Early in January, the California High Court banned emergency room doctors from directly billing insured patients, after their HMOs refused to pay their emergency medical care bills. The High Court has decided that doctors should not be allowed to take up the issue with patients if they believe they’ve been shortchanged by the patient’s HMO.

This new ruling affects around 21 million people, providing them with protection if they are treated by emergency room doctors who are not covered by their HMO plan.

The issue centers around a practice called balance billing. Sometimes, HMOs don’t cover the entirely of an emergency treatment bill, typically because the doctor used by the policy holder isn’t covered by the HMO’s plan. In these cases, the doctor concerned normally directly bills the patient who received the treatment.

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Universal healthcare could be useful in more ways than one. With more than half a million jobs lost in America in November (the biggest decline in a single month in more than thirty years), the country is in dire straights. Nearly 7% of the nation is wholly unemployed, and a total of 12.5% are either unemployed or barely working. That’s 19.3 million Americans who have little or no work.

The incoming administration is preparing a stimulus package to be introduced in the New Year, intended to get the economy ticking over again by investing billions in infrastructure. The package may include upgrading school buildings, upgrading public buildings to improve energy efficiency, building of bridges and roads, extending the reach of broadband internet, and improving electronic record keeping for medical billing.

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The medical breakthroughs that get reported in the media rarely end up being the miracle cures they’re often portrayed as. In 2008, however, there were several important advanced made in medical science that could have a significant impact on public health in years to come.

1. The question of whether organic food is good for you has finally been answered: A review of studies on nutrient content of organic fruits, vegetables, and grains has confirmed that these have up to 25% more nutrients than conventionally-grown produce.
2. Another long-held myth—about the efficacy of antibiotics for sinus infections—was also dispelled in 2008. Over the course of nine studies involving 2,500 participants, it was found that antibiotics didn’t significantly hasten recovery. According to allergist Neil L. Kao, MD, taking a decongestant or mucus thinner, along with a painkiller as needed, is just as beneficial.

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Off-label prescribing—the practice of prescribing medication for a condition for which it is not indicated or approved—is very common in America, particularly in the treatment of psychiatric disorders. In 2001, an estimated 21% of prescriptions for the 160 of the most commonly-used drugs were off-label.  And 75% of those off-label prescriptions were written for conditions for which there is absolutely no scientific evidence to prove they work!

The law doesn’t prevent this practice, although it does prevent pharmaceutical companies from promoting off-label prescribing. Often, there’s no real harm in off-labeling, but equally so, there’s even more often no scientific proof that those off-label drugs are doing you any good. The only evidence is what’s called anecdotal – evidence that has been noted by doctors, but there has been no scientific study carried out to provide hard proof.

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Nearly two million Americans have lost their jobs over the last year: around 500,000 in the last couple of months alone. That’s a staggering number of people who have lost their livelihood, perhaps their sole source of income.

Among their worries is the question of what’s going to happen to the healthcare their employers provided. Families with young children, in particular, may find the doctor’s bills piling up, with no healthcare insurance to cover them.

According to the Kaiser Family Foundation, every 1% increase in the unemployment figure translates into another 1.1 million people who don’t have healthcare insurance. The national unemployment rate was at 6.7% in November 2008 – an additional 7 million people without that crucial insurance.

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AARP (formerly the American Association of Retired Persons, but now known more commonly by its acronym) is a non-profit, non-government interest group which, according to its web site mission statement, is “dedicated to enhancing quality of life for all as we age,” by providing “a wide range of unique benefits, special products, and services for our members.” AARP acts as a member advocate, and is a powerful lobbying group. It also sells insurance, investment products, and endorses certain insurance companies.

Sounds good, yes? But by virtue of its habit of endorsing insurance companies, AARP has recently come under fire. The Kaiser Family Network recently revealed that AARP’s endorsements don’t come cheaply – 43% of the revenue the supposedly non-profit, independent advocacy group collected in 2007 came from royalties and fees the organization took from insurance companies – as payment for endorsements.

Doesn’t sound too much like consumer advocacy, does it.

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Physicians have recently come under fire as a result of a study which showed that half the doctors in America are in the habit of prescribing placebos – drugs which don’t actually do anything. They’re prescribed to patients to make them feel as though something is being done to help their condition. Often, people experience better health simply because they’re mind believes that the drug is helping their condition, when the drug actually has no physiological effects.

However, there is actually another concern about prescribing medications that is far more serious, and even has the potential to be harmful, not to mention needlessly expensive, even if you have a dedicated prescription drug health insurance plan; this is a habit many doctors have called off-label prescribing.

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For various reasons, the Western world has become increasingly reliant on medication to preserve health. It’s not uncommon for people to receive more and more prescriptions as they age: a full twenty percent of people over 65 take ten or more prescription medications regularly. So what’s the problem – those pills are helping you stay healthy, aren’t they?

The problem is, that’s not necessarily true.

An Avalanche of Prescriptions

Health care coverage for chronic diseases tends to shunt people off to multiple doctors – according to statistics from the Agency for Healthcare Research and Quality, 81% of people with a chronic condition see two or more doctors – more than half have three or more, and around a third have four or more.

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Prescription medications are expensive, and many doctors seem to become “prescription-happy.” These doctors’ first response to a patient complaint is usually to prescribe something new if something doesn’t work the first time. Even if you’re just taking one or two medications, you could be paying more than you need if you are taking brand name drugs, instead of generics.

According to a recent study, led by Dr. Aaron Kesselheim of Brigham and Women’s Hospital and Harvard Medical School in Boston, this is particularly true when it comes to medications prescribed for the treatment of heart and cardiovascular conditions. According to the researchers, there is no evidence to suggest that brand name drugs work any better than their generic counterparts.

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Surgery and a week-long hospital stay can equal a bill of tens of thousands of dollars. Even with insurance you can still end up paying several thousand in out-of-pocket expenses. Insurance companies typically negotiate with hospitals for lower bills – but most people don’t realize they can do that too.

Tips for Negotiating Health Care Bills

The first and most important step is simply asking. According to a survey from the Consumer Reports National Research Center, only 31% of Americans have tried to negotiate medical bills – but of those who did try, 93% were successful, and a full third saved over $100. When you apply this to the massive expense of a hospital stay, it could mean a very significant saving.

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