'Nother Healthcare topic: where we spend our dough

[Scanner]

1.- Why is healthcare free in Canada and not here

Nothing is free.

2.- Why isnt alternative medicine covered by insurance but drugs are?

I'll answer that more later as that's more my line of work (not that I am necessarily right, just have perspective) - it's a complicated answer - it's not just a "conspiracy", b/c a lot of alt. treatments just don't have proven research, but it is also partially economic and political.

I'll enjoy answering that one later.

[disneysteve]

Other questions
1.- Why is healthcare free in Canada and not here
2.- Why isnt alternative medicine covered by insurance but drugs are?

1. Healthcare isn't free at all in Canada. It is paid for by taxes.

2. As Scanner points out, most alternative medicine methods don't have any good evidence that they work (and many of them don't). No insurance company or government agency is going to pay for things based on testimonials and placebo effect.

[Radiance]

For when you come back.:

Consider my doctor, he is an N.D., not a an M.D.
N.D. Naturopathic Doctor.

A doctor nonetheless, he went to school and he heals people, he has a practice. So, I believe he should be included as a provider for my insurance.

SOME insurances cover a certain amounts of visits to acupucnturists a year, maybe it is starting to happen. ????

I think we should start calling our insurance companies and asking them to include such coverage.

My insurance covered my midwife and they paid a total amount of 4300 for all my pre natal visits, ultrasounds and the delivery!!!! Talk about savings and frugal healcare!

I don't want to imagine how much their bill would have been if I didn't switch from a 'regular' doctor/hospital to my midwife/my house.
I understand not everybody wants to do what I did, but having the option at least was great. I paid 200 deductible, one payment.

[Radiance]

P.S. most of my co workers have started to switch from their insurance covered doctors to my out of pocket naturopathic providers because they are sick and tired to be the doctors ginea pigs trying one drug after the other, feeling crappy and taking forever to heal. Plus they don't know what it is so it must be a "viral infection" and/or "stress", right?
1-2 visits top to a naturopathic, bam! they feel considerable better...yes, the herbs taste nasty and the accupunture needles sting a bit.... boo hooo
$85 a vist, 7-12 for the meds, unlimited phone consultations and incredible service. The most you wait at holistic places is 20 minutes when they are booked and late!

[disneysteve]

Radiance, the problem is confusing testimonials with scientific evidence. Just because someone likes the provider and "feels" better doesn't actually mean anything. I have many patients who refuse to take "drugs" but happily spend a fortune on herbs, vitamins and other supplements to "treat" the same condition. I can prove definitively, through blood work, that they're condition has not gotten any better but they still insist on "treating" it with "natural" substances.

If and when these "natural" remedies are clinically proven to work, I have no doubt that they will be incorporated into mainstream medicine. There are already numerous examples of this happening over the years. Several current prescription products started as natural remedies. They were purified and refined and standardized and extensively tested to reach their current form.

[elessar78]

Would you want to run an insurance company where you weren't a customer for years, then. . .all of the sudden you say,

"I'd like to sign up now. . .I have cancer."

Actually, in NJ, they can do that. And we have one of the highest costs areound (although the premium quote didn't seem that bad). In NJ, I think we are a "community-based" state and you can go out, be Magic Johnson and sleep with 1000 women, contract HIV, and then sign up for insurance.

I"ll admit I am one to villify ins. co.'s a lot but that doens't seem fair.

So you think that a person that gets cancer while they are in between insurance coverages just be left without medical treatment? Not all disease/illness is caused by "bad living" as illustrated in your Magic Johnson example.

I think this is why there needs to be a non-profit entity (better than medicare or medicaid) that will take care of people without insurance. It's not just the lazy and unemployed that don't have insurance.

[Scanner]

Wow. . .it's so complicated - DisneySteve is right and I must say, echoing (maybe parroting, not to be mean) the insurance industry's position on alternative healthcare.

The problem is much of what allopathy does isn't evidence based either - performing back surgery as a treatment for back pain, giving antibiotics for childhood ear infections and treating depression as the ever mysterious "chemical imbalance" (never can quite get them to nail a definition down on that - just that they are "imbalanced"). I am NOT criticizing these practices necessarily to defend alt. med.; I do think some amount of deference should be given to non-evidence based practices and let the doctor "experiment" a little.

Just showing there is a double standard there for sure that Radiance is speaking of. . .alt. med providers are supposed to be 100% up to snuff but traditional med. gets excused. . .but again, it's complicated. We are reaching the point that a lot of alt. providers dont' want insurance coverage and would rather mimic dentristry which resisted that movement. And it may make more sense to just "self-insure" things like chiropractic, massage and acupuncture.

I hope to talk (and hopefully not prattle on) more later.

[Scanner]

Elessar:

No, I was just saying it seems rather unfair to get cancer and expect to "sign up" for insurance.

Again, if you want to open up an insurance company that does that, be my guest. I may even sign up.

Don't expect me to invest though.

[geojen]

You can do everything right in this country. Have insurance and pay your premiums faithfully for years. Then, when you get sick and need the insurance, they rescind your policy and you are screwed. Nice system.

[EEinNJ]

As much as I would like to see health care and insurance be affordable, especially to individuals and small business, I have a hard time believing the Federal government can do anything but regulate it, without making it worse. Whatever legislation passes, if it doesn't get squashed, is sure to benefit insurance companies, drug companies, doctors and hospitals much more than the increasingly poor consumer.

NJ tried to reform health insurance under Florio in 1993. We ended up with higher costs, fewer choices, and insurers leaving the state.

My small company's insurer, Cigna, raised our rates 40% last year. When my wife obtained coverage elsewhere and I tried to cancel her coverage, they screwed up and dropped both of us, they eventually reinstated me but refused to pro-rate the monthly premium for either of us and took weeks to refund the up-front premium they extort.

Recently I contracted Lyme disease (nasty virus from tick bite). My previous doctor didn't take my insurance, so I called my wife's. The RECEPTIONIST tells me I need a blood test first (oh, and the doctor is not accepting new patients anyway, and is going on vacation besides!). Fortunately I already had antibiotics to take, and I went to a new doctor after that.

My point is, things don't work so well even for someone trying to do the right thing.

[Radiance]

Radiance, the problem is confusing testimonials with scientific evidence. Just because someone likes the provider and "feels" better doesn't actually mean anything.

Well, I didnt stick with my provider because I like him, I stick with him and help him promote his business because he heals me faster and better than any other regular doctor I have ever visited.

Things are changing, many pediatricians go to regular medical school and then they complete holistic education to "offer the best of both worlds" and stay competitive. Moms are particualrly scared of side effects so I am not surprised it starts with pediatricians.

I eventually switch to a full blown naturopathic doctor for us because my previous "hybrid" pediatrician would surrender too soon and start recommending drugs. Again, immediate gratification is not equal long term health...But some moms might want their kids to feel better NOW, so if antihistaminics 'might' help, they want a prescription for that. I understand that, but not what I would do.

I have many patients who refuse to take "drugs" but happily spend a fortune on herbs, vitamins and other supplements to "treat" the same condition.

I've never heard of something like that, quite the opposite, I have a lot of friends and family sticking to drugs and added prescriptions for years... What is it? trying the same thing and expecting a different result,.... insanity!

Most 'regular' doctors are not very knoledgeable about alternative therapies, but are fast to attack them. They will not even read studies about them, but have plenty of documentation against them, at hands reach.

[disneysteve]

Most 'regular' doctors are not very knoledgeable about alternative therapies, but are fast to attack them. They will not even read studies about them, but have plenty of documentation against them, at hands reach.

The problems with the alternative therapy studies that I have read are that they are often poorly designed studies. They often consist of a low number of patients, too few to draw any general conclusions from. They often don't have a placebo control group, making the results essentially worthless. And they often don't control for variables among the patients in the study.

As a "regular" doctor, I'd love to see some good, hard clinical evidence that certain herbs or minerals or vitamins are safe and effective at treating some particular condition. I'd like to know how to choose the appropriate patients for therapy. I'd like to know what the safe and effective dosage is for the product. And I'd like to know what the contraindications and potential interactions are with the product. Today, we simply don't have that type of data on these alternative therapies. Hopefully we will someday and we can incorporate the ones found to be safe and effective into our routine treatment methods.

[Scanner]

Okay, as to why alternative medicine isn't covered. I'll speak as a chiropractor, who has a unique perspective on this. On one hand, we are sort of alternative and sort of mainstream, with one foot in each camp. What I mean by sort of is we can order tests like a doctor, are responsible for a diagnosis, and can do anything that isn't surgical/pharmaceutical in intervention. But that's a big but. . .because why we aren't mainstream is that many DC's, like ND's, think about the body differently, almost cybernetically. And while I know DisneySteve is open to referrals to DC's as a family doc. . .we still have rabid opponents in mainstream medicine, especially orthopedists. We have hospital privledges in many states (in NJ a couple) but we aren't exactly welcome at orthopedic conventions, lol.

We are like 2-face in Batman.

Anyway, we are so mainstreamed now. . .everyone and their sister goes to a chiropractor. A lot of plans do cover it. . .so is it really alternative anymore? A case could be made either way.

Anyway. . .why it isn't alt. med covered. . .in no particular order:

1. Political
If you look who are the medical directors of insurance companies, you'll usually see a MD presiding over it. MD's are direct competitors (in a sense) to alternative medicine so there is little incentive for taking a huge pool of money and earmarking for alt. med.

Also, alt. med groups tend to be weaker politically in lobbying for more inclusion.

2. Economic
This is two parts. As I mentioned before, often the cost of administering alt. med benefits exceeds what the benefit is. Let's say the average person used an acupuncturist 7X at $80/session. That's $560. It may actually cost the employer $500 to administrate it. Therefore, it's just not worth it. IN other words, $560 is not a catastrophic loss to anyone. YOu stand to lose more on a travel vacation.

Also, like I mentioned because ins. co.'s have dickered down many of alt. meds fees, they are becoming less incentivized to participate. We talk about it all the time. . .it's like being the frog in the pot and you slowly get boiled to death when you take insurance and participate with all of them. Probably 50% of my colleagues want to exit insurance at this time but like MD's/DO's aren't exactly sure how sometimes. But many are sucessfully making the leap.

3. Scientific
Like DisneySteve notes, there isn't a lot of evidence behind many alternative procedures. It's only fair that insurance draw the line somewhere. WE cover chiropractic, sometimes acupuncture, sometimes massage. . .then what? Faith healing?

I am not even poo-pooing faith healing per se. . .but the ins. co. has a duty to be responsible fidiciuaries of the monies and they can't just dole it out in a willy-nilly manner.

However, the problem for that, let's say for degenerative disc disease, you have Celebrex as a first line defense based on evidence. What if that fails? HOw about a chiro. adjustment 2x/month? No evidence that will work. That's "maintenance" and "maintenance isn't covered due to lack of evidence." Truth is little evidence anything will work (traditional or alternative). So what do we do? Throw eggs at the patient? I Don't know.

Now. . .I do think there is a compromise to be had here? Yes, I do.

Personally, I think there are some things in healthcare that can be "commoditized" - lab, x-ray, drugs, even some treatments. What I don't think should be "commoditized" are "doctor visits" where evaluation, managemetn and opinions are offered.

If Radiance likes her ND, so and so likes her DC, DisneySteve likes his DO. . .I think there should be a $1000/year benefit to be deployed how the patient likes and . . .and that $1000 should be used up. Fostering relationships with a trusted provider, whatever degree that is, is something I think needs deregulating and de-commoditizing. . .and really just regulating interventions.

I see nothing wrong with a naturopath giving health advice and management to Radiance's problems. . .I think it's only the prescribed interventions that need regulating and of course realizing that a ND may not be the best diagnostician (an internist or family doc is).

Unfortunately, in our economy, the opposite happens - we eshew evaluation and management and coaching and reward intervention.

Those are my thoughts/opinions in a nutshell. I do think we are very weird right now with alt. med. Everyone up on the Hill is crying, "We want alternatives. We need something different." and when alt. med groups present something, they say, "Oh, no we couldn't do that. Can't medicine just be cheaper?"

No, it can't.

[disneysteve]

Anyway, we are so mainstreamed now. . .everyone and their sister goes to a chiropractor. A lot of plans do cover it. . .so is it really alternative anymore?

I think there should be a $1000/year benefit to be deployed how the patient likes and . . .and that $1000 should be used up.

I, for one, have never liked the term "alternative" medicine because I think it implies that you are doing something instead of traditional medicine. I much prefer the term "complementary" medicine because that implies, more accurately, that you are doing something along with traditional treatment. My patients who see a chiropractor still see me for prescription anti-inflammatories, muscle relaxers and pain relievers. The chiropractor is part of the treatment, not the sole treatment.

As for the $1,000/year idea, I'm wondering. Can HSA money be used for complementary medical practices?

[Seeker]

Regarding comparing health insurance to auto insurance, that's a faulty comparison as I've often stated. My auto insurance doesn't pay for routine maintenance, wear and tear, preventative service... It pays for catastrophic events only. We expect and demand, however, that health insurance pay for everything from an annual physical (routine maintenance) to arthritis (wear and tear) to a mammogram (preventative service) and all the catastrophic stuff, as well.

And try getting auto insurance with a few traffic violations or accidents on your record. Many insurers will deny you coverage and the ones that will accept you will charge you an arm and a leg for the privilege.

As for people being the same around the world, that just isn't true. The obesity rate in this country is the highest (or among the highest) in the world. We eat more, we're less active and we're more abusive to our bodies in general. As a result, we have more heart disease, more cancer, more strokes, more diabetes, etc. So the situation in the US is different than in most other developed countries.

The World Today - Obesity rates on rise
Obesity Rates Continue to Rise

It's around the world; yes, US is probably highest, but it's not isolated to this country.

Times have changed, and people have changed, not always for the better.

Obesity is not only caused by laziness, and eating more.... part of the problem (a major part of the problem), is that absolutely everything we eat is toxic to one extent or another.

Fish/mercury, chicken/hormones, fruits&veggies are grown with chemicals to prevent infestation. Water is not clean, and floride is an additive that protects our teeth, but may be harmful to the body. The air we breathe is not pure. Our world is not what it used to be.

Unless you eat 100% organic, stay away from meats, stay away from processed, and filter all your water (and do not place in plastic bottles), you body is actually growing bigger with trying to fight off these contaminants.

This is why the problem is around the world.

As far as auto versus heath insurance, it's the exact same point i'm trying to make. Those that have heath problems have to pay much more for any kind of coverage; IF they can get that coverage.

Not 100% of health problems are caused by us ourselves. I just yesterday read about a seemingly healthy college student, no insurance, just not feeling well, being diagnosed with leukemia. Great. Where does he go from here? What choices does he have for the future, even if they can get into remission? That history will stay with him.... how will he attain any coverage later on in his lifetime?