Medical Costs

As President Obama and his critics prepare for a climactic battle over healthcare, they face a seeming paradox: Millions of Americans say the system they depend on for everything from routine flu shots to life-saving heart surgery is broken and needs fixing. Yet most Americans also say they're pretty satisfied with their healthcare. The explanation for the apparent contradiction -- and a big reason healthcare has turned into such an incendiary fight -- is that it's not one crisis, it's a bundle of crises.

Ampelio Garcia, 74, was barely able to walk when he got to White Memorial Medical Center in Boyle Heights, after the latest flare-up of a chronic lung condition that left him wheezing and gasping for air. Emergency room physician Brian Johnston prescribed drugs and a breathing treatment to open Garcia's airways. Then he admitted him -- for the second time in less than a week. "I can't send this guy home; there's no way," Johnston said. "And I don't think our treatment here is extreme or excessive.

Every circus needs a sideshow, which must be why every time the issue of rising medical costs gets debated, politicians start clamoring for "tort reform." You know the argument: Disgruntled patients, goaded on by unscrupulous lawyers, file frivolous malpractice lawsuits and walk off with millions of dollars in undeserved awards granted by teary-eyed jurors. Doctors respond by practicing "defensive medicine," ordering lots of unnecessary tests to cover their behinds. Bingo! Medical costs hit the stratosphere.

Medical malpractice reform is unlikely to cut healthcare spending significantly, the Congressional Budget Office reported Friday. Enacting a cap on pain-and-suffering and punitive damages, changing liability laws and tightening the statute of limitations on malpractice claims would lower total healthcare spending by about one-half of 1% each year -- $11 billion at the current level -- according to an estimate by the nonpartisan agency. The figure is far lower than previous estimates by groups backing malpractice reform.

Molina Healthcare Inc. said its profit shrank in the fourth quarter on higher medical costs, though the health insurer's performance still met Wall Street estimates. For the period ended Dec. 31 the Long Beach company reported net income of $15.5 million, or 58 cents a share, compared with $17.9 million, or 63 cents, a year earlier. Revenue climbed to $812.5 million from $678.6 million on increased membership and higher premium payments. However, those gains were offset by higher expenses, which rose to $785 million from $648 million, driven by rising medical costs.

Health insurer Aetna Inc. gained more than 1 million new members in the first quarter and reported a modest profit increase. But higher-than-expected medical costs, a problem many insurers wrestled with last year, cast a shadow over the performance. Hartford, Conn.-based Aetna said it adjusted its pricing to accommodate medical costs that rose 14% compared with the same quarter in 2008. Company officials tied the increases largely to factors found in the slumping economy.

Re: "Medical bills tied to more bankruptcies," June 4: A spokesman for private insurers said that "private insurers were in a better position to rein in spiraling medical costs and that the industry had a plan for protecting people from being forced into bankruptcy." Our present healthcare economy makes that hard to believe. His statement is a vivid example of the wolf guarding the henhouse. Wayne Muramatsu Cerritos

The nation's healthcare bill climbed above $2 trillion in 2006, averaging a record $7,026 per person, according to a government report released today. The report is likely to intensify the presidential campaign debate over curbing costs and covering the nation's 47 million uninsured. Costs increased 6.7%, the report by Medicare's actuaries said -- only slightly more than the 6.5% rate in 2005. But it was still well above the overall rate of inflation.

Requiring even a small co-payment dramatically reduces the likelihood that women will get regular mammograms to detect breast cancer. Screening rates from 2001 through 2004 were nearly 11% lower for women who had to contribute a co-pay as low as $12, compared with women whose breast X-rays were free, researchers from Brown and Harvard universities report in the Jan. 24 issue of the New England Journal of Medicine. They surveyed more than 366,000 women ages 65 to 69. "I think it's a surprising result," said Dr. Amal Trivedi of Brown, who led the study.

For busy people, time is money. And when you've got more money than time, the cost of an executive physical examination is kind of like the price of a yacht. If you have to ask, you can't afford it. Tom Gilmore arrived at L.A.'s Good Samaritan Hospital on a bright Friday morning, sporting a dark blue Nike warmup suit the hospital had sent.