Drug prices

[PcflEZFlng]

Current system is providing a choice - I can go to a better doctor or getting my surgery scheduled sooner.

"The rest of world" which pays roughly 1/2 of what we do are not all single payer systems. Our high costs are not the result of not having a single payer. Take Singapore as an example. It is a first world country and with higher per capita income than the US. Their health care cost is lower than the US. They have public and private hospitals and clinics. Private hospitals/clinics are unsubsidized and anyone who can afford can go there, whether it is private pay or through purchased health insurance. Public hospital and clinics charge by tiers. If you want to stay at a lower tier class, say B class with 4 person room, you can pay an unsubsidized rate or get a subsidized rate with proof of lower income. "A" class in a public hospital is not subsidized but cheaper than private hospital. In a public hospital, you get the same specialist / surgeon who will treat you regardless of whether you are in a A, B or C class bed. If I need a bypass heart surgery and with low income, I will stay in C class room but with the same top surgeon while paying close to none for the surgery.

Good post. We do indeed have choices among providers. However, I wouldn't characterize what we have as a purely market-driven system, either, as some do. There are mechanisms at work that keep our prices for medical care much higher than they should be in a true marketplace. As your post illustrates, we shouldn't get caught up in debating whether we have, or should have, a 'socialist' or 'capitalist' system - since we don't really have either one universally, but we should instead look at the nuts-and-bolts of what other countries, such as Singapore, are doing that balance keeping costs under control while providing choice. Heaven knows we have plenty of examples to look to.

 

[geekette]

$18K out of network deductible

hard to find words.

 

[Fredflintstone]

And then there’s this. We just moved here and intended to use this pharmacy for hubby’s high blood pressure meds as they are a preferred pharmacy for his Part D plan. Bad enough there’s been issues getting it for over a year due to recalls. Mail order and physical stores. Now this. Things are getting worse and worse every day. What are the hell are people suppose to do? https://www.laconiadailysun.com/new...cle_46f68f68-4f71-11ea-b754-d3b0099737f7.html

Geez.

That’s enough to raise ones blood pressure.

Why not take a trip to a Mexican Border town?


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[isisdave]

Well, did you see the news and TV stories about some company or insurer in Utah that pays to fly its patients from SLC to San Diego, taxis them across the border to Tijuana, has them get their meds there, and pays them $500 for their trouble, all because it's cheaper than supplying the med in the US themselves? I think the state is the employer. Story link here.

If they can figure out a legal way to do it, I'd be happy to drive down one day a week and mule the stuff back for them.

I switched from one very low priced Wellcare med plan last year to an even lower new one this year. Even though it's the same company, they continued taking payment for last year's plan via autopay until I shut that off. Trying to get a refund for the two months but "it'll happen automatically." Yeah.

Also, the new plan has a different preferred pharmacy. Last year they wanted me to go to CVS (which does their mail-order through Caremark) but this year it's the neighborhood Ralphs. And strangely, I can get 90-day fills of statins and BP meds at Ralphs for the same (free) price as mail order, which I don't think was true last year.

 

[am1]

A waste of time and resources for subpar results. Not sure the solution but it’s not Obamacare.

 

[pedro47]

IMO, all these pharmaceutical companies outside of the United States needs to be closed and force to return to the United States. Pharmaceuticals employers needs to pay a decent wage to American workers to protect Americans. IMHO.

 

[Talent312]

Enough politics, peep... What should and should not be is not helpful.
Sorry. It is what it is. Now, to deal with the situation at hand...

I just picked up a 90-day supply of a brand-name drug becuz my Medicare drug plan ($435 deductible) kicks in next week. So, if nothing else, I'll get a brief grace-period before I start paying thru the nose. However, I'm gonna save a ton over my current health insurance premium (~$700/month) , so I'll grin and bear it.
.

 

[Brett]

IMO, all these pharmaceutical companies outside of the United States needs to be closed and force to return to the United States. Pharmaceuticals employers needs to pay a decent wage to American workers to protect Americans. IMHO.

I suppose you could say that about any manufacturer, pharmaceutical or otherwise.
But passing laws to force companies to only manufacture in the US and to pay a "decent" wage to "protect" Americans - I'm not sure that would lower drug prices or even be possible or desirable

 

[pedro47]

Enough politics, peep... What should and should not be is not helpful.
Sorry. It is what it is. Now, to deal with the situation at hand...

I just picked up a 90-day supply of a brand-name drug becuz my Medicare drug plan ($435 deductible) kicks in next week. So, if nothing else, I'll get a brief grace-period before I start paying thru the nose. However, I'm gonna save a ton over my current health insurance premium (~$700/month) , so I'll grin and bear it.
.

You are only paying $700 per month for health insurance premiums, try over $900 per month for two (2) LOL.

 

[bogey21]

Heck I have traditional Medicare + Supplement + Prescription Drug Plan and it costs me about $5,000 per year (416 per month). The big hit is what they deduct from my Social Security for Plan B, Plan D and IRMMA. Medicare isn't the "Free Lunch" many in the public believe...

George

 

[bluehende]

Heck I have traditional Medicare + Supplement + Prescription Drug Plan and it costs me about $5,000 per year (416 per month). The big hit is what they deduct from my Social Security for Plan B, Plan D and IRMMA. Medicare isn't the "Free Lunch" many in the public believe...

George

You made me look it up. In 2018 medicare paid 11,200 per person enrolled. I do know that medicare has a lower overhead than the insurers do. so 2 yrs medical inflation and hgiher overhead would bring it to over 15000 as a good guess. Certainly not a free lunch but a pretty good senior discount.

 

[VacationForever]

Heck I have traditional Medicare + Supplement + Prescription Drug Plan and it costs me about $5,000 per year (416 per month). The big hit is what they deduct from my Social Security for Plan B, Plan D and IRMMA. Medicare isn't the "Free Lunch" many in the public believe...

George

$5,000 is free lunch to me. I am 8 years away from Medicare and I pay $14,000 in a normal year between premiums, co-pay and cheap medicine, i.e. no hospitalization or major procedure and expensive medicine. I expect that number to go to $20,000 when I reach 64.

 

[pedro47]

$5,000 is free lunch to me. I am 8 years away from Medicare and I pay $14,000 in a normal year between premiums, co-pay and cheap medicine, i.e. no hospitalization or major procedure and expensive medicine. I expect that number to go to $20,000 when I reach 64.

I feel that is outrageous especially in the free world.

I will stop complaining.

 

[rosebud5]

I just don't get in. Everyone agree's that health care is a top priority for them. The cost of medication, hospital stays, etc., doesn't really resonate with many until something bad happens and you recognize how out of touch our health care system is with the average person. Why do we allow this to happen? We elect our leaders. This is the one thing we all have in common. I have always been fairly healthy, had decent insurance through Uncle Sam and within the last six month, I have had kidney stone surgery (still have a 10 mm rock in my kidney), been diagnosed with arthritis and my wife had a stroke 3 weeks ago. This has opened my eyes. This could potentially break some people financially if they lacked good insurance. I'm one of the lucky ones. The question I keep asking myself as we get closer to the 2020 elections: has capitalism gone too far or do we do what most civilized societies around the world have done and fix our health care system and make drugs more affordable to everyone.

 

[WVBaker]

I just don't get in. Everyone agree's that health care is a top priority for them. The cost of medication, hospital stays, etc., doesn't really resonate with many until something bad happens and you recognize how out of touch our health care system is with the average person. Why do we allow this to happen? We elect our leaders. This is the one thing we all have in common. I have always been fairly healthy, had decent insurance through Uncle Sam and within the last six month, I have had kidney stone surgery (still have a 10 mm rock in my kidney), been diagnosed with arthritis and my wife had a stroke 3 weeks ago. This has opened my eyes. This could potentially break some people financially if they lacked good insurance. I'm one of the lucky ones. The question I keep asking myself as we get closer to the 2020 elections: has capitalism gone too far or do we do what most civilized societies around the world have done and fix our health care system and make drugs more affordable to everyone.

Let's hope this doesn't sway to close to the 2020 election.

 

[Brett]

I just don't get in. Everyone agree's that health care is a top priority for them. The cost of medication, hospital stays, etc., doesn't really resonate with many until something bad happens and you recognize how out of touch our health care system is with the average person. Why do we allow this to happen? We elect our leaders. This is the one thing we all have in common. I have always been fairly healthy, had decent insurance through Uncle Sam and within the last six month, I have had kidney stone surgery (still have a 10 mm rock in my kidney), been diagnosed with arthritis and my wife had a stroke 3 weeks ago. This has opened my eyes. This could potentially break some people financially if they lacked good insurance. I'm one of the lucky ones. The question I keep asking myself as we get closer to the 2020 elections: has capitalism gone too far or do we do what most civilized societies around the world have done and fix our health care system and make drugs more affordable to everyone.

it's not just drugs
Healthcare is very profitable for hospitals, insurers and doctors
https://www.amazon.com/American-Sickness-Healthcare-Became-Business/dp/1594206759

 

[Rolltydr]

I just don't get in. Everyone agree's that health care is a top priority for them. The cost of medication, hospital stays, etc., doesn't really resonate with many until something bad happens and you recognize how out of touch our health care system is with the average person. Why do we allow this to happen? We elect our leaders. This is the one thing we all have in common. I have always been fairly healthy, had decent insurance through Uncle Sam and within the last six month, I have had kidney stone surgery (still have a 10 mm rock in my kidney), been diagnosed with arthritis and my wife had a stroke 3 weeks ago. This has opened my eyes. This could potentially break some people financially if they lacked good insurance. I'm one of the lucky ones. The question I keep asking myself as we get closer to the 2020 elections: has capitalism gone too far or do we do what most civilized societies around the world have done and fix our health care system and make drugs more affordable to everyone.

I’m with you, @rosebud5. A person’s health is not solely based on their life choices. Much of it is DNA. Many times, health is affected by accidents of various kinds (automobile, skiing, falls, etc.). I spent 12 days in the hospital with salmonella I contracted at a local restaurant. As we continue to learn every year, new viruses spring up that can cause severe illness and death. A person’s access to treatment for life threatening illnesses or accidents, should not be dependent on their economic status.

 

[CanuckTravlr]

I just read through this thread. Some of the terminology I don't even understand because I have never had to deal with it. I shake my head at the cost and complexity and am just thankful that I don't have to deal with any of this.

 

[joestein]

hard to find words.

For many it is even harder to find the money. Thankfully, it will not break us.

 

[simpsontruckdriver]

The uneducated (aka they can learn if they want) anti-single-payer always say Canadians are coming to the USA for treatment as a reason why we should have our exorbitantly-expensive healthcare. The truth is, America's healthcare system is the "best money can buy". And specialists set up shop in the USA because they can make a ton more than in their home country. So, a Canadian specialist (let's say Pediatric Oncologist) comes to America to make a ton more. A kid in Canada is diagnosed with some cancer, and no one near the kid deals with childhood cancer. So, the kid comes to the USA to get treatment.

On the other hand, I knew a Canadian lady whose cancer spread to most of her body. It came to the point where she was in the hospital at least 3 times a week, and the rest of the month, she was in a nursing home. For almost 2 years, she was not home. She had the best doctors, but chemotherapy and radiation did not help. Her family did not pay for anything, except for her funeral. Did the doctors go broke? No. Did the hospital go broke? No. Did the pharmacy go broke? No. Other Canadians I know get medical care when needed, there is no backlog if they're sick. But getting physicals and other non-emergency stuff, they may have to wait a week. Unlike Americans, who sometimes have to decide between life-sustaining medicines and food.

As a health insurance agent, I would love to see America simply expand Medicare to everyone. Then, they would have a choice between Medicare PFFS (basic Medicare), a Supplement for extra cost, or Medicare Advantage if they want to save money. That would allow Health Insurance agencies to stay in business, since MAPDs and MediGap plans are run by insurance agencies and employ thousands. If 350,000,000 Americans pay $150/month, Medicare will bring in $52.5 Billion. That's more than enough to give Americans low-cost healthcare. And yes, that is per person. So, if you had a choice between your high deductible plan and a zero-deductible HMO or PPO for $150/month/person, I think most would choose the Medicare plan. On the other hand, front-runners in the Democratic side want to eliminate all private insurance to become like Canada or the UK, which will put hundreds of thousands of insurance workers (agents all the way up to CEOs) out of work.

TS

 

[SmithOp]

Its more than just $150/month though right? The proposal I’ve read includes raising the medicare tax on wages to 4%.

I’m not opposed to raising the medicare tax, since I’ve paid it for 40 working years, and now that I’m on Medicare I pay the monthly cost, so it seems fair for seniors to expect the working people under 65 to pay a little more.


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[PcflEZFlng]

Part of the issue is the fragmented nature of the way we pay for our healthcare, and it divides our thinking as a result. I read or hear variations of the following over and over: "Well, *my* healthcare is fine, because *I* (get it through my employer/have a good insurance plan/saved *my* $$$)/have a wonderful doctor/etc.), so *I* think things are fine the way they are." As a result, collectively we don't consider the public good and how that can benefit us in the long run, instead of looking only at our own narrow self-interest.

 

[VacationForever]

~$150 per month is what basic Medicare costs currently. The issue is that it costs alot more and Medicare pays the difference, funded through payroll taxes. To expand Medicare for all, where do you find the money and hence the trillion dollars question. I am all for allowing those below 65 to buy into Medicare at say $700 a month or whatever the true cost is. Because Medicare is well negotiated, it costs less than other private or group insurances. $700 per month is much better than the $1500 per month when I buy at the age of 64.

 

[bluehende]

The uneducated (aka they can learn if they want) anti-single-payer always say Canadians are coming to the USA for treatment as a reason why we should have our exorbitantly-expensive healthcare. The truth is, America's healthcare system is the "best money can buy". And specialists set up shop in the USA because they can make a ton more than in their home country. So, a Canadian specialist (let's say Pediatric Oncologist) comes to America to make a ton more. A kid in Canada is diagnosed with some cancer, and no one near the kid deals with childhood cancer. So, the kid comes to the USA to get treatment.

On the other hand, I knew a Canadian lady whose cancer spread to most of her body. It came to the point where she was in the hospital at least 3 times a week, and the rest of the month, she was in a nursing home. For almost 2 years, she was not home. She had the best doctors, but chemotherapy and radiation did not help. Her family did not pay for anything, except for her funeral. Did the doctors go broke? No. Did the hospital go broke? No. Did the pharmacy go broke? No. Other Canadians I know get medical care when needed, there is no backlog if they're sick. But getting physicals and other non-emergency stuff, they may have to wait a week. Unlike Americans, who sometimes have to decide between life-sustaining medicines and food.

As a health insurance agent, I would love to see America simply expand Medicare to everyone. Then, they would have a choice between Medicare PFFS (basic Medicare), a Supplement for extra cost, or Medicare Advantage if they want to save money. That would allow Health Insurance agencies to stay in business, since MAPDs and MediGap plans are run by insurance agencies and employ thousands. If 350,000,000 Americans pay $150/month, Medicare will bring in $52.5 Billion. That's more than enough to give Americans low-cost healthcare. And yes, that is per person. So, if you had a choice between your high deductible plan and a zero-deductible HMO or PPO for $150/month/person, I think most would choose the Medicare plan. On the other hand, front-runners in the Democratic side want to eliminate all private insurance to become like Canada or the UK, which will put hundreds of thousands of insurance workers (agents all the way up to CEOs) out of work.

TS

Two things I will add. Wait times in the US are not all that great either. Trying to get to a specialist can be a long wait. I just went through a bout with skin cancer. From diagnosis to removal was 2 1/2 months. I called other surgeons and could not get a quicker first appointment than I did in the dermatology practice I was in. While not an emergency skin cancer is not something you can wait on either. Second I have had a lot of interaction with those insurance workers. Let em go.

 

[Fredflintstone]

Two things I will add. Wait times in the US are not all that great either. Trying to get to a specialist can be a long wait. I just went through a bout with skin cancer. From diagnosis to removal was 2 1/2 months. I called other surgeons and could not get a quicker first appointment than I did in the dermatology practice I was in. While not an emergency skin cancer is not something you can wait on either. Second I have had a lot of interaction with those insurance workers. Let em go.

You are right. The US has wait times.

What you should know is if someone in Canada needs a certain specialist and they are located in the US, the patient is taken to this specialist and it’s all paid for by Provincial healthcare. I have a friend who has a rare form of stomach cancer and they were flown to LA by the system to receive specialized care...no cost to them.

What I see as disconcerting is the US spends more GDP on healthcare yet folks pay through the nose. I am all for making money BUT when lives are at stake it should be affordable. Why my American friends need to crawl to a Mexican town to get their life saving drugs is just plain wrong. Something has to give.

US Healthcare 18 percent of GDP

American Health Care: Health Spending and the Federal Budget | Committee for a Responsible Federal Budget

The United States spends more on health care than any other country in the world, and a large share of that spending comes from the federal government.

www.crfb.org

Canada healthcare (public) is 11.6 percent of GDP.

Health spending | CIHI

Explore information on health spending, including reports, data tables and other key resources.

www.cihi.ca

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