Good News about Health Reform - Sort Of. by Anthony Russo MD in the Pflugerville Newspaper

     Every American, etc. gets coverage for preventive health care... as long as the test has been deemed to have a Grade A or B rating by the U.S. Preventive Services Task Force. (Remember their controversy last year - not recommending mammograms or even women to do self breast exams.) The "Patient Protection" and "Affordable" Care Act(quotes added) mandates that all insurance plans cover certain preventive care services without any co-pays or deductibles. That sounds good ... maybe: preventing problems may end up costing less… maybe).     Let's look in detail at one preventive service. You might ask yourself; do I need to know what my cholesterol is? That depends, according to USPSTF (let's shorten it to TF - here referred to as “the force” ) If you are the right gender and age and have been deemed by TF to have the right degree of risk factors, then yes.

     So a 35 year old man has the right to be tested. However, TF says it is only necessary to do the total cholesterol and the good HDL cholesterol. The Force has evidence that there is no need to find out levels for: LDL (bad cholesterol), Triglycerides, etc. This young man could actually have found out his cholesterol at age 21 if he had one of these risk factors:

- diabetes (not borderline diabetes, even if his doctor thinks it is important)
- obesity (the BMI must be 30; if you put your weight in your belly, a big risk for diabetes, but you are not quite obese, then not deemed a risk factor.
- smoking
- high blood pressure
- heart disease
- family history of heart disease only if the male relative was under 50 y.o.(or female under 60)
     What about screening women for cholesterol. The Task Force does not give a grade A or B rating for women, unless they have one of the above risk factors. They recommend women never knowing their cholesterol level unless at risk, NEVER, EVER! What if your doctor ( I mean “health care prescriber” ) wants to do this simple $5 blood test because of multiple borderline factors. Let’s look at this person:
-a 60 y.o. woman who never had a cholesterol check in her life
     She could have the combination of borderline risk factors for heart disease: her glucose A1c level is 6.4 (not quite 6.5 level of diabetes), she is almost obese with a BMI of 29 (not 30), her parents had cardiovascular disease but not within the guidelines, father’s heart attack was at 51 y.o. (over 50) and mother’s stroke was at 61 y.o. (not 60). She heard that high cholesterol and diabetes runs in the family.
     The health reform plan would not cover it since the Task Force does not give her case a Grade of A or B.     Hopefully there will be even more “protection” when it comes to lab charges. Now, the lab sends the full charge of about $100 for cholesterol; when the insurance plan approves of the test, the lab accepts the discounted payment of about $5 as fully paid. Once insurance does not allow it, the lab is obligated to bill the patient the full $100!     Hopefully, insurance plans allow doctors to do tests they feel are necessary. Not everybody is a “Straight A” patient