MONEY Health Care

Why You Should Forget About Ebola and Get a Free Flu Shot Instead

Flu Shot Sign
Getty Images

Americans are nearly as worried about Ebola as they are about catching the flu. But influenza is the risk you should pay attention to. And you probably don't need to spend a penny to protect yourself.

Take a break from worrying about Ebola and get a flu shot this fall. While the Ebola virus has so far affected just four people in the United States, tens of millions are expected to get influenza this season. More than 200,000 of them will be hospitalized and up to 49,000 will likely die from it, according to figures from the Centers for Disease Control and Prevention.

A new HuffPost/YouGov poll of 1,000 adults found that the flu is perceived as only slightly more threatening than the Ebola virus, however. Forty-five percent of people polled said that the flu posed a bigger threat to Americans than Ebola, but a substantial 40% said it was the other way around. Fifteen percent said they weren’t sure.

“Ebola is new, mysterious, exotic, highly fatal, and strange, and people don’t have a sense of control over it,” says William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University.

Influenza, on the other hand, is a familiar illness that people often think they can easily control, Schaffner says. “They think, ‘I could get vaccinated, I could wash my hands’ and prevent it.”

Yet that familiarity may lead to complacency. Flu shots are recommended for just about everyone over six months of age, but less than half of people get vaccinated each year.

Now there’s even more reason to get a shot. The health law requires most health plans to cover a range of preventive benefits at no cost to consumers, including recommended vaccines. The flu shot is one of them. (The only exception is for plans that have been grandfathered under the law.)

The provision making the vaccine available with no out-of-pocket expense is limited to services delivered by a health care provider that is part of the insurer’s network.

Depending on the plan, that could include doctors’ offices, pharmacies, or other outlets.

Medicare also covers flu shots without patient cost sharing.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Health Care

Why You Could Get Stuck Paying for More of Your Health Care

Red traffic light
Your insurer may put a stop to how much it will spend on your surgery. iStock

A growing number of companies are capping what your insurance will pay for certain medical procedures. Get more expensive care, and you could be on the hook for the extra.

Aiming to contain health care costs, a growing number of employers and insurers are adopting a strategy that limits how much they’ll pay for certain medical services such as knee replacements, lab tests and complex imaging. A recent study found that savings from such moves may be modest, however, and some experts question whether “reference pricing,” as it’s called, is good for consumers.

The California Public Employees’ Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees, and their families, has one of the more established reference pricing systems. More than three years ago, the agency began using reference pricing for elective knee and hip replacements, two common procedures for which hospital prices varied widely without discernible differences in quality, says Ann Boynton, CalPERS’ deputy executive officer for Benefit Programs Policy and Planning.

Working with Anthem Blue Cross, the agency set $30,000 as the reference price for those two surgeries in its preferred provider organization plan. Members who get surgery at one of the 52 hospitals that charge $30,000 or less pay only their plan’s regular cost-sharing. If a member chooses to use an in-network hospital that charges more than the reference price, however, they’re on the hook for the entire amount over $30,000, and the extra spending doesn’t count toward their annual maximum out-of-pocket limit, Boynton says.

“We’re not worried about people not getting the care they need,” says Boynton. “They have access to good hospitals, they’re just getting it at a reasonable price.”

In two years, CalPERS saved nearly $6 million on those two procedures, and members saved $600,000 in lower cost sharing, according to research published last year by James C. Robinson, a professor of health economics at the University of California, Berkeley, and director of the Berkeley Center for Health Technology. Most of the savings came from price reductions at expensive hospitals.

The agency recently set caps on how much it would spend for cataract surgery, colonoscopies, and arthroscopic surgery, Boynton says.

Experts say that reference pricing is most appropriate for common, non-emergency procedures or tests that vary widely in price but are generally comparable in quality. Research has generally shown that higher prices for medical services don’t equate with higher quality. Setting a reference price steers consumers to high-quality doctors, hospitals, labs and imaging centers that perform well for the price, proponents say.

Others point out that reference pricing doesn’t necessarily save employers a lot of money, however. A study released earlier this month by the National Institute for Health Care Reform examined the 2011 claims data for 528,000 autoworkers and their dependents, both active and retired. It analyzed roughly 350 high-volume and/or high-priced inpatient and ambulatory medical services that reference pricing might reasonably be applied to.

The overall potential savings was 5%, the study found.

“It was surprising that even with all that pricing variation, reference pricing doesn’t have a more dramatic impact on spending,” says Chapin White, a senior policy researcher at RAND and lead author of the study.

Even though the results may be modest, a growing number of very large companies are incorporating reference pricing, according to benefits consultant Mercer’s annual employer health insurance survey. The percentage of employers with 10,000 or more employees that used reference pricing grew from 10% in 2012 to 15% in 2013, the survey found. Thirty percent said they were considering adding reference pricing, the survey found. Among employers with 500 or fewer workers, adoption was flat at 10% in 2013, compared with 11% in 2012.

The approach is consistent with employers’ general interest in encouraging employees to make cost-effective choices on the job, whether for health care or business supplies, says Sander Domaszewicz, a principal in Mercer’s health and benefits practice.

This spring, the Obama administration said that large group and self-insured health plans could use reference pricing.

The health law sets limits on how much consumers have to pay out of pocket annually for in-network care before insurance picks up the whole tab—in 2015, it’s $6,600 for an individual and $13,200 for a family plan. But if consumers choose providers whose prices are higher than a plan’s reference price, those amounts don’t count toward the out-of-pocket maximum, the administration guidance said.

Leaving consumers on the hook for amounts over the reference price needlessly drags them into the battle between providers and health plans over prices, says White.

“You expect the health plan to do a few things: negotiate reasonable prices with providers, and not to enter into network contracts with providers who provide bad quality care,” White says. “Reference pricing is kind of an admission that health plans have failed on one or both of those fronts.”

Some experts, however, say the strategy can work for consumers.

“What I think is that reference pricing is a choice-preserving strategy, when you look at the alternative, which is a narrow network,” says Robinson.

That may be a question of semantics, if relatively few providers meet the reference price.

Recent guidance from the administration spells out some of the requirements that health plans must meet in order to ensure that there are adequate numbers of high-quality providers if reference-based pricing is used. Among other things, it suggests that plans consider geographic distance from providers or patient wait times.

Like so much about reference pricing, it remains a work in progress. The administration says it will continue to monitor the practice, and may provide additional guidance in the future.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Health Care

How to Save Lots of Money on the Health Tests You Need

Legs on scale at doctor's office
Scott M. Lacey

Catching medical problems early is good for your health—and your wallet. But don't go overboard. Learn to weigh the pros and cons of what the doctor orders.

The latest big push in health care is keeping you from getting sick in the first place. Insurers are sending you reminders to schedule regular exams. Employers are rewarding workers who quit smoking or lose weight. And a key provision in the Affordable Care Act, a.k.a. Obamacare, is full coverage for certain preventive care—with no out-of-pocket costs for you.

Getting a handful of basic tests ­every year can reap rich rewards. “So many diseases, such as hypertension and diabetes, are symptomless in the early stages, when they can be easily caught and controlled,” says Dr. Nieca Goldberg, director of the NYU Women’s Heart Center. So see your primary-care doctor annually once you reach your forties (until then, every two or three years is usually sufficient).

Even though fully covered tests are getting more common, for many ­others you will face co-pays or co-­insurance—and shoulder the full cost until you reach your deductible. To keep those costs to a minimum, we recommend two strategies.

First, look for ways to save on every test you take. Prices can vary widely for the same service, even when you stick with in-network doctors and facilities.

Start by checking your health insurer’s website—many list doctors that insurers believe offer quality care at fair prices. Keep in mind that MRIs, CT scans, and other imaging tests often cost much less at free­standing radiology centers. ­(Just be sure the facility is accredited by the American College of Radiology and that your doc will accept the results.) And when your doctor orders a blood test, ask about all your options, including outside the office. “Labs are so standardized, a $10 lipid panel will get the same results and same quality as a $200 lipid panel,” says Scott Matthews of Castlight Health, which helps big businesses manage their health care costs.

Second, learn which screenings are worth your health care dollars and which you can skip. Here’s what you need to know:

6 Essential Tests for Everyone

1) Skin exam

With skin cancer on the rise, it’s smart to have a dermatologist examine the skin over your entire body, looking for suspicious growths, moles, and lesions.

When to get it: At least once a year. “If you have risk factors, such as being fair, having a lot of moles, or having a family history of skin cancer, you may need to be seen as often as every three to six months,” says Dr. David Leffell, chief of dermatologic surgery at the Yale School of Medicine. You could go to your ­primary-care doctor, but dermatologists are better at diagnosing potentially cancerous lesions, studies show.

Cost: $50 to $150. Insurance covers the visit after you meet your deductible; your usual co-pay or co-insurance will apply.

2) Cholesterol check

This blood test, a.k.a. a lipid panel or profile, reports your total cholesterol, your LDL (“bad”) cholesterol, your HDL (“good”) cholesterol, and a type of fat in the blood called triglycerides. High levels of all but the good stuff raise your risk of heart disease and stroke.

When to get it: Men over 45 and women over 50 should be checked every one to three years, says Goldberg. (Until menopause, women have the protective benefits of estrogen.) At younger ages, test every four to six years. Among the reasons for more frequent screenings: Your results aren’t normal, there’s a family history of heart disease, or you have risk factors like being overweight, you smoke, or you have high blood pressure.

Cost: $110 to $305 for test alone. Cholesterol testing is often included in an annual physical, which insurance covers in full.

3) Blood-pressure check

High blood pressure raises your risk of heart disease, stroke, kidney failure, and other serious conditions.

When to get it: Every two years as part of a routine physical; once a year or more if your pressure is above 120/80.

Cost: $70 to $200 for a doctor’s visit, but insurance pays the full tab for your annual preventive checkups

4) Eye exam

Even if you think your vision is 20/20, have your eyes examined regularly—­especially after 40. As you age, you’re at risk for conditions such as glaucoma, which is symptomless. “An exam can also find signs of another disease that may be affecting your eyes, such as diabetes or high blood pressure,” says Dr. Rebecca Taylor, an ophthalmologist in Nashville and a spokesperson for the American Academy of Ophthalmology.

When to get it: Before age 40, Taylor suggests getting a full exam with an optometrist or ophthalmologist every five to 10 years (yearly if you wear glasses or contacts). After that, make it every two years. Reasons to get more frequent exams include a family history of eye disease, previous eye injuries or surgery, diabetes or high blood pressure, or you are over 65.

Cost: $75 to $200 with an ophthalmologist; $50 to $150 with an optometrist. Insurance coverage varies.

5) A1C blood test

This has become the screening test of choice for diabetes, as it measures your average blood glucose over roughly three months; the fasting blood glucose test tells doctors just what your level is at that moment.

When to get it: The standard recommendation is every three years starting at 45. The American Diabetes Association advises beginning earlier if you’re overweight and have certain risk factors, including high blood pressure.

Cost: $40 to $260 for test. If you have high blood pressure, insurance covers in full.

6) Colonoscopy

This exam is your best defense against colon cancer. While there are other screening tools, a colonoscopy is considered the gold standard: “It doesn’t just diagnose; if the doctor sees adenomas [potentially precancerous polyps], he can remove them then and there,” says Dr. Seth Gross, director of endoscopy at Tisch Hospital at NYU Langone Medical Center.

When to get it: Start at age 50, earlier if you’ve got other risk factors, such as a family history or if you have suspicious symptoms. If the test is negative, get one every 10 years.

Cost: $1,100 to $2,800. Insurance pays every 10 years for adults ages 50 to 75.

4 Essential Tests for Women

Insurance will cover the basic pelvic and breast exams that are part of your annual visit to a gynecologist. Other tests aren’t needed as often—and your insurance coverage will probably reflect that.

1) Pap smear

A Pap smear, also called a Pap test, is when your gynecologist collects cells from your cervix to screen for precancerous changes. Thanks to this test, the cervical cancer death rate declined by almost 70% between 1955 and 1992, according to the American Cancer Society (ACS).

When to get it: Every three years, provided your last test was normal; most women can stop at age 65.

Cost: $75 to $350. Insurance pays in full every three years from ages 21 to 65.

2) Mammogram

There’s been controversy in recent years about when to begin breast cancer screening and how often to do it, but the American Cancer Society and American College of Obstetricians and Gynecologists still recommend getting your first mammogram, an X-ray of your breasts, at 40— earlier if you have risk factors like a family history. Ask your doctor about 3-D mammography, now available at some major medical centers: It reduces false positives and slightly bumps up detection rates, according to a recent JAMA study.

When to get it: Once a year starting at age 40.

Cost: $150 to $375. Screening is covered every one to two years at age 40-plus. Most plans don’t cover more precise 3-D mammograms, so you may owe $40 to $60.

3) DEXA scan for bone density

An X-ray test to measure bone density, this screening is recommended for all women at age 65. But you may want to get one around menopause, when declining estrogen levels increase your risk of osteoporosis.

When to get it: Start at age 65, then consult doctor. With risk factors like smoking and osteoporosis in family, begin at menopause.

Cost: $60 to $385. Insurance pays in full when 65-plus; with preapproval, it often pays for younger postmenopausal women too.

4) HPV (Human – papilloma- virus) test

Typically done at the same time as a Pap, this checks for strains of HPV that are most likely to cause cervical cancer. Before age 30, nearly all sexually active people contract HPV at some point, according to the Centers for Disease Control. Most of the time, HPV is harmless and clears up on its own. But since HPV infection is less common in women over 30, a positive test result is more apt to signal a potential problem.

When to get it: Women ages 30 to 65 should get an HPV test paired with a Pap smear every five years.

Cost: $30 to $125. Insurance pays in full every five years from 30 to 65.

6 Tests You May Need

1) Vitamin D test

Vitamin D helps you absorb calcium and maintain strong bones. Since up to 75% of Americans have low levels (a 2009 study suggests), ask your doctor about adding this to your physical, advises Dr. Marianne Legato, professor emeritus of clinical medicine at Columbia University Medical Center.

Cost: $25 to $150; some, but not all, insurers cover

2) Thyroid-stimulating hormone test

Experts disagree about whether routine thyroid screening is necessary, but make sure to get your blood level of TSH checked if you have fatigue and unexplained weight gain.

Cost: $15 to $115; often covered. Deductible and co-pay or co-insurance apply.

3) Cholesterol particle tests

People whose particles of LDL cholesterol are mostly small and dense have a threefold greater risk of coronary heart disease. Ask your doctor about this test if your cholesterol is borderline, especially if you’re debating whether to go on cholesterol-lowering medications, Goldberg says.

Cost: $15 to $265; not usually covered for routine screening but may be covered in part if you have risk factors.

4) Coronary calcium scan

A CT scan of your heart is used to look for specks of calcium in your arteries that may indicate early signs of coronary artery disease. While this scan is not recommended for everyone, it can be useful if you’ve got a family history or other risk factors. “A score greater than 300 tells us that you’re at increased risk of cardiovascular events in the next five to 10 years,” Goldberg says.

Another heart exam—an exercise stress test—isn’t a useful screening tool if you’re low risk, she adds, due to a high rate of false positives. As a rule, it’s best reserved for people who have risk factors or symptoms such as chest pain or an irregular heartbeat.

Cost: $10 to $300; not usually covered for routine screening, but may be covered in part if you have risk factors.

5) CRP (C-reactive protein) test

This measures blood levels of CRP, an inflammatory protein associated with heart disease. It’s most predictive in men over 50 and women over 60, Goldberg says. In a 2010 study, people in these age groups who were at intermediate risk of heart disease and who had normal cholesterol but high CRP levels benefited from going on cholesterol-lowering medications.

Cost: $10 to $115; not usually covered for healthy patients but often covered in part if you have risk factors.

6) Prostate exam

Screening for prostate cancer used to be a must. Now it’s a maybe. “Intuitively, it makes sense to treat prostate cancers early,” says Dr. Richard Wender, chief cancer control officer at the American Cancer Society. “But some grow so slowly that they’d probably never be life-threatening, and the treatment would be worse for quality of life than the disease itself.” That said, a study published in The New England Journal of Medicine this past March found that men under age 65 who underwent surgery for early-stage prostate cancer (instead of watchful waiting) had better survival rates.

Bottom line: At 50, talk to your doctor about your risks (like a family history). If you decide to undergo a PSA (prostate-specific antigen) blood test and it’s under 2.5 ng/mL, you can wait at least another two years to retest. If it’s over that, test annually.

Cost: $25 to $125 and may be covered by insurance for men older than 50, or starting at age 40 if you face certain risk factors.

 

 

 

TIME 2014 Election

Voters Say Events in U.S. ‘Out of Control’

Poll finds anxiety on a range of issues, from Ebola to health care costs

Call it the Freakout Election.

Two-thirds of likely voters in the most competitive states and congressional districts in the midterm election fight think events in the U.S. are “out of control,” according to a new poll. The survey by Politico found widespread anxiety about the Ebola outbreak, terrorism, health care costs and President Barack Obama’s leadership. Only 36% think the U.S. is “in a good position to meet its economic and national security” challenges.

The poll underscores how both Obama’s low approval ratings and a general sense of disarray are weighing down Democrats just weeks before voters go to the polls to decide which party will control the Senate. A majority of voters, 54%, either strongly disapprove or somewhat disapprove of Obama’s job performance.

Read more at Politico

MONEY Medicare

Some Medicare Advantage Plans Have Hidden Risks—Here’s How to Avoid Them

hands using measuring tape
Nils Kahle

Although they promise quality care at lower cost, some Medicare Advantage plans fall short. Before you enroll, here are key questions to ask.

Seniors have flocked to Medicare Advantage in recent years, attracted by savings on premiums and the convenience of one-stop shopping. But as the annual Medicare enrollment season began this week, a memorandum from federal officials to plan providers surfaced that serves as a big red warning flag.

The upshot: Assess the quality of any Advantage plan before you sign up.

The memorandum, first reported by the New York Times, described ongoing compliance problems uncovered in federal audits of Advantage and prescription drug plans. These include inadequate rationales for denial of coverage, failure to consider clinical information from doctors and failure to notify patients of their rights to appeal decisions. The audits also uncovered problems with inappropriate rejection of prescription drug claims.

Advantage is a managed care alternative to traditional fee-for-service Medicare. It rolls together coverage for hospitalization, outpatient services and, usually, prescription drugs. Advantage plans also cap your out-of-pocket expenses, making Medigap supplemental plans unnecessary.

The savings can be substantial. Medigap plan premiums can cost $200 monthly or more, and stand-alone drug plans will average $39 a month next year. Enrollees have been voting with their wallets: 30% are in Advantage plans this year, up from 13% in 2005, according to the Henry J. Kaiser Family Foundation.

Advantage plans are subject to strict rules and regulations, and must cover all services offered in original Medicare, with the exception of hospice services. Some offer extra coverage, such as vision, hearing, dental and wellness programs.

And there is evidence that the quality of these plans is rising. Medicare uses a five-star rating system to grade plan quality, and plans can earn bonus payments based on their ratings. Average enrollment-weighted star ratings increased to 3.92 for 2015, from 3.86 in 2013 and 3.71 in 2013, according to Avalere Health, an industry research and consulting firm. Avalere projects that 60% of Advantage enrollment will be in four- or five-star plans next year, up from 52% this year.

But the Medicare memorandum focuses on problems outside the rating system. “It’s about basic blocking and tackling and whether a plan adheres to the program’s technical specs,” says Dan Mendelson, Avalere’s chief executive officer. “These are the basic functions that every plan should be able to handle.”

Nevertheless, consumer advocates say they deal with these compliance problems regularly, and more often with enrollees in Advantage than in traditional Medicare.

“The most typical problems have to do with plans that are making it difficult or impossible for people to get their medications,” says Jocelyn Watrous, an advocate for patients at the Center for Medicare Advocacy. “They impose prior authorizations or other utilization management rules that they make up out of whole cloth.”

Consumer advocates urge Medicare enrollees to restrict their shopping this fall to four- and five-rated plans, of which plenty are available in most parts of the country. “If a plan consistently gets four or five stars, all other things being equal it will be a high performer,” says Joe Baker, president of the Medicare Rights Center.

Few Medicare enrollees roll up their sleeves to shop, however. A study by Kaiser found that, on average, just 13% of enrollees voluntarily switched their Advantage or drug plans over four recent enrollment periods. And focus groups with seniors conducted by the foundation last May found that few pay attention to the star ratings.

“Seniors said they don’t use the ratings because they don’t feel they reflect their experiences with plans,” said Gretchen Jacobson, associate director of the foundation’s Medicare program. “Even when we told them that their plan only has two stars, many just wanted to stay in that plan.”

Advocates say the star ratings are just a starting point for smart shoppers.

They say you should check to make sure health providers you want to see are in a plan’s network. You should also consider how you would react if any of those providers disappeared during the 12 months that you are locked into the plan. Advantage plans can—and do—drop providers. UnitedHealth Group, the industry’s largest player, made headlines last year when it dropped thousands of doctors in 10 states. Advantage plans in Florida, Pennsylvania, California and Delaware also terminated provider relationships.

Also be sure to examine the prescription drug “formularies” in your plan—the rules under which your medications are covered. And talk with your doctors about any plan you are considering, especially if you see specialists for a chronic condition.

The Medicare memorandum to plans also underscores the importance of appealing denied claims, Baker says. “Appeal, appeal, appeal—it’s like ‘location, location, location’ in real estate.”

TIME Health Care

The Price of Staying Alive For the Next 3 Hours

Stayin' alive—and cheap at the price
Stayin' alive—and cheap at the price ZU_09; Getty Images

A new study suggests a little spending now can buy you a lot of time later

How much do you reckon you’d pay not to be dead three hours from now? That probably depends. If you’re 25 and healthy, a whole lot. If you’re 95 and sickly, maybe not so much. But for people in one part of the world—the former East Germany—the cost has been figured out, and it’s surprisingly cheap: three hours of life will set you back (or your government, really) just one euro, or a little below a buck-thirty at current exchange rates.

That’s the conclusion of a new study out of Germany’s Max Planck Institute, and it says a lot about the power of a little bit of money now to save a lot of suffering later—with implications for all manner of public health challenges, including the current Ebola crisis.

The new findings are a result of one of the greatest, real-time longitudinal studies ever conducted, one that began the moment the Berlin Wall fell, on Nov. 9 1989. Before that year, there were two Germanys not just politically, but epidemiologically. Life expectancy in the western half of the country was 76 years; in the poorer, sicker east, it was 73.5. But after unification began, social spending in the East began rising, from the equivalent of €2,100 per person per year to €5,100 by the year 2000. In that same period, the difference in lifespan across the old divide went in the opposite direction, shrinking from 2.5 years to just one year as the east Germans gained more time. Crunch those numbers and you get the three extra hours of extra life per person per euro per year.

“Without the pension payments of citizens in east and west converging to equivalent levels,” said Max Planck demographer Tobias Vogt in a statement, “the gap in life expectancy could not have been closed.” Increased public spending, Vogt adds, is often framed as an unfortunate knock-on effect of longer life. “But in contrast,” he says, “our analysis shows that public spending can also be seen as an investment in longer life.”

The idea that generous, tactical spending now can be both a money-saver and lifesaver is one that health policy experts tirelessly make—and that people in charge of approving the budgets too often ignore. Bill Gates often makes the point that $1 billion spent to eradicate polio over the next few years will save $50 billion over the next 20 years, not just because there will no longer be any cases of the disease to treat, but because the global vaccination programs which are necessary just to contain the virus can be stopped altogether when that virus is no more.

As TIME reported in September, British inventor Marc Koska made a splash at the TEDMed conference in Washington DC when he unveiled his K1 syringe—an auto-destruct needle that locks after it’s used just once and breaks if too much force is used to pull the plunger back out. That prevents needle re-use—and that in turn not only reduces blood-borne pathogens from being spread, it does so at a saving. According to the World Health Organization (WHO), $1 spent on K1 syringes saves $14.57 in health care costs down the line—or $280 for a $20 order of the shots.

All across the health care spectrum, such leveraging is possible. Critics of the Affordable Care Act have slammed the law for the cost of the preventative services it provides, and while it’s way too early to determine exactly how successful the law will be, the encouraging stabilization in the growth of health costs suggests that something, at least, is working.

Global health officials are making a similar, though more urgent, preventative argument concerning the Ebola epidemic in West Africa. Americans are rightly jumpy over the few cases that have landed on our shores, but the 1,000 new infections per week that are occurring in the hot-spot nations of Liberia, Guinea and Sierra Leone make our concerns look small. Frighteningly, according to the WHO’s newest projections, that figure will explode to 10,000 cases per week by December if the resources are not deployed to contain the epidemic fast.

“We either stop Ebola now,” WHO’s Anthony Banbury said in a stark presentation to the U.N. Security Council on Sept. 14, “or we face an entirely unprecedented situation for which we do not have a plan.”

Suiting up and wading into the Ebola infection zone is a decidedly bigger and scarier deal than spending an extra euro on public health or an extra dollar for a new syringe. But the larger idea of intervention today preventing far larger suffering tomorrow remains one of medicine’s enduring truths. We lose sight of it at our peril.

TIME health

How Lessons From the AIDS Crisis Can Help Us Beat Ebola

Health officials counsel guests on the p
Health officials counsel guests on the prevention of HIV/AIDS transmission at the Argungu fishing festival in Kebbi State, northwestern Nigeria on March 13, 2008. Hundreds of fishermen from different parts of Nigeria and neighbouring West African countries have started arriving in Argungu fishing Town to participate in the fishing festival. AFP PHOTO / PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images) PIUS UTOMI EKPEI—AFP/Getty Images

Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, D.C.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster

Without urgent action, Ebola could become “the world’s next AIDS,” said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC). HIV/AIDS has killed some 36 million people since the epidemic began, and another 35 million are living with the virus. Is history really about to repeat itself?

It doesn’t have to, if we have the wisdom to learn from past experiences. The tools we need immediately are swift international action, strong leadership, respect for science and broad-based compassion. But once we contain Ebola – and we will – we need new resource commitments and global health strategies to bring the next deadly epidemic under control much more quickly.

We’ve already done some things right. President Obama traveled to CDC headquarters in Atlanta, a rare presidential action, to detail an aggressive offensive against Ebola that includes sending troops and supplies to build health care facilities in Africa. Contrast that with the response to AIDS under President Reagan, who did not mention the epidemic publicly until 1987, six years after people started dying from it. This time around, we’re seeing leadership at the top.

Health officials have also put out a unified message about how Ebola can be transmitted – only through direct contact with bodily fluids. That, too, stands in welcome contrast with HIV, where irresponsible rumors quickly took hold and people worried about sharing toilets seats and touching doorknobs. The importance of educating health care workers and keeping them safe represents a commonality between Ebola and HIV, and must be among our highest priorities. Following the science is the only way we’re going to stop this thing.

Another lesson from HIV is that adequate resources can transform disease outcomes. The President’s Emergency Plan for AIDS Relief (PEPFAR), a $15 billion, five-year commitment under President George W. Bush saved millions of lives around the world. But by contrast, even though the CDC is attacking Ebola with the largest global response in its history, the effort doesn’t come close to having the budget necessary to do all the field work needed to really beat back Ebola. Bipartisan funding support is crucial to enable public health officials to act aggressively.

One lesson that has not been well learned is that we stigmatize people at our own peril. During the AIDS epidemic, we saw an American teenager, Ryan White, expelled from school after he contracted HIV through a blood transfusion. In Dallas, where the first known Ebola victim in the U.S. has died, we hear reports that people of African origin have been turned away from restaurants and parents are pulling their children out of school. Cries to ban flights from Ebola-affected countries — an ineffective strategy reminiscent of the 22-year ban on the entry of HIV-positive people into the U.S. — are growing louder.

Experience tells us that when we are driven by fear, we tend to push infected people underground, further from the reach of the health-care system and perhaps closer to harming others. There was a time when many people assumed every gay man could spread AIDS; now some are suspicious that anyone from West Africa could harbor a deadly virus. Acting on ignorance is the best way to disrupt an optimal public health response.

We should look to other infectious diseases for lessons as well. After severe acute respiratory syndrome (SARS) surfaced in China in 2002 and spread to more than 30 countries in just a few months, an aggressive, well-coordinated global response averted a potential catastrophe. We saw how much could be done when political and cultural differences were set aside in favor of cooperation. SARS also spurred the World Health Organization (WHO) to update its International Health Regulations for the first time in 35 years, and prompted many countries to strengthen their surveillance and response infrastructure, including establishing new national public health agencies.

But glaring gaps remain in the health care and public health systems of many nations, despite years of warnings from almost anyone who has taken a careful look at them. With a population of 4 million, Liberia has only 250 doctors left in the country. That’s more than just Liberia’s problem, because if we can’t contain the Ebola epidemic there, we’re at much higher risk here. And within our own borders, we have a public health system that the Institute of Medicine termed “neglected” back in 2002. That assessment was largely unchanged a decade later when the IOM said that “public health is not funded commensurate with its mission” in the U.S.

The international community dragged its feet far too long on Ebola, and as a result, the virus still has the upper hand, outpacing the steps finally being taken to defeat it. Sierra Leone has just 304 beds for Ebola patients and needs almost 1,500 right now; by next week, it will need more. When it comes to control and prevention, speed is paramount. With the epidemic doubling every three weeks, the actions we take today will have a much greater impact than if we take those actions a month from now.

When we finally subdue this epidemic, we also need to shed our complacency towards the infectious diseases that plague us still, and the new ones likely to arrive with little warning. In a globalized world, they remain an immense threat. Almost 50,000 new HIV infections occur in the United States every year, as do 2 million worldwide. Influenza kills thousands of people annually, and more virulent strains can be much more dire. Yet we shrug most of this off, rarely paying attention until blaring headlines announce an impending cataclysm.

To get ahead of the curve, we need a renewed commitment to research and action, and enough resources to put more public health boots on the ground, both at home and abroad. Greater support for the Global Health Security Agenda, designed to close gaps in the world’s ability to quell infectious disease, should be a priority. The agenda, launched earlier this year, is a partnership involving the U.S. government, WHO, other international agencies and some 30 partner countries.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster, and then stepping in to prevent it from getting even worse. We can’t afford to keep repeating that pattern, and squandering blood and treasure in the process.

Ebola is a humanitarian crisis, but it does not belong to West Africa alone. We are all in this together.

 

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Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, DC. She served from 2009 to 2013 as Chief Public Health Counsel with the Committee on Energy and Commerce in the U.S. House of Representatives. Ms. Katz was the lead Democratic committee staff on the public health components of the health reform initiative passed by the House of Representatives in November 2009. Prior to her work with the Committee, Ms. Katz was the Walter G. Ross Professor of Health Policy of the School of Public Health and Health Services at The George Washington University. She served as the dean of the school from 2003 to 2008. This article also appears in the Aspen Journal of ideas.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

CDC to Send Dallas Healthcare Worker Infected with Ebola to Special Hospital

CDC Atlanta Ebola
Exterior of the Center for Disease Control (CDC) headquarters in Atlanta on Oct. 13, 2014. Jessica McGowan—Getty Images

Officials are weighing the possibility in the wake of failures in Dallas, but there is only room for 19 patients

Thomas Eric Duncan, the first Ebola case diagnosed in the U.S., was a warning to hospitals that a patient infected with the deadly virus could walk into their emergency room at any time. Hospitals from New York City to Seattle are now running Ebola drills, testing their staffs to ensure they are prepared to diagnose the disease without putting healthcare workers at risk of contracting it.

“Every hospital in the country needs to be ready to diagnose Ebola,” Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention (CDC), said at a news conference on Tuesday.

The question is whether every hospital is equipped to care for a patient who tests positive for the disease, which has killed nearly 4,500 people in West Africa. During this outbreak, the most deadly since the disease was first discovered in 1976, the mortality rate is about 70%, according to statistics compiled by the World Health Organization. Health care workers are at particular risk for infection, which is transmitted through contact with a symptomatic patient’s bodily fluids, like blood or vomit.

Those risks have been born out in Texas Health Presbyterian Hospital in Dallas, where Duncan was admitted on Sept. 28 and died on Oct. 8. Early Wednesday, the hospital said a second healthcare worker who administered care to Duncan had tested positive for the disease. The hospital’s stumbles have prompted critics to question whether the additional infections were avoidable—and whether future patients should be cared for at specialized hospitals with the expertise and facilities to treat Ebola cases.

Frieden said Tuesday that the second healthcare worker would be transported to Emory University Hospital in Atlanta, which has a specialized isolation unit for treating diseases like Ebola and has successfully cared for patients with the virus in the past.

Some doctors say moving future Ebola patients to specialized hospitals makes sense. “Given some of the complexities, patients who have this disease are probably best cared for by those who have experience caring for it, and whose healthcare workers are highly trained and drilled in self-protection,” says Dr. Gabe Kelen, the director of the Johns Hopkins Office of Critical Event Preparedness and Response. “It’s not appropriate to think that each and every hospital in the country could bring the resources, the intense training for the healthcare workers that is required.”

There are four hospitals in the U.S. with special isolation units designed to contain biohazards like Ebola. In addition to Emory, they are the National Institutes of Health Clinical Center, in Bethesda, Md., a hospital at the University of Nebraska in Omaha and St. Patrick Hospital in Missoula, Mt. The facilities in Atlanta and Omaha have successfully treated Americans infected with Ebola overseas without any healthcare workers contracting the virus.

Though transporting future cases to these facilities may be prudent, they have limited beds: only 19 between them, according to CNN. Exclusively using specialized hospitals to treat Ebola is only an option so long as the number of cases in the U.S. remains extremely low.

A CDC spokesman said the agency may announce further measures for Ebola on Wednesday.

-Additional reporting by Zeke J. Miller

TIME justice

Supreme Court Halts Some Texas Abortion Restrictions

A group from Texas display their flags during a rally on the Mall for the March for Life anti-abortion demonstration on Jan. 22, 2014.
A group from Texas display their flags during a rally on the Mall for the March for Life anti-abortion demonstration on Jan. 22, 2014. Tom Williams—Roll Call/Getty Images

Justices suspended key parts of a law that has closed all but eight facilities providing abortions in the Lone Star state

The Supreme Court on Tuesday blocked key parts of a 2013 law in Texas that had closed all but eight facilities providing abortions in America’s second most-populous state.

In an unsigned order, the justices sided with abortion rights advocates and health care providers in suspending an Oct. 2 ruling by a panel of the New Orleans-based U.S. 5th Circuit Court of Appeals that Texas could immediately apply a rule making abortion clinics statewide spend millions of dollars on hospital-level upgrades.

The court also put on hold a separate provision of the law only as it applies to clinics in McAllen and El Paso that requires doctors at the facilities to have admitting privileges at nearby hospitals. The admitting privileges remains in effect elsewhere in Texas.

Justices Samuel Alito, Antonin Scalia and Clarence Thomas said they would have ruled against the clinics in all respects.

The 5th Circuit is still considering the overall constitutionality of the sweeping measure overwhelmingly passed by the GOP-controlled Texas Legislature and signed into law by Gov. Rick Perry last year.

But even as it weighs the merits of the law, the appeals court said that it can be enforced in the meantime — opening the door for the emergency appeal to the Supreme Court.

The 5th Circuit decision had blocked an August ruling by Austin-based U.S. District Judge Lee Yeakel, who had found that requiring hospital-style upgrades was less about safety than making access to abortion difficult. Yeakel’s ruling temporarily suspended the upgrade rules before they could go into effect Sept. 1 — and the order from the Supreme Court means they are on hold again.

Allowing the rules on hospital-level upgrades to be enforced — including mandatory operating rooms and air filtration systems — shuttered more than a dozen clinics across Texas.

Until the nation’s highest court intervened, only abortion facilities in the Houston, Austin, San Antonio and the Dallas-Fort Worth areas remained open. And none was left along the Texas-Mexico border or outside any of the state’s largest urban areas.

Some other clinics, meanwhile, had closed even earlier amid enforcement of the rule on admitting privileges at nearby hospitals. That portion has already been upheld twice by the appeals court.

The fight over the Texas law is the latest over tough new abortion restrictions that have been enacted across the country. The office of Texas Attorney General Greg Abbott, a Republican who is the favorite in next month’s governor’s race, is leading the defense of the law.

Critics call the measure a backdoor effort to outlaw abortions.

Attorneys for the state have denied that Texas women would be burdened by fewer abortion facilities, saying nearly 9 in 10 would still live within 150 miles of a provider. The law’s opponents, however, note that still leaves nearly a million Texas women embarking on drives longer than three hours to get an abortion.

Democrat Wendy Davis launched her campaign for governor behind the celebrity she achieved through a nearly 13-hour filibuster last summer that temporarily blocked the law in the state Senate.Justices stop parts of Texas abortion law

MONEY health insurance

Why You May Have to Spend More on Health Care Next Year

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Larry Washburn—Getty Images/fStop

When open enrollment kicks off at your workplace this fall, you should see only modest premium hikes. But you'll also come across more plans with higher out-of-pocket costs and surcharges to cover your spouse.

Fall is enrollment season for many people who get insurance through their workplace. Premium increases for 2015 plans are expected to be modest on average, but the shift toward higher out-of-pocket costs overall for consumers will continue as employers try to keep a lid on their costs and incorporate health law changes.

Experts anticipate that premiums will rise a modest 4% in 2015, on average, slightly higher than last year but lower than typical recent increases.

“That’s really low,” says Tracy Watts, a senior partner at benefits consultant Mercer.

Even so, more employers say they’re making changes to their health plans in 2015 to rein in cost growth; 68% said they plan to do so in 2015, compared with 55% just two years earlier, according to preliminary data from Mercer’s annual employer benefits survey.

They are motivated in part by upcoming changes mandated by the health law. Starting in January, companies that employ 100 workers or more generally have to offer those who work at least 30 hours a week health insurance or face penalties.

“The more people you cover, the more it’s going to cost,” says Watts.

In addition, experts say, employers are ramping up efforts to avoid a 40% excise tax on expensive health plans—those with premiums that exceed $10,200 for individuals or $27,500 for families—that will take effect in 2018.

More employees can expect to be offered high-deductible health plans linked to health savings accounts or health reimbursement arrangements in 2015. Nearly three-quarters of companies with more than 1,000 workers offer such plans, according to the 2014 Towers Watson/National Business Group on Health employer health care survey. Nine percent said they planned to add them in 2015.

For a growing number of employees, those plans may be the only ones available through work. For 2015, 30% of large employers said they expected to offer only an account-based plan to workers, nearly double the percentage that did so in 2014, the Towers Watson/NBGH survey found.

For some consumers, however, those plans raise concerns about the cost of care. A new survey by The Associated Press and the NORC Center For Public Affairs Research found that people with high deductible plans were twice as likely as those with traditional health insurance to report that they did not go to a doctor when sick or injured because of concerns about the costs.

When employers shift toward plans with higher deductibles, they often try to sweeten the deal for employees by offering to put money into the financial accounts to help defray the workers’ increased cost, says Brian Marcotte, president and CEO of the National Business Group on Health. The extra cash—an average $600 per employee—is often tied to wellness activities such as agreeing to get health screenings, says Marcotte. As employees evaluate their health plan offerings this fall, it’s worth checking to see if such incentives are offered.

Also this year, workers may find it increasingly expensive to cover their spouses, especially if they have coverage available through their own jobs.

Employers have been increasing workers’ costs to cover dependents, including spouses, in recent years. Nearly half of employers say they’ve hiked employee contributions for dependent coverage, and another 19% plan to do so in 2015, according to the Towers Watson/NBGH survey. Upcoming increases are particularly aimed at spouses, including $50 to $100 monthly surcharges for spousal coverage, says Sandy Ageloff, a senior consultant at benefits consultant Towers Watson.

“Legally under the Affordable Care Act, plans can’t exclude coverage for kids,” says Ageloff. “But they’re really trying to shift the onus back on to spouses.”

This fall, employees who work for small businesses may see fewer changes in their coverage than those who work for large companies. In March, the Obama administration announced that individuals and small businesses with plans that didn’t comply with health law coverage and cost requirements could be extended until 2017.

As many as 80% of companies with up to 50 employees opted to renew their non-compliant plans for 2014, says David Chase, national health care policy director at the Small Business Majority, an advocacy group. A similar percentage will likely try to do so this year as well, he says.

“That’s going to be a popular option for folks, if their states allow it,” Chase says. It’s up to states to determine whether insurers can continue to sell small group plans that don’t meet the requirements of the health law.

There could be a downside, however. “Sticking with the same plan doesn’t mean sticking with the same premium,” Chase says. “Those premiums could go up more than ACA-compliant plans.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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