A family of five in which the father has taken care of countless, becoming one of the most well-known primary care doctors in Sumter, found themselves being taken care of by their community Monday night. Clay Lowder, his wife, Kelliegh, and their two children who were home at the time escaped to watch it burn to the ground off St. Charles Road just into Lee County from Mayesville. Lowder founded Colonial Healthcare, a primary and family care practice that has locations in Sumter, Columbia and Manning as well as in five North Carolina cities. Going outside to look for an intruder, he said he smelled the “faintest whisper of smoke.” Instead of a person, he found smoke pouring out of the garage. Lowder is thankful. He’s thankful no one was asleep upstairs. The two-story house, thousands of square feet, was engulfed in 10-15 minutes. They are left with most of their cellphones and the pajamas they were wearing, Lowder his reading glasses and not even a T-shirt on his back.

One dog made it out. The Lowders are high school sweethearts. Their youngest and only daughter, Liza, was home Monday night from college, where she is fulfilling family fandom at Clemson University. She wrote about the family photos, the cherished tangibles that were destroyed Monday night. Clay Lowder is thankful for his family. Lowder said, his voice breaking through tears. As a doctor, he has seen loss. But always from a bedside’s distance. Always with a protective barrier of not knowing first-hand. He said he has friends who lost loved ones this week. Lee County Fire Chief Mike Bedenbaugh said the blaze started in the garage, and investigators are still working to determine the cause. The call came in at 9:45 p.m. The house was 75% involved when they arrived. They had it under control by 11:17 p.m. The Lowders wanted a pond at their dream home. It hosted a baptism and a wedding. On Monday, firefighters pumped its water onto the crumbling home as others shuttled water in from Mayesville. He said the response from the community, their friends, former patients, has been humbling. The loss is deep, the grief heavy, but he is thankful.

Tomas Krusliak, a 27-year-old chef in western Virginia, took on two extra jobs, working some days from 5 a.m. 11 p.m., to pay medical bills after his wife had a miscarriage as the couple tried to have their first baby. “I was used to having insurance where I could go to the doctor and get the treatment I needed,” said Krusliak, who is originally from Slovakia. “It was definitely a shock when I got to the U.S. Many other industrialized nations rely on private health insurance, but few of their citizens face the kind of medical bills Americans routinely do. Fewer than one in 10 patients in Germany and Holland, for example, reported problems getting medical care because of cost, the New York-based Commonwealth Fund found in a 2016 survey. By contrast, four in 10 U.S. 12 months, according to the Times-KFF poll conducted last fall. 5,000 family deductible reported problems affording healthcare. Other academic studies show patients with cancer, epilepsy, arthritis, multiple sclerosis and other serious diseases also delay care or skimp on vital medications when they are required to pay more out of pocket.

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Doctors typically recommend patients with such conditions get regular care to control the disease and prevent complications. This wasn’t how the high-deductible revolution was supposed to play out. Twenty years ago, amid a backlash against HMO restrictions on people’s ability to choose their doctors, high-deductible plans were billed as a way to empower patients and free them from the unpopular constraints of managed care. Even then there were red flags: As far back as the 1970s, a landmark study by the California-based Rand Corp. Backers of the high-deductible strategy nevertheless argued that patients, given “skin in the game,” would become active consumers who would force drugmakers, hospitals and other medical providers to rein in prices. Employers, desperate for a way to control healthcare spending, saw an opportunity to hold down costs. Many of the first companies to offer high-deductible plans gave employees seed money for medical savings accounts, with the idea that the cash would help workers pay their deductibles. Within a few years, the George W. Bush administration — backed later by Congress — carved out tax benefits for the accounts.

As high-deductible plans caught fire, however, many employers saw they could save even more by not contributing to their employees’ accounts. “The idea was hijacked,” said Tony Miller, a Minnesota healthcare entrepreneur who developed some of the first high-deductible plans for large employers like medical device giant Medtronic, but who has since grown disenchanted with how companies shifted costs onto patients. The change left workers responsible for saving for healthcare on their own. Yet government data show that most workers haven’t had extra money to set aside. 2,000 in available savings — including cash, non-retirement stocks, mutual funds and other liquid assets — according to a KFF analysis of government data conducted for The Times. “In the real world, average people are living paycheck to paycheck,” said Helen Darling, the former head of the National Business Group on Health, a leading employer organization focused on health benefits. Moreover, the vision of legions of patients becoming engaged shoppers pushing down prices has turned out to be a mirage. Only 17% of workers say they have attempted to shop around to find the best price for a medical service in the previous year, according to the Times-Kaiser poll.

And doctors, hospitals and clinics continue to make costs nearly impossible for patients to determine, according to consumer advocates, independent research and the Times/KFF survey. Two-thirds of surveyed workers said finding out the cost of a medical treatment or procedure was somewhat or very difficult. Today, most Americans with a job-based health plan still give their insurance good marks. Two-thirds call their coverage excellent or good, according to the Times/KFF poll, which found that workers are primarily grateful to have any coverage. But those with the highest deductibles are substantially less satisfied, with fewer than half giving their plans high marks. Americans with chronic illnesses are more likely than healthy workers to say their insurance has gotten worse in recent years and less likely to feel the system works well for people like them, the poll found. Across the board, large numbers of U.S. “The whole situation drives me nuts,” said Bryan Shirley, a lawyer in Minnesota who said in the past he would question whether he needed to take his children to the doctor because he worried about paying the deductible. Shirley, 46, said he put off medical attention for his sports injuries and at one point put thousands of dollars of medical bills on credit cards. “I know we are better off than most,” he said. A growing number of healthcare officials, and even some corporate leaders, say it’s time to reassess the cost-sharing revolution. “I would love to see us reevaluate the whole purpose of co-pays and deductibles,” said McAneny, the American Medical Assn. president. Even former Utah Gov.

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