You have reached your limit of free articles this month.

Enjoy unlimited access to myPalmBeachPost.com

Starting at just 99¢ for 8 weeks.

GREAT REASONS TO SUBSCRIBE TODAY!

  • IN-DEPTH REPORTING
  • INTERACTIVE STORYTELLING
  • NEW TOPICS & COVERAGE
  • ePAPER
X

You have read of premium articles.

Get unlimited access to all of our breaking news, in-depth coverage and bonus content- exclusively for subscribers. Starting at just 99¢ for 8 weeks

X

Welcome to myPalmBeachPost.com

This subscriber-only site gives you exclusive access to breaking news, in-depth coverage, exclusive interactives and bonus content.

You can read free articles of your choice a month that are only available on myPalmBeachPost.com.

POINT OF VIEW Scant protection offered for autoimmune patients


Researchers are discovering new potential ways to treat a number of autoimmune diseases, such as scleroderma and lupus, that affect hundreds of thousands of Americans. Novel treatments are being investigated that will help restore the health and productivity of these affected patients.

Unfortunately, even if researchers are successful in developing new treatments for scleroderma and other related autoimmune disorders like rheumatoid arthritis, patients may not benefit. In response to rising health care costs, insurers are increasingly rationing access to treatments and doctors. As a result, patients are growing sicker, which ultimately increases health care costs.

Costs are rising at a worrying pace. America currently spends about $3 trillion on health care. From now until 2025, health spending will grow an estimated 5.8 percent each year.

So it’s at least understandable why insurers are employing every possible tactic to keep their costs down. However, most of their efforts don’t actually avert spending — they just shift the burden onto patients, or into the future.

Insurers increasingly require patients to pay a percentage of the total cost of specialty drugs, rather than a fixed co-pay. These medicines often are the most effective treatments for autoimmune disorders. Patients with rheumatoid arthritis can face out-of-pocket costs of $500 to $5,000 a month if they need these necessary specialty drugs.

Insurers are also raising deductibles. From 2006 to 2015, the average deductible rose from $303 to $1,077 for those on employer-sponsored health plans, according to the Kaiser Family Foundation. Many rheumatoid arthritis patients typically have to spend more than $2,500 before coverage kicks in.

Insurance companies are also restricting which doctors or hospitals patients can access.

For example, when one Texas couple purchased a Blue Cross plan through the federal package, they found that many of their specialists were no longer in-network. The wife, who suffers from rheumatoid arthritis, lost access to her specialist. She has yet to find an in-network specialist within 100 miles of her home.

Such limited coverage of specialists is the norm, not the exception. About 70 percent of exchange plans cover fewer than a quarter of all the physicians in a given area.

The high cost-sharing requirements and insufficient coverage of specialists mean that many autoimmune patients can’t afford to seek care. Going without treatment poses a serious risk. Untreated rheumatoid arthritis can lead to complications ranging from progressive disability, to increased risk of infection, coronary artery disease, and even malignancies.

Those complications ultimately cost more than what regular doctor visits and drug regimens would have cost. Coronary artery disease, for instance, can cost more than $17,000 in a patient’s first year of treatment.

The current insurance system demands too much of patients. Most Americans can’t afford to pay thousands of dollars a month in out-of-pocket expenses or travel hundreds of miles to see a doctor. Limiting insurance expenses would keep patients healthier and curb long-term health spending.

MICHAEL SCHWEITZ, WEST PALM BEACH

Editor’s note: Dr. Michael Schweitz, a rheumatologist, is past president of the Coalition of State Rheumatology Organizations.



Reader Comments ...


Next Up in Opinion

Medicaid’s rise symbolic of liberals’ welfare state run amok

The number of Americans enrolled in Medicaid has increased from 29 million in 1990 to 73 million today — an increase of 252 percent over a period when the nation’s population increased 30 percent. Total spending on Medicaid today is $574 billion, 275 percent above the $209 billion of 2000. Medicaid amounts to about 40 percent of the total...
YOUR VIEWS

Now we know why Scott nixed Medicaid option When the Affordable Care Act was rolled out, our Gov. Scott refused the option to expand Medicaid in Florida, even though the federal government was offering to cover 90 percent of the cost. Mr. Scott’s reason to refuse this generous offer was his belief that we could not depend on the federal government...
POINT OF VIEW: State Speaker should learn about ‘next-door government’
POINT OF VIEW: State Speaker should learn about ‘next-door government’

I was surprised recently by fellow Republican Richard Corcoran’s remarks at a Tampa breakfast. Corcoran, the speaker of the Florida House of Representatives, praised top-down Tallahassee solutions and claimed state politicians are less susceptible to special interest influence than local leaders. “To get something through in Tallahassee...
CARTOON
CARTOON

CARTOON VIEW JOHN BRANCH
Letters Wellington leaders backward; no ‘gray area’ about homosexuality

Wellington backward; no ‘gray area’ here We all are entitled to our opinion, and to voice it, but when the mayor institutionalizes it, it can be foolhardy and in the worst case, disastrous. (“Wellington bans ‘conversion therapy’; mayor is lone vote against,” June 14) Our mayor in Wellington, Anne Gerwig, stated &ldquo...
More Stories