Medical Costs

The government is putting millions of Medicare dollars at risk by authorizing fictitious sellers of wheelchairs, prosthetics and other medical supplies to submit reimbursement claims with only limited review, congressional investigators say. A Government Accountability Office study, obtained by the Associated Press, sought to follow up on oversight gaps that have plagued the Centers for Medicare & Medicaid Services since at least 2005.

Orange County Board of Supervisors Chairman John Moorlach sought to withhold nearly $54,000 in funding from a doctors group Tuesday because it recently filed a request seeking records from CalOptima, the county's version of the statewide MediCal program. Fellow supervisors balked at his request, with one calling it "antagonistic" and another saying it amounted to retaliation. The funding measure ultimately passed with the doctors' funding intact.

Emergency room patients can no longer be stuck with the bill when hospitals or physicians disagree with insurance companies on their fees. Under new state rules that take effect today, hospitals and physicians are barred from billing patients for the balance of emergency care not covered by insurers. But the relief for patients may not last long. Hospitals and physicians are protesting the rules in court.

In late 2007, Centinela Hospital in Inglewood was losing nearly $1 million a month and had piled up $15 million in debt. Among the causes of the crisis: $25 million in overdue bills. Collecting that money would have given Centinela a measure of relief. But the bills went unpaid, and the century-old medical center was sold. The new owners slashed services, closed half the operating rooms and laid off a third of the employees. Who owed Centinela that elusive $25 million?

When Andy Dijak injured his right knee playing tennis, he wasn't surprised that he needed surgery. "It swelled up like a balloon," said the 50-year-old West Lake resident. The real shocker was the price tag: $12,000 to $15,000 to repair tattered cartilage. Dijak, a creative director for an entertainment company, has no health insurance, so he started shopping for a deal.

Low cost isn't the only reason Americans are traveling to foreign countries for healthcare. Timmi Ryerson of Vista, Calif., went abroad looking for expertise she couldn't find at home. Her deteriorating hip led her to India two years ago for a procedure known as hip resurfacing. The surgery has been performed for years in Europe and Asia but was still new in the United States. "I wasn't willing to be a guinea pig," Ryerson, now 62, said of her decision to seek a veteran foreign surgeon.

When Barack Obama steps into the Oval Office in January, healthcare reform will join a list of priorities crowded with two wars, a ballooning budget deficit and an economy mired in one of the worst slowdowns since the Great Depression. But the bleak environment may paradoxically spur the kind of costly, sweeping overhaul of the nation's healthcare system that has eluded policymakers in Washington for decades, many political strategists, industry leaders and economists say.

Employers are dramatically shifting healthcare costs onto workers, so much so that the average annual deductible for an individual surpassed $1,000 for the first time this year, according to a new study. Millions of workers -- whether employed by small, medium or large companies -- must now pay an average of $1,001 out of their own pockets before their health insurance coverage begins paying a share of the expenses. That's up 17% from $859 last year.

Marine Cpl. James Dixon was wounded twice in Iraq -- by a roadside bomb and a land mine. He suffered a traumatic brain injury, a concussion, a dislocated hip and hearing loss. He was diagnosed with post-traumatic stress disorder. Army Sgt. Lori Meshell shattered a hip and crushed her back and knees while diving for cover during a mortar attack in Iraq. She has undergone a hip replacement and knee reconstruction and needs at least three more surgeries.

If you lose your job, you should be able to maintain your health insurance coverage -- but it will cost you. The easiest and often the least expensive way to get health insurance if you are out of work is through a spouse. If your spouse has group benefits on the job, have him or her add you to that plan. Such group plans can't exclude people with preexisting conditions, and they are less expensive than other options because the employer is picking up the lion's share of the premium.