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When You Can’t Buy Health Insurance, at Any Price

Monday, February 21st, 2011

As you might already know, I’m a staunch advocate for access to health care, and cheered when health care reform became the law last year. We need the opportunity to stay well and keep our families well, and we need to be able to afford medical care when things go wrong. As a mother and a physician, I’ve seen firsthand how imperative this is.

There are those who say we should repeal the recent landmark health care reforms that Congress passed last year. But that would mean that some people would be shut out of health care completely. Some seem to believe it’s just those who are too poor to afford health insurance, or who can afford it but choose not to buy it, who go without. Those are faulty assumptions, as this op ed by the co-founder of Palm Computer, who was denied insurance before the new law passed, shows:

It never occurred to me that we would be denied! Yes, we had listed a bunch of minor ailments, but nothing serious. No cancer, no chronic diseases like asthma or diabetes, no hospital stays.

Why were we denied? What were these pre-existing conditions that put us into high-risk categories? For me, it was a corn on my toe for which my podiatrist had recommended an in-office procedure. My daughter was denied because she takes regular medication for a common teenage issue. My husband was denied because his ophthalmologist had identified a slow-growing cataract. Basically, if there is any possible procedure in your future, insurers will deny you.

If a woman with $millions couldn’t get approved because of a corn on her toe, what would happen to the average woman, or a child, with a more serious issue if health care reform were repealed?

We need to keep ourselves informed about what’s really at stake. And, trust me, there’s a great deal at stake. If health care reform is repealed, we go back to the days when life-saving care is denied to people who can’t pay the costs—oftentimes, hundreds of thousands of dollars—out-of-pocket. We go back to seeing our kids kicked off our policies when they’re just out of high school and don’t yet have jobs that offer health insurance. We go back to denials for pre-existing conditions as tiny—and ludicrous—as a corn on the toe. Or acne. Or depression. Nevermind more serious illnesses.

We can’t go back. Look at how far we’ve come. Please, be as informed as possible about your new rights under health care reform. You can find most of the information you need at this website set up by the government to guide you through your options and your rights.

– Yvonne S. Thornton, MD, MPH

Time to Deliver? Mother Nature Knows Best

Thursday, December 30th, 2010

For years, I’ve been sounding the alarm about Cesarean delivery on-demand, and have persuaded my patients that childbirth isn’t something you can simply pencil into your schedule when convenient. It’s not just that a baby needs all the time nature gives her within the womb to develop, and that delivering just a few days early can mean that lung development and other functions may be potentially compromised. Cesareans are major surgery, which brings inherent danger to both mom and newborn. Necessary Cesareans are often life-savers. Unnecessary Cesareans can be just the opposite.

And now, at last, the word is spreading.

The San Jose Mercury News reports:


Babies born early through induction or C-section without a medical reason are nearly twice as likely to spend time in the neonatal intensive care unit, researchers say. They also are more likely to contract infections and need breathing machines, according to a 2009 study in the New England Journal of Medicine and a number of other reports.


“We are finding out that the last weeks of pregnancy really do count,” said Leslie Kowalewski, an associate state director for the March of Dimes.


“At 35 weeks, the brain is only two-thirds of what it will weigh at 40 weeks.” Many organizations are responding with programs designed to eliminate early elective deliveries. Most significantly, chapters of the American Congress of Obstetricians and Gynecologists have begun to notify doctors about the serious consequences of performing early elective births.

With luck, as information about potential consequences spreads, expectant mothers and their doctors will decide to let nature take her course, for the sake of the mom’s health and her baby’s.

– Yvonne S. Thornton, MD, MPH

Aspirin, a “miracle” drug, adds another notch to its belt

Friday, December 17th, 2010

Most people know that daily low-dose aspirin is often prescribed by doctors to help prevent heart attack and stroke. Now, a new study shows that aspirin may help prevent cancer, as well.

We’ve known for some time that people who take aspirin appear to have lower incidences of certain cancers, but this study, published in the December 7, 2010 issue of The Lancet, and authored by Oxford University neurologist, Peter Rothwell, offers far more convincing evidence than we’ve had to date. Rothwell analyzed eight previous randomized, controlled studies, that studied the effects of regular aspirin use among more than 25,000 people. About half were given a daily low-dose aspirin (equivalent to a “baby” aspirin) and the other half were given a placebo. Those on aspirin had a 21 percent lower death rate from solid tumor cancers.

According to Time magazine, here’s what Rothwell found:

“Deaths from esophageal cancer were reduced by 60% in the aspirin-takers (who took the drug for at least five years), compared with the placebo group. Lung cancer deaths were reduced by 30%, colorectal cancer deaths were cut by 40% and prostate cancer deaths were lowered by 10%, compared with the patients who got placebo.

“What’s more, the longer people took aspirin, the greater their reduction in cancer risk. The findings are in line with other research that has found anticancer benefits of aspirin in the lab, as well as observational studies that have shown aspirin’s protective effect against colorectal and other cancers. Researchers say the drug’s benefit may have to do with its anti-inflammatory effect.”

Does this mean that everyone should take aspirin? Well, no. Even that innocent looking little pill you buy over-the-counter at the drug store comes with some very serious potential side-effects. Bleeding in the gut, caused by aspirin, can, itself, cause serious illness and even death. Only use aspirin on a regular basis  – or any other drug, over the counter or not –if your physician has recommended it and is monitoring your use.

But if your doctor already has put you on an aspirin regimen, it’s good to know that you might be getting a very valuable side-benefit.

– Yvonne S. Thornton, MD, MPH

New Rules on Health Insurance Keep Insurers Honest.

Tuesday, November 23rd, 2010

Starting in 2011, health insurance companies will be limited in how much they can charge you for insurance. If you work for a large employer, your health insurer will have to use at least 85 percent of your premiums to pay for actual health care or activities that improve health care quality. If you’re self-employed or work for a small business, your health insurer will be required to use 80 percent of your premiums for health care and improving health care.

That means that health insurance companies can no longer divert more than 20 to 25 percent to profits, or salaries, or marketing, and other overhead.

How much will this affect you? Potentially, a great deal.

Kathleen Sebelius, secretary of the Department of Health and Human Services (HHS), told reporters at a press event that some health insurers currently spend less than 60 percent of premium revenues on health care. And that drives up your costs for health insurance:

“Those overhead costs contribute little or nothing to the care of patients and to the health of Americans. And while some administrative costs are certainly necessary, we believe that they have gotten out of hand. And that’s going to change in 2011.”

But what if health insurance companies fail to follow the new regulations? Starting in 2012, if your insurer doesn’t spend 80 to 85 percent of revenues on health care or activities that improve health care quality, you’ll be due a rebate on your premiums.

It’s about time that consumers had some clout when dealing with health insurance companies, and I applaud these changes. I also look forward to hearing your stories about how the new health care law affects you and your family. Has the new law helped your family get or keep health insurance? Get better care? Please let me know in the comments section.

– Yvonne S. Thornton, MD, MPH

All your questions answered on how Healthcare Reform will affect you

Thursday, September 23rd, 2010

You might have read that as of  today, September 23, 2010, consumers will have several new rights when dealing with health insurance companies:

  1. Children can no longer be turned down for health insurance due to pre-existing conditions.
  2. Your insurer can no longer cancel your health insurance policy if you get sick.
  3. Your insurer can no longer charge you a co-pay for preventive care or tests such as mammograms and colonoscopies.
  4. If you have a medical emergency and need to go to an out-of-network hospital, insurers can’t charge you additional fees.
  5. You won’t need a referral from your primary care physician to visit your Ob-Gyn.
  6. Insurance companies can no longer cap the dollar amount of lifetime benefits available to you for essential medical care.
  7. You now have a right to appeal to an outside authority if your insurer denies a claim.
  8. Your adult children can stay on your health insurance policy up to the age of 26.

One thing the above should tell you: you’ve lost your last excuse for putting off that mammogram (make an appointment today, if you haven’t yet).

These changes are hugely valuable – but most people don’t yet know about them.

And the above are just the beginning. The Kaiser Family Foundation has one of the most comprehensive explanations I’ve seen of just how healthcare reform is likely to affect you and your family. And while you’re at the website, check out the animated video for an entertaining, thorough explanation of your expanded rights under the new legislation. It covers just about every question you might have.


– Yvonne S. Thornton, MD, MPH

The new, several-mornings-after pill

Monday, August 16th, 2010

The FDA has just approved an emergency contraceptive that can prevent pregnancy if taken up to five days after intercourse.

The new drug, ulipristal acetate (ella), will be available by prescription only, unlike the so-called “morning-after pill,” levonorgestrel, which can be bought over-the-counter.

While ella is not the first emergency contraceptive to be approved, it gives women a wider window of opportunity to prevent pregnancy than previous emergency contraceptives such as levonorgestrel, which must be taken within 72 hours to be effective.

Although it’s been used in Europe for the past year, ella won’t be available here in the U.S. for another two to three months. And there are still risks and side-effects associated with it, as with all drugs. Still, the introduction of a new emergency alternative is good news for women and their doctors, in preventing unintended pregnancy.

– Yvonne S. Thornton, MD. MPH

Dance Your Way to Fitness?

Thursday, July 22nd, 2010

I read a press release the other day from the University of Illinois at Chicago where researcher David Marquez is conducting a study. He plans to get older Latinos out on the dance floor to determine whether doing the mambo, merengue and cha-cha-cha will help them stay fit, and perhaps avoid obesity, diabetes and other ills of a sedentary lifestyle.

While the results won’t yet be in for a while, I whole-heartedly endorse the premise. A number of years ago, I had gained a lot of weight, was overworked and was getting little exercise. Then I signed up for ballroom dancing classes. Not only did I have a blast (winning a dance contest along the way), but I whittled down my waistline while doing it.  Other studies have shown that ballroom dancing can also benefit your mental fitness and decrease your risk of developing Alzheimer’s disease.

So, if you’re bored with exercise machines, and if jogging just isn’t your thing, put on your dancing shoes and go. Unless your doctor advises against physically challenging activity, I can’t think of a better, more fun-filled fitness routine.

See you on the dance floor.

– Yvonne S. Thornton, MD, MPH

Overweight or Obese? Don’t Count On Your Birth Control Pills.

Wednesday, July 14th, 2010

Since the pill first appeared on the scene, about 50 years ago, women have felt secure knowing that they had an almost foolproof way to avoid unwanted pregnancies. And that’s been mostly true.

But maybe not for all women.

If you’re overweight or obese, recent studies suggest that birth control pills might not be as effective for you as they are for more slender women:

“In one study of oral contraceptive pills, women with a body mass index (BMI) in the overweight range (a BMI of 25 or more) had a higher risk of pregnancy that those in the normal weight range. In another study of contraceptive skin patches, higher body weight — not higher BMI — was associated with higher risks of pregnancy.”

In addition to the sobering news about the lessened effectiveness of hormonal birth control, these birth control methods are thought to slightly increase a woman’s risks of heart disease, high blood pressure and other conditions. When you consider that overweight and obese women are already at increased risk of heart disease, diabetes and other ills, and that pregnancy is a riskier venture, overall, for obese women and their babies, you have a new incentive for getting your weight down.

I know it isn’t easy. I’ve struggled with weight myself and can attest to the fact that it’s a constant battle. But it’s a battle we must fight – and win. And now, we have one more reason to do it.

– Yvonne S. Thornton, MD, MPH

Pre-existing condition? No longer a problem.

Friday, July 9th, 2010

After all the hoopla, once healthcare reform was signed into law earlier this year, it didn’t immediately seem like much had changed. Most of the provisions of the new healthcare bill aren’t slated to take effect for a few years yet.

But there’s one provision, an all-important one for people who have been denied health insurance in the past, that could be a lifesaver.

And it takes effect this summer.

You can now get health insurance – good comprehensive coverage – if you’ve previously been turned down due to a pre-existing condition. Your new insurance will cover that pre-existing condition along with your other medical needs. Perhaps best of all, according to law, the premiums for this insurance must be affordable. You should pay about what anyone else your age pays, regardless of health.

Depending on the state where you live, the insurance plan will either be run by the state or federal government. Go here to find out about how to apply in your state.

So, if you have been denied insurance, or denied insurance for your pre-existing condition, and have been without any health insurance for six months or more, this is for you.

Take advantage. And here’s to your good health.

– Yvonne S. Thornton, MD, MPH

Promising Advances In Treating Breast Cancer

Wednesday, June 9th, 2010

As many as 12.7 percent of American women will be diagnosed with breast cancer at some point in their lives, according to the National Cancer Institute. The disease, if caught early, is very survivable. The big questions about treatment have included how aggressively to attack the tumors to keep cancer from recurring.

Two new studies, reported in The New York Times, suggest that a woman’s long-term survival doesn’t necessarily hinge on choosing the most aggressive treatment. And, if that conclusion is confirmed by further studies, it’s very good news, because treatment can come with significant side-effects.


“A new study has found that for certain women getting a lumpectomy, the standard treatment — an operation to remove underarm lymph nodes that can leave them with painfully swollen arms — may not be necessary. Compared with not removing the nodes, the surgery did not prolong survival or prevent recurrence of the cancer.

“And a second study found that a single dose of radiation, delivered directly to the site of the tumor right after a woman has a lumpectomy, was as effective as the six or so weeks of daily radiation treatments that most women now endure.”

Two notes of caution, however. The study on lumpectomy followed patients for five years; the study on radiation followed patients for four years. Breast cancer can recur after five years so we won’t know for sure that less aggressive treatment makes sense unless a longer term follow-up yields similarly promising results. But each study is cause for hope if not yet celebration.

– Yvonne S. Thornton, MD, MPH