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Health Care Hurting Because Of The Recession

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Health Care Hurting Because Of The Recession

Health Care

Health Care Hurting Because Of The Recession

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LYNN NEARY, host:

This is Talk of the Nation. I'm Lynn Neary in Washington. Neal Conan's away. Many of the just over three and a half million people who lost their jobs since the beginning of the recession have lost their health insurance as well. Even people who had health insurance face tough financial questions. A recent report by the Kaiser Family Foundation says nearly half of all Americans report someone in their family cutback or put off medical care or skimped on prescription medicine to cut costs. And some hospitals and doctors report seeing patients whose health is suffering because of the recession. Stressed out about their financial situation, they may be drinking or smoking too much and canceling gym memberships, when they need them most. Is it possible to stay healthy and save money on medical costs? We'll find out. It's part of our occasional series, Your Life in a Recession. Today, your health care in a recession. Later on, on the Opinion Page, Clarence Page takes issue with Larry King's assertion that there's a lot of advantages to being black these days. But first, your health care in a recession. Are you cutting back on your health care? What are you doing to reduce your health cost? Tell us your story. Our phone number, 800-989-8255 and the email address is talk@npr.org. And you can join the conversation at our Web site, go to npr.org and click on Talk of the Nation. NPR health policy correspondent Julie Rovner is here with us in Studio 3A to help through the maze of health care once again. Good to be with you, Julie.

JULIE ROVNER: Nice to be here.

NEARY: So listen, is there really hard evidence that people are cutting back on medical care because of the recession or is this all anecdotal?

ROVNER: Well, there are some hard evidence. We certainly see the poll that you cited from the Kaiser Family Foundation, I should point out that was done in October, which was really just at the start of what we think of as, you know, the big financial meltdown. And I should point out that these were not necessarily people without insurance. We're seeing a lot of people with insurance. One of the things we've been seeing certainly accelerate over this last year is people with insurance being asked to pay more by their employers. Particularly this year, I think a lot of people have their open seasons and their new insurance starts at the beginning of the year. And they're being asked to pay more in premiums, in co-payments, in deductibles, so suddenly, their health costs are going up. One of the things we're seeing is that people may be asked to take these wage freezes or you know, even pay cuts.

NEARY: Right.

ROVNER: And yet, their health-insurance costs are going up at the same time. Health insurance or health care - health spending is going up still much faster than inflation and much, much faster than wages. So we're all feeling this pinch of health-care costs going up much more rapidly. And it obviously hurts much more at a time when we do and feel like we do have less money to spend on it.

NEARY: Yeah, so what are the health implications if people are beginning to skimp on health care as a way to save money?

ROVNER: Well, certainly this is where it becomes much more anecdotal, but you know, talking to doctors, talking to hospitals, you know, you're seeing people, obviously if you go off your blood pressure medication or your cholesterol medication that can have health care, you know, consequences large and small. You can obviously have a heart attack or a stroke or, you know, something catastrophic. People who are, you know, taking antidepressants can have, you know, problems with depression coming back, you know, more chronic conditions that can recur. Certainly there are issues of people simply having, you know, a lot more stress. People who had been going to the gym and losing weight are now, you know, reported to be gaining weight again, you know, eating perhaps cheaper but more, you know, more caloric food and therefore gaining weight or perhaps even just more comfort food...

NEARY: Right.

ROVNER: (Laughing) And gaining weight because we are stressed.

NEARY: Of course, because this whole, you know, stress is going to make people sicker.

ROVNER: That's right. And you know, stress is not helpful for people who have certain chronic conditions, things like, you know, high blood pressure which stress can actually have an impact on.

NEARY: Yeah. Let's take a call now. We've got Lynn calling from Northern California. Hi, Lynn.

LYNN (Caller): Hi.

NEARY: Go ahead.

LYNN: Well, I just wanted to share that I know that I need a colonoscopy. We're supposed to have a screening beginning at the age of 50. And if you have any changes in your bowel habits, then you're definitely supposed to have it done. And I'm not having it done because of the cost. And I've spoken with another patient recently who didn't even want to have a chest CT scan done because he was afraid if he had lung cancer, he wouldn't be able to afford the costs.

NEARY: And do you have health insurance?

LYNN: I do, but it's just all the deductible and all the part that you don't get covered that could be enough to wipe you out.

NEARY: Yeah. All right, well, thanks so much for calling us, Lynn.

LYNN: You're welcome.

NEARY: Now, there's a good example. Somebody has health-care coverage and yet putting off what we know is a really good preventive test.

ROVNER: That's right, and there's at least anecdotal evidence. Here's an anecdote of people who are not going and getting recommended tests and certainly preventive care would be the first thing to go. You're not sick, you feel healthy, you know you should get it, but its money out of your pocket that you may not necessarily, you know, want to spend or feel that you're able to spend right now. And those are the first things that are going to go. I mean, obviously if you fall down or slip on the ice and break your ankle, you're going to go and get that dealt with. But it's the preventive stuff, the stuff that you know you ought to get, that you feel like you can perhaps put off until maybe you feel like you have the money.

NEARY: Now, this woman has health insurance, a lot of people still do, but what about people who have lost their health insurance because they've lost their job?

ROVNER: Well, a lot of people are in this situation where they're really desperate to try and find health insurance. Now, there is something called COBRA, it is a provision of an enormous tax and spend law from 1986, but it's the best known provision. It lets you keep your health insurance from your job for up to 18 months, and in a few cases, 36 months and if you leave or lose your job - but it's very expensive. Basically, what it says is you can keep that health insurance, but you got to pay the entire premium. It's pretty much where people discover just how generous their employers are when it comes to health insurance, because people gets some sticker shock when they discover that , you know, the average premium just for a single person can be about a thousand dollars. Families USA did a study a couple of months ago and found out that in - I think it was 41 states that the average COBRA premium was three quarters of the unemployment benefit, so it's just really unaffordable for most people to try and sign up for that COBRA benefit. In recognition of that, the stimulus bills that are now going through the House and the Senate would actually subsidize that COBRA benefit.

NEARY: Oh, really.

ROVNER: Sixty five of it, 65 percent subsidy, and it would be retroacted back to last September. So if you've lost your job since last September, you would be eligible for that subsidy. Now, I think, it's only a nine-month subsidy, so it wouldn't be...

NEARY: But it would help, that would be a big help for people...

ROVNER: It would be a big help.

NEARY: Who are trying to bridge the gap between one job to the next.

ROVNER: Exactly, would let you keep. And another important thing to know about COBRA is that if it's too expensive for your whole family but there's someone who's in the middle of some kind of health event, someone who's pregnant, someone's who's undergoing chemotherapy, you could actually sign up for COBRA just for that one person, you don't have to take it for the whole family. So that's an option, that it would be a little bit less expensive, but just to keep that health insurance going for that one person is a possibility under COBRA.

NEARY: I want to bring our second guest into the conversation now. Francesca Lunzer Kritz is with us. She writes a weekly column on health-care costs for the Los Angeles Times. She's also here with us in Studio 3A. Thanks for being with us.

Ms. FRANCESCA LUNZER KRITZ (Writer, Los Angeles Times): Nice to be here.

NEARY: And you have your own health situation today, I know, you've got a cold. So we'll understand that as we go along. But I wanted to ask you to continue this conversation about COBRA because I know in one of the articles that you have written that I read that you said - I think you recommend that even if it seems very expensive this is an option people should really try to take advantage of.

Ms. KRITZ: This is if they have no other alternative for two reasons. One is, it continues care and having a discontinuation in care can mean that when you go back to getting insurance either through your employer or on your own, you may not be eligible for some insurance. You need to have a continuation care, particularly if you have pre-existing condition. And the other reason that is important is that it may well be the least expensive option you can get. Although, it's expensive, if you buy insurance on the open market in most cases, COBRA will be the least expensive option for you.

NEARY: If you can't do it, if you lose your health insurance during this period of unemployment and then you get a new job. What's the disadvantages or what...?

Ms. KRITZ: It's very variable but you may, if you have a pre-existing condition and then you let your insurance drop, you may find that when you go get your insurance or for a member of your family when you get a new job, you may find that that condition is not covered for a period of time. Again I'm couching it because you may find that could be one of the ways that you can certainly find out what's specific to you is that the Department of Labor is offering information both online and through telephones, and you can call them. Go to the Department of Labor. I believe its dol.gov and look up, job benefits toolkit, and you'll be able to find lots of information. And then there'll be a toll-free number, and you can call them and ask them very specific question related to you. And they can answer your very specific question.

NEARY: Now, once COBRA runs out, what happens then?

Ms. KRTIZ: Well, you...

NEARY: Can you continue that same health care?

Ms. KRITZ: There is an extension as Julie mentioned to 36 months for some people but for now, once it runs out, it runs out. What remains to be seen is what other changes could happen if the economy continues to worsen and if COBRA is the way that the president decides that he would like to help people fund their health insurance, it could continue. Another way that may do it is that there may be an expansion of Medicaid. Medicaid now, for the most part only applies to people who have children. There could be changes to Medicaid so that even if you don't have children you may qualify. It's worth looking at your papers every day because there is going to be something new and there could be something new in your own state. You want to become familiar with happens in your state. And I have found in calling state health insurance agencies, there are people standing by the phones who really want to give you good information. And if you simply put into a search engine, state health insurance agency or state health insurance information, you're going to get a toll-free number with people sitting there. And although, I can give you good general information, you can get information that pertains directly to you by calling these agencies.

NEARY: Now, Julie?

ROVNER: At the very end of COBRA, if you actually, if you couldn't afford to do COBRA for the entire time, for that entire 18 months, you must be offered something called a COBRA conversion policy. Now, the quirk of a COBRA conversion policy is that it could be even more expensive than COBRA and usually is more expensive than COBRA because the only people who go to the end of COBRA are people who really have trouble getting insurance. So they are really expensive, but if you really need it there is insurance at the end of COBRA.

NEARY: Now, talking, Julie, just in terms of health-care reform, is that something that's separate from what we're discussing now with what the president is proposing regarding to COBRA? I mean, that's...

ROVNER: Yes, that is something that is separate. This is - what's going on in this stimulus which is called, I think, the recovery package, this is intended to be a down payment sort of an immediate short-term get people sort of over the hump of what's going on with this recession and then Congress are going to start looking at health reform later on in this year.

NEARY: Any idea how long that's going to take?

ROVNER: I would not hazard a guess.

(Soundbite of laughter)

ROVNER: Some months, I think would be a safe assumption.

NEARY: Could have been within a year though, let's say? I mean, we're in a, you know, we're in an emergency situation. It seems to me there is emergency legislation being considered but even the long-term reform needs to be acted on quickly, I would think.

ROVNER: Certainly the hope is within a year.

NEARY: Yeah. All right, we're going to take a short break right now. They're going to return, continue talking about your health care in the recession and how to cut costs without hurting your health. We'll get more of your calls in a moment at 800-989-8255 or send us an email to talk@npr.org. I'm Lynn Neary. It's Talk of the Nation from NPR News.

This is Talk of the Nation. I'm Lynn Neary in Washington. Even if you still have health insurance, there is a good chance your costs are going up. In one survey, 40 percent of big companies raised premiums for their workers last year. Even more plan to hike them in 2009. We're talking about the tough choices many face in this economy, your health care and a recession. Are you cutting back on your health care? What are you doing to reduce your health-care costs? Tell us your story. Our phone number is 800-989-8255 and our email address is talk@npr.org. You can join the conversation at our Web site. Go to npr.org and click on Talk of the Nation. NPR health care - health-policy correspondent Julie Rovner is with us and we're also joined by Fran Kritz. She writes a weekly column on health care costs for the Los Angeles Times, and we have a link to her latest comment at npr.org/talk. Let's go to a caller now. We're going to go to Andrew who is calling from Cleveland, Ohio. Hi, Andrew, go ahead.

ANDREW (Caller): Hi, actually, I find that recently my entire life has been mirroring all the current events in the news, by preceding it by about five months. Earlier this summer, I was forced to get rid of my health insurance. My employer at the time was part-time and they provided it, but I couldn't afford it through them so I had to get it on my own. And then overtime, the paycheck that was coming in from that employer just wasn't enough to cover the monthly costs and I had to drop off health insurance. I did so midstream through a course of medication. I kept up with the course of medication as prescribed and the unfortunate thing recently is I've had to - there is a whole process involved in stopping this medication. And I've kind of had to research that myself and go to that myself without the ability of going to see my doctors, simply because I can't afford the office visit. And it's been tricky. It involves a lot of personal research and support from friends but I just, you know, there's a lot of days where I'm like, OK, what is this side effect? Why am I feeling this way? And it's really - it's scary. And also, you know, when you feel this sensations that you're feeling before and you're worried that something is wrong, and that's only compounded when you think to yourself, well I could go and get check out, make sure nothing is seriously wrong and then you stop and think, well, dear God, what if something is, what then? You know, what am I going to do? And you just - you're left with no choice and no choice.

NEARY: Fran, do you have any thoughts to offer to Andrew?

Ms. KRITZ: Well, one thing that we have been suggesting and it's really a suggestion of public health officers as well is that there is a network of community health centers, clinics and community centers now. It's not the same as going to your doctor where you can schedule appointment at two and be seen at 2:30. You may have to wait, there may be a small co-pay, it may not be convenient to your home. You may not be able to get the exact same drug that you're taking. It may not be on the drug list that they offer but it is one way of people being able to be seen by a physician, and to very possibly continue your course of medication at a low cost. And it's worth looking through your state health department or city health department to ask. I don't mean to make this seem as though it's a panacea. It's not the same as simply having a doctor who knows you. But there are very able and enthusiastic providers who are providing care.

NEARY: And are there doctors or are there physicians there at this community...?

Ms. KRITZ: That's a very good question, you may see nurses. You may see a doctor. You may see what they call physician extenders, physician assistants. You probably can ask to see a physician for a particular concern and then be followed up by a nurse. The other thing is that your local hospital may well have a clinic that - not the emergency room. Don't go there unless you have a clear emergency because the fees from some of that insurance are very high, but you can call the hospital. And ask there if they have a clinic. Even here in Washington several have recently opened up and they will see people who don't have insurance. Again, there can be a waiting time. There can be co-pay.

NEARY: How can people go about trying to find out about these community health centers in their community or the clinics as you just mentioned?

Ms. KRITZ: I believe that the city numbers are always 311 and if you call 311 in your city, you should be able to find - ask for resource, ask for community health resource. The other one is that there is a community health center association which you can look up on the Web, and also your state and city and local health department and your public library. The libraries are - I checked my library yesterday in Silver Spring and they had medical resources as well. And you might have bypassed these things before because you were employed and insured. But now they might be something not to bypass at all. And again we don't mean to make this - you may have a wait, you may have to wait a few days. You may not see, you may see a nurse or you may see an extremely experienced nurse who knows these issues, but at least it's a way into the system. You can get some help this way.

NEARY: Andrew, is that any help to you at all or have you already tried all of this?

ANDREW: Well, the problem is in the past, when I've approached the clinics in our area, a lot of times the wait was so great for just basic health issues, like say, you've got a really nasty bug or something's going on, by the time you can get in or find the day that you can get in to see these people, you know, might have already passed. You know, and it's just - it's kind of crazy. As far as my predicament, I was very fortunate in that the medication I was taking was a very low dosage. So, I, you know, I able to kind of do it on my own. And I was - I got off when I was scheduled to get off medication. But it is, I guess, I know that the resources are out there but, you know, as it is, I now have a full-time job and it's, you know, you don't want to become a squeaky wheel saying, I need to take time off to wait all day at a clinic.

NEARY: Yeah. I'm sorry, did want to answer...?

Ms. KRITZ: I want to say for a bug, I was talking about either a check-up or a medical condition. If you're not feeling well, the flu, an ear infection, a child's ear infection - one option may well be, whether people have insurance or not, is a growing number of retail clinics in stores and in chain pharmacies. If you have insurance, the co-pay can often be as little as $10, and if you don't, it tends to be about $50 or $60. And if you work with the pharmacy there may be some discounts. So if you are concerned about a child whose sick today, those are generally staffed by nurse practitioners.

NEARY: Andrew thanks to your call. We want to get to some other folks as well. So, thank you so much for calling in. I want to read an email that came in as well. This is from Sarah from - I believe she's writing from Cincinnati. As someone who's been chronically sick, I can say that my health care is not only scaled back but its nonexistent. I have lupus untreated because of a lack of health insurance. No medications, no doctors, nothing. I am afraid this means I will die earlier but I don't have a choice in the matter.

You know, this just speaks to the urgency of this situation and you know, we're hearing these stories, it's hard to know how widespread a story like Sarah's or Andrew's is, but if their alternative is to go to free clinics that they have to wait a long time for, why not - why doesn't the government, you know, move more quickly to create some kind of system even if some people feel that, you know, national health care, you're going to have to wait. I mean, it almost sounds ironic to say, we're waiting for community health program, weeks for community health programs for these people but we don't want a national health care system because we're going to have to wait too long for doctors.

ROVNER: I actually spoke to the association community health centers earlier today who were saying that they are seeing a very big upswing in demand. There is more money for them also in the stimulus bill but obviously, you know, it's hard to imagine it will enough to shorten the wait by a whole lot. And these are places, you know, I might point out that serve people with insurance and people without insurance and people with Medicaid. I mean, it's for people who are underserved, you know, in areas where there are not a lot of health-care facilities, as well as people who don't have a lot, you know, either a lot of money or don't have insurance. So, it serves a variety of sources, community health centers and...

NEARY: And I don't mean to over-dramatize this but Sarah seems to feel that's it's possible she's - really truly feels it's possible she's going to die soon.

Ms. KRITZ: I think that there are - Atul Gawande wrote a piece at the New Yorker and what she talked about when - just last week where he said in the switch from Medicare to Medicare part D because there was some ramping-up time, he thinks that they're probably people who died because they couldn't get their medicine on time.

NEARY: So this is a real thing?

Ms. KRITZ: This is a real thing but I want to make suggestions and again, these are stop gap. These are Band-Aids. I don't pretend that anything I'm suggesting is an alternative to a national health reform. But that's not happening today, and these people are calling in today. And my other suggestions would be to go to the foundations, the lupus association. If you have a condition and you should call the organization. Again, I believe that search engines are your best friend. Librarians are your best friend. The other thing that you would want to do is go to helpfinder.gov and look up the calendar of observances. Cause very often there are free testings on certain days. If it's National Ovarian Cancer Week or Breast Cancer Awareness Month there'll be free mammograms, there'll be free ovarian screenings. Those organizations have some money that they can use to be able to certainly pay for screenings and then perhaps to pay for treatment. And then I want to suggest, in fact a clergy member mentioned this to me, and you want to go to your church, you want to go to your synagogue. If you find yourself with health bills, you have to pay them. You will find yourself in terrible debt. Look for every resource of assistance. No one's - I'm not pretending this is easy but I just urge you to look at every avenue including your pastor or your rabbi, these associations.

NEARY: All right, let's take another call from Louis(ph) who's calling from across Wisconsin. Hi, Luis.

LOUIS (Caller): Hello there. How is it going?

NEARY: Good, good.

LOUIS: When I found myself in a situation like the previous caller who even with insurance from a retail company chose not to have the colon procedure after I turned into my 50s, simply because after the insurance and with the deductibles, it still would have been three to $4,000 out of my pocket. And that was just - that would have wiped out my so-called emergency medical savings account.

NEARY: Right.

LOUIS: Since then I lost my job but did maintain the COBRA, which is absolutely fantastic for just dental. Unfortunately, with a pretty bad sweet tooth here, I'm at the dentist constantly. And that really comes in handy. Now, my question is the company that owned the store that I lost my job from is now selling that store. It's a local company selling a major hardware chain. And I'm wondering how that's going to affect the COBRA I have now and should continue to have well, since September for almost another year.

NEARY: All right, let's get to Julie on that. Julie?

ROVNER: You should, the rules under COBRA, if the company goes out of business then there's nothing to COBRA, too.

LOUIS: Right.

ROVNER: But I believe that if the company is still in business and I assume - and it's still offering health insurance, I think even if it gets sold as long as still offering health insurance, you should you're right to COBRA should go with that. I'm not a 100 percent sure.

NEARY: Any places you should go to...

Ms. KRITZ: The Department of Labor.

NEARY: Yeah, that kind of thing.

ROVNER: Department of Labor will be able to tell you. But there's something I do want to add to both to this caller and to the previous caller. You know, the one that's thing that most dangerous I think in this, you know, current economic climate is to go bare, to go without insurance, particularly if you have a pre-existing health condition. The important thing to remember is 63 days. And that's the cut off after which you're considered to have a break in health insurance coverage. If you can't afford the COBRA, and obviously there's going to be a lot of people who cannot afford the COBRA, you can find health insurance and even if it's just bare-bones Health Insurance that won't cover very much that you know - that will only, you know, pick up in the biggest of catastrophes. At least it will keep you covered that when you get another job and do get, you know, health insurance with that job, you will not get dinged by that pre-existing insurance, you know, exclusion which goes on for a year. So, it is important to keep some kind coverage. And if you do have to find it, you know, you can get on the Internet. You can get, you know, maybe the bare-bones coverage that it's not going to do very much while you have it. But it will protect you for the interim before you have to - you know before you get to move back to what you consider more comprehensive coverage.

LOUIS: Now, question about that plan they're trying get through with the stimulus plan to subsidize part of COBRA.

NEARY: Mm hmm.

LUIS: That's 60 percent?

NEARY: Sixty five.

ROVNER: Sixty five.

LOUIS: All right - so with that, I'm still looking at $240 a month for the health part of COBRA, which a lot of people out there with jobs is probably be willing to pay both being on an unemployment. Again, I'd pray for that.

NEARY: That's tough, that's tough.

ROVNER: Yeah, it's not a bad idea.

NEARY: Louis, thanks so much. I just want to thank you for calling in, Louis, because we're trying to get some more callers on.

LOUIS: All right, have a great day.

NEARY: All right thanks so much. And we're talking about your health in a recession. And I want to remind you that you are listening to Talk of the Nation from NPR News. Let's go now to Robert. And Robert is calling from Aberdeen, South Dakota. Hi, Robert.

ROBERT: (Caller) Hello, can you hear me?

COHEN: I can, go right ahead.

ROBERT: I'm 50 years old and I had health care offered by my employer but it was - I could afford to buy a policy a little bit cheaper on my own. The employer basically was just a vehicle to offer the health care. But my hours are being cut back. I drive a truck and because of the recession or what not, I - mine and everybody's hours have been cut back. And I had been put in a position where I can no longer afford to pay for it. I mean, it's literally just groceries or health care and I'm - like I said, I'm 50, so, I'm at that age where all the preventive things are really becoming important. And I just don't feel that I have any direction to go. And, you know, even the preventive stuff, you know, I mean I go in for a check up and you know, jeez, they cost me - it cost me a week's pay.

NEARY: Yeah, so you would just wait until - Robert, you're - what would your reaction then be? You're just going to wait until you actually have to go, where there'd be an emergency?

ROBERT: Something goes wrong. I believe there's so many people in that situation. Yes, that's where I'm at.

NEARY: Yeah, Fran.

ROBERT: I have - I did note preventive is out of the question, and if something catastrophic goes wrong, well then I guess I'll have to deal with that. But if, you know, I mean, jeez, I just don't feel like there's anything I can do except, you know, wait for an emergent situation.

NEARY: You know, Fran, one thing I wanted to ask you about - because I think in one of your columns, you said that, and I don't know how real this is, that there's a possibility you should talk to your doctor because maybe you can negotiate prices. Is that real or...?

Ms. KRITZ: You can possibly negotiate prices if you pay cash. But if you are insured, you cannot. They have made a...

NEARY: Oh I see.

Ms. KRITZ: For the most part. They have in fact, I thought you'd able to say doctor can you waive the co-pay. But according to American Medical Association, you cannot. They've made that contract with the insurer and they cannot waive it, and they may not be able to waive the fee. If you're paying out of pocket, you may want to go to your doctor and say, can we make up a payment schedule? But I wanted to make a suggestion, and that is first of all, Julie's suggestion to have at least something - something bare-bone, something high deductible is really crucial for - both for catastrophic coverage and for continuation of care - continuity of care. But also, if you go into a hospital, now if you don't have any resources and let's say you need a CAT scan, the BusinessWeek reported that they are now saying to people, well, I see that you haven't maxed out your credit card or I see you have a 401k. And they may ask you to use those resources. So, having some insurance will help you to pay for some of those costs. If you find yourself not being able to afford care, particularly if you've gone to an emergency room, my daughter - we have insurance. My daughter went to the emergency room for an asthma attack. If we hadn't had insurance, it would have been about $450. We'd pay on our way out and I asked what would happen? And they said, well, we would send you a bill. Don't wait for them to send you a bill. Go up to the financial office. Work out a settlement with them without a credit card so that you're not paying interest. Sit down with them. Work out a payment plan if you find yourself in that situation.

NEARY: All right. Thanks for calling, Robert. Appreciate that. And just, sort of in conclusion, one other thing just a moment left. And maybe either one of you can take this about this whole idea of not getting the preventive care. This is a potential serious problem, creating more serious problems with the health care system and people aren't getting the preventive care.

ROVNER: Yeah, it's clearly going to raise costs down the line for people who don't get preventive care and then end up needing more expensive care later.

NEARY: Yeah. And I don't know if you wanted to answer that, Fran.

Ms. KRITZ: I'll just add quickly that the agency for health care research and quality on its Web site has a list of tests that you should have right through your life. Look it through, when you need a colonoscopy, when you a mammogram, and then go to helpfinder.gov and find the observances calendar, match the tests you need to the match - to the tests that maybe available for free or very little cost.

NEARY: OK. Francesca Lunzer Kritz writes a weekly column on health care costs for the Los Angeles Times. And Julie Rovner is NPR's health policy correspondent. Thanks to both of you for being with us.

Ms. KRITZ: Thank you.

NEARY: Up next, a new president and new talk of progress in race relations. Is black the new black? Syndicated columnist, Clarence Page joins us on the Opinion Page. Stay with us. It's Talk of the Nation from NPR News.

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