However, as expensive as medical insurance is, it’s less costly that going without it. For the average uninsured person, it doesn’t take many trips to the emergency room to drive you to bankruptcy. A typical visit to the ER costs upwards of $1,000 dollars. And God forbid you need to be hospitalized. One week in the average hospital is going to cost you fifty grand. That’s a hell of a lot of rent and more than enough to wipe most of us out. It’s certainly enough to make you think twice before saying that you can’t afford major medical insurance. The truth is you can’t afford not to have it.

Of course, government programs going into effect over the next few years aim to reduce the cost of medical insurance for those with lower incomes, but don’t kid yourself: it’s still going to be expensive. Perhaps all the more so because the insurance companies will need to insure those who are in poor health, spreading the cost of coverage amongst all of us.

Perhaps the best argument for biting the bullet and getting medical insurance whether you can afford it or not, though, is that studies have shown that it increases your life expectancy. Perhaps this is blatantly obvious already, but that’s especially true if you have a life threatening condition.

One poignant example is Cystic Fibrosis patients. Those with medical insurance, who are able to receive the appropriate care when they need it, live an average of more than 20 years after they are diagnosed. Those without medical insurance live an average of about 6 years after diagnosis.

Of course, that’s only one medical condition. There are literally thousands of different things that can kill you which can be prevented, or at least significantly delayed, with proper medical care. So, even before it becomes mandatory for every US citizen to have medical insurance, you might want to consider looking at other areas you can cut back rather than your health budget.

Photo via Sam Howzit

Of course, for now, most of us in the United States have traditional medical insurance coverage. Of all points of the health care debate, there are few more hotly contested than who should have the right to determine what kinds of treatments we receive. As it is now, doctors, health care professionals, prescription drug companies and medical insurance actuaries all have a say in the matter.

So, in today’s system, what happens if our medical insurance says no to a treatment or medicine our physician recommends? Most people assume they’re simply screwed, but that’s not really the case. Here’s the best process to deal with being told no by your insurance company:

1. Contact your doctor. There may be alternate treatments which are as good or nearly so and are acceptable to your insurance company.

1. Contact your insurance company to file a grievance. If your doctor says there isn’t another treatment that will work for your case, get it in writing and submit your claim again, along with a grievance. Too many people simply accept no the first time. Your insurance company will do an internal review, and may reverse their earlier decision.

1. If they don’t, file an external grievance with your state’s governing body. Sometimes simply having this filed will get some favorable action on the insurance company’s part, as it isn’t in their best interests to deal with multiple grievances.

1. If that doesn’t work, consider contacting an attorney. Sometimes they can help, sometimes they can’t, but it’s worth a shot. This is your health we’re talking about, after all.

Not knowing, however, can cost you hundreds or even thousands of dollars. The fact that there are many types of medical insurance policies, and countless variations on each type of policy means you probably aren’t going to be able to sort it all out yourself unless you happen to be a licensed medical insurance agent, but there are some things you should look into before you need medical attention. Here are some of the basics, all of which should be detailed in your policy. If they aren’t, ask your benefits person or call the medical insurance company yourself:

• What is your insurance company’s policy concerning trips to the emergency room? Virtually all insurance companies will cover a trip to the ER if it’s obviously warranted, but different insurance companies have vastly different ideas of what does or does not justify a trip to the emergency room. The last thing you want is a bill from the hospital, as they are much more expensive than a doctor’s office visit. Incidentally, the last thing your insurance company wants is a bill from the ER for exactly the same reason.

• What is your insurance company’s policy concerning medical clinics? Most communities have walk in clinics which have much more amenable hours than traditional doctor’s offices. And if you happen to slice your hand open after five o’clock, you would think the insurance company would prefer you go there than the emergency room. Not always the case, as it turns out. It’s better to know before you need to go and better to give your insurance company a large ER bill than to get soaked with a smaller walk in clinic bill that you need to pay yourself.

• What is your medical insurance company’s policy regarding specialists, chiropractors, etc.? Some types of insurance allow you to see a specialist directly, others make you get a referral from your general practitioner.

• Which doctors can you choose from? Some insurance companies let you pick your own doctors, others restrict who they will pay for. Always know ahead of time which doctors your insurance company will cover when you visit.

Photo via farleyj

You might think it odd that medical insurance would come to mind, but think about it. If marijuana is an acceptable prescription for some ailments, how long will it be before insurance companies have to take a hard look at whether or not they will pay for it? And with new legislation on the way that promises to take medical decisions out of insurance companies’ hands and into doctors’, how long will it be before they’re required to pay for it?

Now make no mistake, we’re not suggesting that medical insurance companies shouldn’t pay for a guy’s weed if he can find a doctor to say that he needs it. If the law is implemented elsewhere like it is in Michigan, where users with prescriptions are expected to “grow your own,” the insurance companies will probably walk away a lot cheaper than paying for other less entertaining and more traditional medicines.

The plant reproduces itself, so they’d only have to pay for it once, at least in theory. We’re not sure what a pot plant is going for on the open market. Of course, that’s partly because pot plants aren’t sold on the open market. But it would have to be cheaper than some of the medications that are used to treat the same ailments.

Of course, it remains to be seen how federal law will affect the state’s laws. So far, the federal government seems to keep a mostly hands-off approach to the whole thing since California became the first state to legalize medical marijuana in 1996. But there’s no promise it will stay that way. It is still against federal law to possess MJ, and there’s no telling when the government will decide to enforce its laws.

So far fourteen states have legalized pot for those who can get a doctor’s script. Is it for the better or the worse? And will insurance eventually pay for it? If it does, I’ll betcha we have a sudden tragic outbreak of glaucoma.

Photo via r0bz

But who should be making our medical decisions. It’s easy to just say that we should be making the decisions between ourselves and our doctors. And ultimately, that’s what happens anyway. Medical insurance companies don’t ultimately decide what treatments you will or won’t receive. They just decide which ones they will or won’t pay for.

Of course, with the sky high costs of many medical services, the distinction can be paper thin at times. The fact that you can opt to pay for and receive any service you want doesn’t help the overwhelming majority of us. So, we should take the medical insurance companies out of the decision making loop, right?

On the surface that sounds like a great idea. The only problem with it is that you’d be killing the goose that laid the golden egg. If insurance companies accepted every medical suggestion out of hand, they couldn’t operate profitably. And insurance companies are not run entirely by pocket protector wearing bean counters with actuary tables. You’d better believe that medical insurance companies retain some of the finest medical minds in the country to advise them concerning which treatments they should and should not consider viable.

That’s not to say insurance companies always get it right. Usually, the one closest to the action makes the best call. With your health, that’s you and your doctor. But with that said, if insurance companies didn’t put some controls on what treatments they will accept and pay for, they would soon be bankrupt and unable to pay for anything for anyone.

Of course, in some countries, the government controls those kinds of decisions. There are arguments for and against that, to be sure. But ultimately, whether it’s a panel of bureaucrats or a panel of actuaries, at some point, bean counters somewhere are going to have their say about what will and what won’t be paid for. In the end, it comes down to picking your poison.

Photo via Eva Blue

It should go without saying by now that you need to be eating healthy. You need a good variety of healthy foods in your day to day diet. These should include lean meats and proteins, plenty of vegetables, lots of fruit, and probably a lot more whole grain than you’ve been eating.

So, what changes do we really need to make to our diets? Well, if you’re a typical American, you probably need to lay off the bacon and burger and eat more fish and chicken (grilled, not deep fried). You also need to stop counting potato chips as a vegetable and getting some good green and yellow veggies into your diet instead. And stock your house with fresh fruit for snacks instead of the high fat crackers, Twinkies, and other manufactured snacks that we already know aren’t very good for us.

Get up and get moving

We also know that we should be exercising every day, but studies show that most of us don’t. Would it really be that difficult for us to turn off one half hour television program and go for a walk instead? Too many of us hear the word exercise and immediately conjure up images of people grunting and working out in the gym. And, let’s face it, while the images of the potential results may appeal to us, most of us aren’t willing to work that hard. But, you don’t have to go to that extreme to benefit your health. A half hour of regular aerobic exercise (like walking or swimming) is enough to give us tremendous health benefits.

When you need a little help

Another thing we can do to improve our health and avoid some of those doctor’s visits is to supplement our diet with vitamins and minerals. Particularly antioxidants like Vitamin C. Studies show that increasing Vitamin C intake can help stave off common illnesses such as colds. Taken together with Vitamin E, the effects are even more pronounced. Consult your health or nutritional professional concerning what types of supplements and what amounts are best for you.

Living a healthy lifestyle, in the end, is not only more satisfying, but also less expensive than simply going to the doctor all of the time. Just because we have medical insurance doesn’t mean we need to create a lifestyle that demands that we use it all the time.

Photo via Denise Cross

Now, don’t go off on any conspiracy theories. Your doctor isn’t trying to keep you sick. The medical profession is highly regulated, and doing anything intentionally that would be detrimental to patients’ health is just not worth the risk. And even if it weren’t for the trouble they could get in, most doctors didn’t go to school for 12 years just to run a business.

Most of us look at doctors and see a group of people who have an enviable lifestyle. While it is true that they are among the higher paid professions in the country, they also generally put in much longer hours than other professionals. ER doctors often pull 24 hour shifts. Even doctors with a private office or clinic typically work a long work day. Additionally, doctors are expected to continue their education constantly, keeping abreast of the latest findings in the medical field. All told, the pay of an average doctor, after you take out their expenses, is less than $30 an hour.

Like any other business person, a doctor who runs an office has expenses. The building costs money, the employees (nurses, receptionists, billing) costs money, advertising costs money. Medical offices and clinics have all of the expenses of other businesses. And all of that says nothing of the high costs of malpractice insurance (another good reason for your doctor not to do anything detrimental to your health).

Most of us pay for our doctor’s services by way of medical insurance. Our insurance premiums come out of our paychecks, so that when you go to the doctor, you simply flash your shiny card, hand over a ten spot for a co pay and get the treatment you need. Voila!

For doctors, though, the billing system is a bit less convenient. First of all, different insurance companies will cover different things. Doctors have to keep that in mind when dealing with patients. Secondly, many insurance companies only pay out monthly or quarterly. So, the doctor may be several months waiting to be paid for the services rendered.

Doctors tend to receive a somewhat unfair share of the blame if something goes wrong in their work. The human body is complex, and diagnosing illnesses and treatments sometimes amounts to a bit of an educated guessing game. So, next time you go to the doctor and what she prescribes works. Consider going back anyway to say thanks. It’s entirely possible he hasn’t even been paid yet.

That’s not an easy question to answer yet. Many of the members of Congress who voted on the legislation admittedly haven’t read it thoroughly and it has yet to be seen how all of it will look once it’s implemented. Further complicating things is the fact that much of it won’t be implemented for several years.

The bottom line is that most of us don’t have all of the details yet, and the new policies will affect different people in different ways, depending on their circumstances. But here are a few effects that you can count on:

• If you have medical insurance, you probably won’t notice much change. There is some speculation that prices will rise, but they’ve been doing that anyway.

• Those who have been unable to receive insurance due to health issues will be able to get coverage.

• Much of the increasing cost of insurance (due to insurance companies paying more in claims) will be covered by business. Bear in mind, however, that businesses seldom simply swallow added costs, instead passing them along to their customers or finding other ways to cut costs.

• All Americans will be required to obtain insurance, with rather stiff penalties for refusing to do so. There will be subsidies in place for those with lower incomes, but it’s not clear yet where all of the cutoffs will be.

• Business owners, especially small business owners, will receive incentives to insure their employees. This obviously affects you if you own a small business, or are employed by one. The amount small business will be able to claim as deductions for employee health care will be increased significantly, the hope being that more small employers will be able to insure their workers.

However it turns out, there are two things that are fairly certain:

1. It doesn’t quite make health care affordable to everyone as many on the left would like to assert.

1. Nor is the end of the free world as we know it, as many on the right would have us believe. Life will go on. We just need to figure out how this will affect one small part of it.

Many people, and Americans especially, live grossly unhealthy lifestyles. We eat enormous portions of things we know aren’t good for us, and wonder why we are obese. Here’s term number one of your new policy, if you decide to take it out: cut down on how much you eat, especially the garbage.

Of course, eating right does take some effort. But, it doesn’t cost any more than what most of us are doing now. Sure, there might be an initial investment when we replace the myriad of unhealthy snacks and boxed and canned foods with fresh produce, but as a lifestyle, it doesn’t cost any more to eat healthy food than it does to eat junk.

Another thing we need to do if we want to take on a policy of living healthy is to start getting some exercise. And no, moving furniture to find the remote control doesn’t count. Get up and do something active every day. Whether you invest a half hour, an hour, or more, the key is to do it on a regular basis. There are countless ways you can exercise, ranging from simply taking a walk to joining a gym. It doesn’t matter what you do nearly as much as that you do.

On top of eating right and exercising, we need to consider eliminating or modifying risky behaviors. STDs are the biggest tragedy in this country, primarily because they are almost 100% preventable. No, we’re not suggesting you move into a monastery and abstain for the rest of your life. But chances are you already know how to be safe in that respect. If not, revisit 10^th grade health class or ask your doctor.

Other risky or unhealthy behaviors that eliminating could save us many hours individually, and millions of dollars as a society, possibly driving our medical insurance costs down include smoking and excessive use of alcohol and other drugs.

So regardless of what kind of insurance you have, even if you don’t have any, invest in yourself and your personal health by taking up the most important policy – the policy of making and following through on good decisions regarding your lifestyle.

Photo via greg westfall.

A quote from the author Augusten Burroughs reads, “When you have your health, you have everything. When you do not have your health, nothing else matters at all.” This adage certainly is true, as one cannot truly contribute to and enjoy life without health and a sense of well-being. The American healthcare system is already inherently complex, and legislation passed some months ago mandate sweeping changes that make it all the more so. To help people navigate the roiling seas of healthcare issues, health professionals and learned others who deal with or who have survived acute and chronic illnesses offer advice and support via blogs such as these:

1. The Health Care Blog: Information on health care administration.
2. Medical Breakthroughs: A gathering of medical breakthroughs, family health and issues important to women.
3. Medical News Today: Hourly updates on the medical field drawing from sources such as Lancet and the Journal of the American Medical Association.
4. Top Radiology News: Events and issues relative to medical imaging studies.
5. NeurologicaBlog: A blog written by a clinical neurologist at Yale University School of Medicine.
6. Firefighter/EMS Blogs: Blogs for first responders.
7. DB’s Medical Rants: A blog maintained by an internist who encourages reader interaction.
8. JeffreyMD.com: A doctor’s journey through medical school.
9. Healing Hospitals: Thoughts from a former health care administrator.
10. ER Stories: Real life tales from a practicing Emergency Room doctor.
11. Medical Tourism Blog: For those who plan to travel to get health care.
12. Medical Justice: Issues surrounding legislation and malpractice.
13. Medical Transcription Herald: Views of a medical transcriptionist on his field.
14. Life Sciences: World News from the biotechnology industry.
15. In the Pipeline: Thoughts from a professional from the pharmaceutical industry.
16. Alzheimer’s Reading Room: Facts and support for those who deal with this disease.
17. Aging Parents Insights: Help for adults for care of their aging parents.
18. Orbit Medical: News and information about mobility equipment.
19. IBS Tales: Living with irritable bowel syndrome.
20. MedGadget: Tracks emerging medical gadgets and technology.
21. Healism: Testimonials regarding medical tourism.
22. Stirrup Queens: A whimsical blog for women’s issues.
23. Diabetes Mine: Help for those with diabetes.
24. Clinical Cases and Images: Blog by a former professor of medicine.
25. Eye on the FDA: News from the world of new drugs.
26. Health Affairs: Healthcare policy thought and research.
27. Everything Health: Blog by a Chief Medical Officer at a California Hospital.
28. Nursing Home Surveyor: Things to be aware of as one considers a nursing home.
29. Notes of an Anesthesioboist: Blog of a wife and mother who is a doctor also.
30. Mothers in Medicine: Thoughts from those who double as mother and physician.
31. Rural Doctoring: Musings of a doctor who chose to practice in a less crowded area.
32. Scanman’s Notes: Views from a radiologist.
33. Surgeonsblog: Thoughts from a retired general surgeon.
34. StorytellERdoc: Written by an Emergency Room doctor.
35. The Healthcare IT Guy: Issues and ideas relative to medical recordkeeping.
36. Borderline Personality Disorder: An expert talks about this mental illness.
37. Dr. Gwenn Is In: A pediatrician and mother weighs in on health issues.
38. Perimenopause: For women about to enter the change of life.
39. Health Outlook: Written by a layman who investigates health issues.
40. Cancer Slayer: Words from a cancer survivor.
41. Healing Lyme: Tips and advice for victims of Lyme disease.
42. Scoliosis Specialists: Help for those with this spine disorder.