Seven Ways to Save Money Under Obamacare, by Cynthia J. Koelker, MD

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With 2014 and the enactment of Obamacare only days away, we’re all wondering what this so-called Affordable Care Act will really cost us.  Will your premiums be higher?  Or your deductible?  Will you lose employer-based coverage?  Will your doctor simply give up and retire? 

But Obamacare is not all bad.  I view it as a wake-up call.  In fact, I wouldn’t be writing this article nor teaching people survival medicine skills if not for our current president. 
People tend to blame Obamacare for all the upcoming health care woes, but many of the looming hassles (from a doctor’s point of view) were in the pipeline long before his tenure, including penalties for not using an electronic health record, the costly conversion to a new coding system, and never-ending threats of Medicare payment cuts to levels far below the cost of care. 

This article is not about finding the cheapest insurance; rather, it’s about decreasing your reliance on the system and learning how to care for yourself as far as possible.  What follows are seven practical ways you can save a trip to the doctor now and how you can help yourself if and when you’re on your own.

  • Sore throats.  Most sore throats are caused by viruses, particularly when associated with hoarseness or a cough, and thus require no antibiotics.  But what if it’s strep?  Wouldn’t you love to be able to test yourself at home?  It turns out you can.  The same Rapid Strep Kits used by doctors are available to you over-the-counter at a very reasonable price.  For as little as $35 you can purchase a box of 25 test kits online, with a listed shelf life of at least 1–2 years (and likely much longer).  The tests are really no more difficult than checking your own blood sugar.  Performed correctly, accuracy (specificity and sensitivity) is on the order of 95%. 

Another way to determine the likelihood of strep throat is by the Centor Criteria.  Each of four symptoms receives a point:  fever, pus on tonsils, tender glands in the neck, and absence of cough.  Then add a point for age <15, or subtract a point for age >44. 
The risk of strep is determined based on total points:
0–1             <10% risk            (no antibiotics indicated)
2–3            15–32% risk            (consider testing, and treat if positive)
4–5            56% risk            (treat with antibiotics)
Currently recommended antibiotics include penicillin and amoxicillin (250 –500 mg 3x daily for 10 days).  Other possible choices are erythromycin, azithromycin, cephalexin, other cephalosporins, or Augmentin. 

  • Bladder infections.  If you’re getting up three times a night to urinate, are you just drinking too much water or is it perhaps a bladder infection?  Again, wouldn’t it be nice to test yourself at home?  Yet again, it turns out you can.  The same test strips doctors use are also available online (Multistix 10 SG or generic equivalent) for $15 to $50 for a box of 100.  If leukocytes (white blood cells) and/or nitrites or blood are present in the urine, an infection is quite likely.  Treatment is directed at drinking plenty of water (aim for 8 glasses a day) and short-term treatment (usually 3 days is sufficient) with an antibiotic such as trimethoprim-sulfamethoxazole, ciprofloxacin, amoxicillin, or amoxicillin-clavulanate.  (This information applies to women only; men with urinary symptoms may have an STD, prostate infection, or a kidney stone.)
  • Ankle injuries.  Say your son twists his ankle, and you wonder if it’s broken.  Do you really need an X-ray?  Not as often as you might think.  The Ottawa Ankle Rules give an excellent estimate of whether or not a bone is likely broken.  An ankle X-ray is only needed if there is any pain in the malleolar zone (ankle bones on either side) PLUS any of the following:
  • Bone tenderness along either ankle bone (right over the bone, or up the leg 2–3 inches)
  • Inability to bear weight for 4 steps BOTH immediately after injury AND in the ER. 

If you can walk on a sprained ankle, odds are quite slim that it is broken. 

Another test is the tuning fork test.  Placing a vibrating tuning fork over a broken bone causes pain, but not so if the ankle is simply sprained. 

A presumed fractured ankle should be splinted a few days with no weight-bearing permitted, then casted after danger of additional swelling is past (total of 6 to 8 weeks).  A sprained ankle should be splinted as well, but with walking permitted as tolerated.

  • Poison ivy.  Most people still think poison ivy is contagious, but it’s not.  And it will resolve on its own by two weeks.  Treatment is only aimed at making the patient more comfortable (unless you’ve inhaled poison ivy smoke or rubbed it in your eyes).  So you don’t have to see a doctor for simple poison ivy, poison oak, or poison sumac.  Over-the-counter hydrocortisone cream can help (and many people swear by jewelweed).  Some doctors will call in a stronger steroid without an appointment.  OTC antihistamines help the itch (Benadryl, Zyrtec, Claritin, Allegra), and are as strong as prescription drugs.  Of all the patients I’ve seen with poison ivy over the years, at most 5% actually needed to see a physician.
  • Ear ache.  Most ear aches don’t require antibiotics or a trip to the doctor.  A few days of pain medication is all that is required in adults and older children with otitis media.  Physicians still prescribe antibiotics at times, but often only to please the patient.  With every rule there are exceptions:  the very ill-looking child, babies, and some children with recurrent ear infections do benefit from antibiotics.  Top antibiotic choices include amoxicillin, amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, cefdinir, and azithromycin.
  • GERD.  Would you rather pay $150 for the “purple pill” or $5 for its first cousin?  It’s not really amazing that a brand-name medication for acid reflux would be so expensive, but rather that a similar generic has dropped in price so quickly.  The “purple pill” is esomeprazole, which decreases the amount of stomach acid produced.  A very similar medication, pantoprazole, does the same job, but the generic is now dirt cheap.  If you are taking prescription Nexium, Aciphex, Prilosec, Prevacid, or Dexilant for heartburn or acid reflux, you may want to switch to this money-saving generic.  Unfortunately, pantoprazole remains by prescription only.  Second-best inexpensive choices would be OTC generic Prevacid or Prilosec.  Checking these online today, I find prices as low as $10 for 60 count 20-mg omeprazole (generic Prilosec) – also a great deal.

And don’t forget that heartburn can be greatly reduced by avoiding aspirin, other anti-inflammatory drugs (ibuprofen, naproxen), tobacco, alcohol, caffeine, spicy foods, fatty, foods, acid foods, and too much food.  (If it tastes good, don’t eat it.)

  • Diabetes.   You can learn to treat diabetes (Type 2) on your own with very little danger of complications [if you closely monitor your blood sugar levels.] Of course, you should begin with a reasonable diet and exercise, but beyond that certain herbs will help a mild case (e.g. cinnamon 1 to 6 grams a day), and OTC insulin may be required for more severe disease.  Anyone can get a blood sugar monitor without a prescription, though the test strips can be costly.  You can also obtain a test kit for hemoglobin A1C for under $10/test on Amazon and elsewhere.  Simple urine strips (see above) aid in testing your urine for protein, ketones, and sugar.  There is more information available free online to anyone than I had access to as a medical student.  Check out aafp.org for dozens of free articles.  Ideally you should work with your own doctor now (while you can) to establish a treatment regimen you can follow and monitor on your own when no doctor’s help is available.

When I teach my Survival Medicine classes, I tell my students that we’re aiming at the 90%, i.e. those with typical problems – not the 10% with severe or unusual conditions.  The foregoing information does not cover every situation, but it does apply to most, and I think 90% is a good place to start. 

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