Cost sharing, when you first hear it, might sound like a good thing. Something to help lessen the burden of costs you’re being socked with for your health insurance. Unfortunately, cost sharing in the United States often ends up to the detriment of the consumer, as health insurance companies raise their rates and have to ask consumers to pay a higher portion of what services cost. Sometimes insurance companies have to raise the rates for employers, who then have to turn around and raise the co-pays for their employers. It’s a vicious cycle, but other countries around the world have developed models to help lower and limit cost sharing that falls on the shoulder of consumers, and the United States might do very well to look into these models and implement them here. Especially with things as they are in our current economy, anything that can be done to keep hitting already weighed-down consumers with more costs should be a high priority.

What Exactly IS Cost Sharing in Health Insurance?

There are a few key specific points to understand when looking at the role cost sharing plays in health insurance. Direct forms of cost sharing between consumers and health insurance providers are things like the following: co-payments (what you pay per service), coinsurance (a percentage of the charge that you have to pay) and deductibles (the amount you have to pay out of your own pocket before coverage begins. This can be on all services or you can have a certain deductible on a type of procedure). Indirect cost sharing isn’t typically included in the standard definition of cost sharing in insurance, but they still cost consumers money and come right out of your pocket. These can be things like: charges when you go to see an out-of-network doctor, going to a specialist before seeing a primary care physician and being charged full price for that, any health services not covered by your insurance plan and health care premiums.

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Your kindly neighborhood pediatrician may be trying to get you to vaccinate your child this year against the flu virus. Maybe you’re already skeptical about whether the shot does any good for those receiving it, and you may be recoiling in horror as your baby’s doctor tries to inject your infant at just six months old. Such is the disturbing trend popping up by doctors who are a part of the American Academy of Pediatrics. Read on to learn about this organization’s drive to vaccinate babies and children, whether the shot has been proven helpful or not.

Flu Shots: Necessary Evil?

No parent likes to see their baby get shots-the screaming, the crying, the tears of despair over getting stuck with that big, mean needle. Studies have shown in recent years that the flu shot might not be necessary for keeping people healthy, unless the people in question are the elderly and infirmed or the very young and sickly. If you have a child, you may be hearing the AAP’s outcry that children from 6 months of age all the way up to 18 year olds should be required to have an annual flu shot. Well, for helpless babies at 6 months of age, this may have some validity. However, for children and especially teenagers, studies have shown that the flu vaccine only works in about 1% of the studied population. For parents who don’t want any unnecessary drugs injected into their little one’s bodies, this new insistence may raise more than a few hackles.

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In the past few years, you couldn’t turn on the television without seeing an advertisement for some new kind of drug. Erectile dysfunction, blood pressure, allergies, and restless leg syndrome (yes that is real) are all some of the drugs you may have seen splashed boldly in front of you on the screen. If you have been paying close attention, or just spend hours glued to the television, you may have noticed that drug ads have become less and less frequent throughout 2008. What’s causing this ad-less phenomenon, and is just due to the struggling economy?

Drugs Are Denied More Than Approved

Many drug companies are getting many of their fancy new drugs approved by the FDA and other regulatory bodies, so there’s no point in spending money advertising a drug that no doctor is going to buy and prescribe. If drugs are making it past the rigorous approval process, they are often drugs that target smaller population groups, like a cholesterol drug. There is no sense on spending millions on advertising on a drug that won’t be treating millions of people. According to figures from TNS Media Intelligence, U.S. drug ad spending dropped 6% in the first eight months of 2008, to $3.2 billion. That comes after a 3% dip in the full-year 2007, which had a total of $5.3 billion. Ad spending had generally been upward previously, peaking at $5.4 billion in 2006.

A Change in Media

You may not have realized this, but most of the ad spending done by drug companies is in the form of print ads. I don’t read magazines much anymore but when I did, I would see a ton of different drugs being advertised, varying heavily from magazine to magazine and their target audience. As with so many things, the trend now is headed toward the online world. People want their information in an instant, and web advertising can provide that. While you can easily flip through a magazine and read a drug’s information there, it is so much easier for a consumer to have an ad pop up on their screen, click on it and then read all the information they ever wanted to know about a particular drug. It makes complete sense to funnel money into online advertising (but then again, I encourage everyone to get online, whether it’s for fund raising, communication or shopping). Drug giant AstraZeneca told Dow Jones Newswires that some 20% of its consumer marketing budget was for digital advertising this year, up from around 15% in 2007. 1/5 of a company’s marketing budget going toward making sure online consumers get the drug message? It seems smart to me on the part of the drug companies.

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Bud, ganja, grass, herb, Mary Jane, weed…the ever-controversial marijuana has many nicknames, and just as people can’t decide what to call it, the United States can’t make up its mind on the drug’s legality, uses and whether or not insurance companies should cover it. It is a slippery slope, with many pros and cons on both sides of the argument, but just where are people coming from? Medical marijuana is legal in many other countries around the world, so why not here in the United States? Will we ever reach a point where not only is cannabis legal for medicinal purposes, but it is covered under a health insurance plan like other drugs of its ilk?

Medical Marijuana Facts and Figures

Medical marijuana, henceforth to be referred to simply as “cannabis” to save my poor fingers the typing exertion, has a different story if you are comparing state versus federal level here in the United States. At the federal level, cannabis is illegal, period due to falling under the Controlled Substances Act. As far as cannabis as a medical treatment goes, states have the right to choose whether the drug is or isn’t legal. Alaska, Arizona, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington all have approved and regulate cannabis for medicinal use. One thing that it is important to be clear on: medical use does not mean that the drug is approved for a prescription as medicine.

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Where to Go From Here

It may seem like there is no aspect of our country that isn’t an utter mess right now. Big banks are being bailed out, the auto industry is flailing like a car in the river and as we see here, the health care industry is rapidly falling ill to this economic virus. Is there any hope? I feel that there is. We have a new President with new ways of thinking around how health care and insurance should be offered, and while I don’t hang my hat on things changing immensely and immediately after the old administration departs, I do think they are on course to change for the better. How much worse can it get? The road to change has to be one we travel.

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The term “Medicaid issues” is rather vague, and you can let your fingers do the walking online if you are wanting to learn more about Medicaid plans. Medicare Advantage, however, is more specific. These are health insurance plans that are a part of the Medicare program, and they include things like:

• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

The interesting thing is that these plans do exist and are available under Medicare, so it is only my educated guess that Health Net was lobbying to reduce restrictions here as well, possibly opening the doors to more potential members and not barring people for health issues.

Considering that Medicare is intended to provide health care to our elderly population, trying to keep people from getting health coverage based on preexisting medical conditions is pretty absurd. You show me one 75 year old who has made it that far in life without bringing any medical baggage along with them and I’ll buy you a cookie.

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