The County of San Bernardino (California) Department of Aging and Adult Services has issued a warning that scammers are posing as government officials and contacting senior citizens in the area by phone, e-mail, and even in person. They ask if the person has health insurance. If the answer is no, they threaten to send them to jail for allegedly not adhering to federal health policies. Then they offer to sell the victim “Obamacare insurance” which will supposedly keep them out of jail.

It shouldn’t need stating, but: There is no Obamacare insurance, these seniors aren’t going to be hauled off to jail and the scam is a blatant misreading of the provisions of the recent health care reforms. For the record, in 2014, citizens will be required to have health care coverage — but there will be access to public programs for those who don’t have private insurance. And those who still don’t procure coverage only face graduated fines, not jail time.

While this scam appears to be limited to San Bernardino, so far, it’s worth keeping an eye out for similar frauds in other parts of the country. It’s also a reminder to all health professionals that there are still a lot of people who don’t understand how health care reform actually effects them — and there are plenty of people spreading misinformation.

If you suspect someone has been a victim of these particular con artists, authorities encourage you to call law enforcement or San Bernardino Adult Protective Services at 877-565-2020.

A new study from Health Affairs demonstrates the problem. Out of more than 1,500 interviews with patients, the researchers said the dominant themes were:

• More is better.
• Newer is better.
• You get what you pay for, and
• Guidelines limit doctors’ ability to give patients the care they deserve.

No wonder health care costs keep spiraling out of control.

Using the patient story line from the episode “Ignorance is Bliss,” the final tally came in at just about $300k.

Originally, the patient presented with anemia, a mild cough and ataxia or lack of muscle coordination. The preliminary diagnosis was a rare blood disease. Upon learning of the patient’s heavy drinking, the diagnosis was changed to a potential liver problem which required a liver biopsy at roughly $10k.

Then the patient collapsed — requiring an MRI for about $1k. The MRI indicated the patient had previously suffered a broken rib that healed incorrectly, damaging the spleen — and spurring the growth of 16 “baby spleens.” The estimated cost of a (highly unconventional) “multiple-splenectomy” was $200k.

Following this treatment, the patient suffered a stroke, requiring another $60k in various treatments. In the meantime, he also received various drug treatments which cost in the area of $90k.

That estimate doesn’t take into account the fact that one patient received essentially 24/7 care from a team of specialists — who handled no other patients while he was in their care. (They did however, spend a fair amount of time looking gorgeous and discussing their complicated love lives.)

While it’s easy to mock the show’s portrayal of life in a hospital, $300k to treat one patient is a sadly realistic number given today’s out-of-control health care costs.

Currently, 50% of the general public approves of the reform, 35% said they disapprove — down from 41% just a month ago.

Broken down by political party, 69% of self-identified Republicans opposed the law. Among Democrats, 73% approved of the law. Forty-eight percent of independents said they approve.

The U.S. health care system ranked last in a recent comparison of six other large countries.

Despite the amount of money spent each year, and the rigorous training health care providers undergo, the results just don’t equal those of other countries, according to the study done by the Commonwealth Fund.

The report compared the U.S. health care system with those of Australia, Britain, Canada, Germany, Netherlands and New Zealand.

It found that the U.S. spends more than twice as much as most other countries — while still ranking last on safety. The U.S. also came in close to or at the bottom of the list in several other key areas, such as number of patients who forgo care due to the cost and access to primary care providers.

Overall, the U.S. ranked last. Netherlands topped the list.

You can see the full report here.

The Department of Health and Human Services announced it will invest $250 million over the next few years to increase the number of primary health care providers.

Among the planned uses for the money are:

• Creating more primary care residency spots.
• Encouraging states to develop their own programs to increase their local primary care workforce.
• Supporting the training of more physician assistants in primary care.
• Encouraging more students to pursue nursing degrees full-time.
• Creating clinics run by nurse practitioners.

The spending is part of the Patient Protection and Affordable Care Act.

One in five people visited hospital emergency departments in 2007, according to a new report by the CDC. The report revealed some interesting trends in ED usage that could be useful for clinicians and administrators alike.

While the number of emergency visits is still high, the rate of non-emergency visits to EDs is down. For 2007, only 10% of ED visits by people under 65 were deemed non-urgent.

What’s most interesting is who’s going to the ED. The report found that uninsured patients were no more likely to make non-urgent trips to the ED than those who did have health insurance and a primary care provider.

But people over 65 with insurance were more likely to seek care. That fact indicates that despite the recent health care reform, the rate of visits to EDs is likely to remain high — and probably get worse — as the population ages.

Anecdotal reports indicate that patients have a lot of questions about the health reform law. And they’re asking the people they trust most — their current providers.

Doctors are reporting that discussions of the law’s provisions come up in about half of all patient visits, and add an hour or more to their day.

Key problem: Doctors and other clinicians don’t always have answers. And they may be put in a position of having to explain a law with uncertain outcomes that they personally opposed.

Love or hate the reforms, patient confusion and fear isn’t helping anyone. Doctors have also reported that patients are pushing to have treatments done sooner than they are needed because they fear that the procedure won’t be covered or they’ll face a waiting list if they don’t have it done now.

How are you handling health care reform questions at your organization? Share your insight in the comments.

The initiatives are designed to address a number of public health issues, ranging from smoking to increased exercise — with the ultimate goal being a reduction in the number of people who need additional treatment or hospitalization later.

For example, the FDA will get new authority to regulate tobacco products, restaurants will have to provide nutritional data, and new mothers are due “reasonable” breaks for breast-feeding by their employers. A new federal program will provide communities with funds for bike paths, hiking trails and playgrounds.

Some of the programs more directly affect health care providers: Medicare and Medicaid will provide expanded coverage for things like free physicals, smoking cessation programs for pregnant women, etc. And insurance companies won’t be able to charge co-payments or deductibles for vaccines, recommended screenings and similar preventative care.

On their own, the initiatives are far less controversial than the Patient Protection and Affordable Care Act, as a whole. But skeptics say the increased federal spending won’t save money in the long run.

Meet Dr. Jack Cassell. He’s a Florida urologist who posted this notice on his practice’s front door: “If you voted for Obama…seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”

In the office’s waiting area, patients are further presented with health reform timelines distributed by Republican officials. Above the handouts, another sign reads: “This is what the morons in Washington have done to your health care. Take one, read it and vote out anyone who voted for it.”

Unsurprisingly, some patients complained, and now Rep. Alan Grayson, in whose district the practice resides, has denounced the sign as “sore losers [coming] out in force.”

Cassell has already received a significant amount of press coverage over the incident — with more sure to follow.

For his part, Cassell has said in numerous interviews that he isn’t refusing to treat anyone — no matter what the sign on the door says. At the same time, he said if patients see the sign and decide to go to another doctor, he’s fine with that. He also said that the care he gives to his patients wouldn’t change based on their political views, but that he would prefer not to treat those who were in favor of the health care bill.

Cassell’s practice is located in heavily Republican Lake County, so the effect of the notice on his practice’s bottom line will probably be minimal. And Cassell’s wife is a Republican candidate for county commissioner — presumably, the notice could help bolster her campaign.

Free speech v. Ethics

For health care providers, the situation raises a few questions.

Is it legal?

Probably. Cassell has a right to free speech, and has no legal obligation to treat someone with opposing political views. It would only be illegal discrimination if Cassell’s sign discouraged members of protected classes — race, gender, religion, sexual orientation, etc. — from entering.

However, Rep. Grayson pointed out in one interview that targeting Obama supporters would effect a disproportionate number of members of protected classes, such as African-Americans.

Is it ethical?

We say: probably not. Although Cassell says he’s not turning patients away, the sign on the door literally says, “Go elsewhere.” It’s hard to see how patients with differing political views could feel confident they’d get top-notch care from a doctor who has stated he would rather not treat them.

And certainly, even some patients who agree with Cassell (or are simply apolitical) may not relish having his political views shoved in their faces every time they go for an appointment.

Visiting a doctor isn’t like getting a car tune-up. The nature of the relationship between a doctor and patient requires openness and candor — traits not easily established when the first thing a new patient sees is partisan notices to “go elsewhere.”

What’s your take? Should Cassell leave the sign up to protect his first amendment rights? Or is he exercising his free speech at the price of his patients’ care? Share your thoughts in the comments.