health outcomes are truly the goal,” says study coauthor Kelly Freeman, MSN, “more resources are needed to best illuminate the most impactful types of lifestyle interventions and how to successfully implement them in a sustainable manner.”

Nearly nine out of 10 U.S. seniors struggle with some chronic illness, so you’d think healthcare policymakers would want to encourage insurers, clinics, and practitioners to recommend more cost-effective treatment protocols when advising these patients. And you’d think those patients would be clamoring for this sort of high-value care. But healthcare companies need to protect their bottom lines and, to be fair, plenty of seniors would rather take a pill or submit to surgery (and complain about the costs later) than clean up their diet, ramp up their exercise, or start meditating.

There’s no way of predicting, of course, whether our continued aversion to conventional medicine will serve MLW and me as well in the years to come as it has in the past. We were certainly grateful for our local clinic when it came time for COVID vaccinations, and we’re hardly sanguine about the potential of serious acute health issues arising down the road. But the salutary effects of our four-decade embrace of alternative medicine do influence our thinking.

When we each received notices the other day from the clinic we joined last fall encouraging us to schedule an annual physical exam, we convened at the dining-room table to discuss the invitation. It was, admittedly, a brief discussion, primarily focused on the likelihood of spending 10 minutes deflecting every suggestion volleyed at us from an overworked and well-intentioned physician. In the end, we just looked at each other and grimaced: “Nah.”

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