I write about America’s health care system, and I got caught up in it
nakedcapitalism.comUsed to do these “pre-authorizations” for Humana and wanted to kill myself after a week.
Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”.
Made me realize this whole country is broken and those at the top are morally bankrupt.
There's an absurdity about our time in that we have data, data analysis, extreme communication yet the efficiency and refinement of policies are still limited by the same bottlenecks.
Not just your country, Nothing throws spotlight on how wonderful capitalism has become(/s) like checking out health insurance industry in almost every country without a socialized health-care. Okay may be private-prisons would come close second.
I get denied health insurance policy itself due to my physical disabilities against the local laws and regulations in my country[1]. That includes major International brands.
How can I put this gently, capitalism thinks I'm not worth living or saving.
[1] https://abishekmuthian.com/insurers-are-putting-the-lives-of...
Why is that broken? Even systems with universal healthcare have rules like this.
Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?
In all healthcare systems some form of rationing occurs since there aren’t enough resources to provide the best care to everyone. A system that rations care based on ability to pay or on wether or not your employer is generous is immoral. It is also immoral to profit off of denying someone care. Tough decisions have to be made and financially rewarding a company by denying care is despicable.
> A system that rations care based on ability to pay... is immoral.
You lost me there. What makes it immoral? Money is an asset allocation tool, so why is it morally wrong to use it for medicine the same way we do for food and housing?
Genuine question. I have a hard time understanding what sets medicine apart from everything else when people think healthcare should be universally free, but not food, water, clothing, housing, etc. especially considering those other things are more directly necessary for survival.
The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand)
If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'.
> If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'.
Yes it can... there is more than one oncologist in the world. Competition exists.
As for if youre talking about the chemo drugs, you don't have to use the latest-and-greatest on-patent treatment. There are now decades of drugs that are off patent. They may not be as good, but then again, it is your life so many choose to pay for the new better ones. If it was illegal to pay more for better drugs than they would never exist (and don't talk to me about government funding; not a single socialized medicine country has innovated any drug of value in the past 50 years, and yes, they do steal from us in the USA by taking our IP and not paying for it).
The first covid vaccines came out of the UK and Germany. Whoever told you we're just stealing from the US has their head firmly in the sand.
Medical prices being inelastic (to the extent they are) has much more to do with medicare/medicaid/FDA regulations, govt & insurance allowable reimbursement rate lists, and costly govt requirements to even participate in a govt funded plan (like electronic medical records).
Proof? Services not typically covered, like plastic surgery or cosmetic dermatology. Clearly listed and even advertised prices for their services, openly discussed up front.
But if the govt reimbursement rate for an annual checkup is $x, why would anyone need to list that price up front, or have reason to ever charge any less?
Your last comment is the reason for the massive gap between list price versus net price in the US system.
The US has a rule about “usual & customary price”. That’s a legal definition and providers can’t charge any customer more than that.
If you’re looking to price discriminate, you set your U&C price as high as possible, maybe 2-5x what you’d accept. That way if you find a customer willing to pay 4X, you’re not running afoul of the law.
For everyone else, you negotiate a much more reasonable net price, typically through insurance.
The people who get screwed in the end are ones without insurance. They get billed the imaginary number nobody ever intended anyone to pay.
> The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand)
Changing housing situations is exactly as easy as changing hospitals and emergency rooms no? Since the latter are mostly decided by where you live. In fact, most mid to large cities feature many hospitals near any given residence, so it is actually easier. I would also point out that the demand curve for housing, energy and food are far more inelastic than for medicine.
> If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'.
Why couldn't the market find a price? Cancer actually seems like the worse example possible. The people I've known who've been diagnosed with cancer have shopped around for care from many different hospitals. It would seem that cancer would be the perfect candidate for market forces to lower prices since a diagnosis generally affords a bit of time to find and decide on treatment options. Even in the extreme case of 'you have months to live' people tend to spend a few weeks collecting different opinions.
You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated. markets don't deal with this situation well. changing hospitals don't change the baseline costs for providing health care in a significant manner for there to be competition nor are many hospitals in a competitive market (often there is only one hospital for an entire rural region).
that's before even getting into pharma. which can charge millions of dollars for life saving/changing drugs for single course treatments. hell take a look at what happened with epipens. there is no protection against profiteering via nebulous 'markets' when your choices are 'purchase or die'.
> You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated
This account, or at least should account, for a very small minority of interactions with healthcare facilities. Saying that's why the whole market is defunct is recklessly reductionist.
> markets don't deal with this situation well.
They don't deal with it at all. Imagine if some people needed bread or they'd die, would that change the price on the shelf? No, because the bread didn't get there because of that niche market, it got there because most people eat it. It is the same with healthcare. If a hospital exists because people routinely visit the doctor, some people needing their life saved isn't going to suddenly change prices.
> that's before even getting into pharma. which can charge millions of dollars for life saving/changing drugs for single course treatments. hell take a look at what happened with epipens. there is no protection against profiteering via nebulous 'markets' when your choices are 'purchase or die'.
Totally agree. The issue there is regulation and how we allow companies to be a position of no competition. If the government stepped in and payed those prices for you, it wouldn't solve the problem.
> This account, or at least should account, for a very small minority of interactions with healthcare facilities.
sadly its not. you're in pain? you need to visit a medical facility to figure out whats wrong. without knowing how serious it is it can lead to a life long issue. again you don't really have choices here. pay the healthcare tax or risk long term issues.
there is a reason preventative medicine is cheaper (overall) than delaying care until a condition has progressed.
the capitalists idea of a market simply doesn't apply to healthcare.
> If a hospital exists because people routinely visit the doctor.
this isn't true. we fund hospitals in rural areas because there literally isnt enough people to keep one operating via patient care.
you're also asserting that if the populace can't sustain the healthcare system then it shouldn't be available to people. which is fairly cruel and immoral.
> sadly its not. you're in pain? you need to visit a medical facility to figure out whats wrong. without knowing how serious it is it can lead to a life long issue. again you don't really have choices here. pay the healthcare tax or risk long term issues.
I don't see how that is a congruent thought. The 'sadly it's not' doesn't follow from your statement after. If you are in pain without knowing how serious it is, you would likely get opinions from several doctors. You're not going to walk into the first hospital you find and say "I'll pay anything you ask just fix me."
> the capitalists idea of a market simply doesn't apply to healthcare.
You still haven't made a logically coherent argument as to why it doesn't. The vast majority of healthcare transactions are made between two lucid and consenting parties.
> this isn't true. we fund hospitals in rural areas because there literally isnt enough people to keep one operating via patient care.
That backs my point, right? Those hospitals aren't funded by emergency care either, which means the point about costs being a one sided negotiation while the other party is dying is still inaccurate.
> you're also asserting that if the populace can't sustain the healthcare system then it shouldn't be available to people. which is fairly cruel and immoral.
I don't think recognizing the limits of a given resource is cruel or immoral, it's reality. Us not having perfectly clean energy is killing us all, but it isn't cruel and immoral, it's a problem that needs solving. If a town can't afford a hospital, and you want to live in a town with a hospital, move, right? I don't see any reason why taxpayers should pay so a small mountain town in the middle of nowhere can have a staff of doctors and nurses to support a population of 100 people. If someone wants to live in the mountains of Oregon, I don't see how we have a responsibility to pay for a medical care facility to follow them up.
> If you are in pain without knowing how serious it is, you would likely get opinions from several doctors.
> You're not going to walk into the first hospital you find and say "I'll pay anything you ask just fix me."
these two statements are functionally equivalent. by running around paying every hospital for opinions you're literally saying 'I'll pay anything you ask just fix me'. It also tracks with my statement that medical pricing isn't influenced by rational markets which are what is required for a capitalist free market to 'work'. people need to be able to say 'this is unnecessary' which never happens in health care.
In healthcare you have two modes: 1. I can afford the care, price is fairly immaterial make me better. 2. I can't afford the care, doesn't matter what the price is.
> that backs my point, right? Those hospitals aren't funded by emergency care either, which means the point about costs being a one sided negotiation while the other party is dying is still inaccurate.
not sure how you get to this idea. the point is you're hung up on the dying aspect which is basically immaterial. I can torture you and get you to say anything I want. medical care is basically the same thought process for those who need care. The only thing that prevents people from paying any price is literally not being able to afford it. Otherwise people will 100% bankrupt themselves to make pain go away.
Given that the majority of bankruptcies in the US are due to health care just proves this point.
There is no way to make this kind of market work in a 'free' market system.
> I don't see any reason why taxpayers should pay so a small mountain town
we already do. you can argue whatever you want but as a society we've already mandated this level of access. for the same reason we've mandate fire and police coverage. its a public safety issue and a tax payer in bum fuck no where have the same right to have their taxes ensure they're covered as joe shmoe in NYC.
There are MANY reasons why this is economically a good thing via 2nd/3rd order effects that more than pays for itself.
> I don't think recognizing the limits of a given resource is cruel or immoral, it's reality.
every country with universal coverage disagrees with you. I'm not going to belabor this point further. Reality has proven otherwise. The US system is just completely dysfunctional. and thinking otherwise DOES make you cruel and immoral. If you want to discuss how to make a healthcare system that works, fine, but I'm not going to moralize with you on a clearly disgusting world view.
> by running around paying every hospital for opinions you're literally saying 'I'll pay anything you ask just fix me'
No you're not. You can choose which hospitals you're getting opinions from.
> In healthcare you have two modes: 1. I can afford the care, price is fairly immaterial make me better. 2. I can't afford the care, doesn't matter what the price is.
No it doesn't. I've shopped around for PCP. It wasn't like that at all. Do you think every doctor works in an inner city ICU or something? I'm not sure where you're pulling this view from.
> Given that the majority of bankruptcies in the US are due to health care just proves this point.
What point does it prove? I don't really see what point you're making. Is it the US system has major problems? If so, I agree. Is it that nationalized healthcare is the best choice? I haven't seen you make an argument for that at all other than conjuring your own personal ethical code.
> these two statements are functionally equivalent
I'm trying to make a coherent point, so that makes sense.
> not sure how you get to this idea. the point is you're hung up on the dying aspect which is basically immaterial...
So you agree with me now? Emergency care doesn't play a major role in the market?
> we already do. you can argue whatever you want but as a society we've already mandated this level of access
I'd like to see the mandate you're referencing. Sounds like you actually agree with codifying qualifying circumstances for care ;)
> every country with universal coverage disagrees with you
No they don't. Countries with nationalized healthcare routinely ration care. They recognize limited resources same as us, just through a bureaucratic system a oppose to a market system. Just because it's a man with an office deciding if you get to see the doctor rather than your bank account doesn't make it morally superior.
> If you want to discuss how to make a healthcare system that works, fine
This is the discussion I've been getting at the whole time. You're the one constantly conjuring some vague sense of morality as opposed to discussing which models may work better than others.
> No you're not. You can choose which hospitals you're getting opinions from.
you clearly don't understand how hospitals work. getting opinions costs money. just visiting and taking their time costs money.
you can get a hospital to quote you the cost of a procedure. but to actually get a doctor to diagnose you takes time, resources, and tests. this costs money. and without doing said work you have no idea what procedures to get a quote for.
and frankly the only reason to get multiple opinions is if the current doctor has failed to resolve your problem.
no one jumps doctor to doctor unless there is something wrong with the current one like a lack of progress on resolving the issue.
> You're the one constantly conjuring some vague sense of morality as opposed to discussing which models may work better than others.
without understanding the moral outcomes of an economic system makes any such discussion meaningless. You should checkout Albert Hirschman https://www.ias.edu/press-releases/albert-o-hirschman-1915%E...
I don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc.
And indeed the US has many such services, though they are often overwhelmed, or performed through a complex set of nonprofits combining govt funds with donor money as best they can to provide good support. Sometimes they are overwhelmed specifically because of externalities related to the for-profit insurance healthcare system. The high and often unpredictable cost of any medical situation, means people with tight budgets become sicker before getting care, if they ever get it, leading to a higher percentage of bad outcomes, up to and including job loss and homelessness for the individual, and knock-on effects for the rest of their family. This puts extra pressure on the parts of the support system that do exist - those already mentioned, and, of course, the police, who end up getting called to many situations that could have been prevented by the people involved having better services to begin with, to meet their health, food, and housing needs.
> don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc.
Isn't it though? "This thing should be free for everyone all the time" is a lot different than "we should help people out a little if they're down on their luck". Temporary housing, food banks, etc are the latter, and I'm all for the same with medicine. The fact that food and housing are subject to markets makes it easier for organizations to carry out such missions, which is one of the barriers you mention in your second paragraph when you talk about the complexities of dealing with insurance companies.
People don't consume healthcare "all the time" the same way they do food, housing, water. Preventive healthcare is cheaper/less work than treating illnesses that have gotten more serious, leading to less total consumption of healthcare (and those other downstream resources impacted by people avoiding preventive care). Also "Free healthcare available to all" doesn't preclude a private market. The Govt Healthcare is not always timely, may not cover treatments people want, or cover certain elective surgeries. Some people will always choose to participate in a private insurance market that provides value above a baseline govt health plan.
You can't pitch ways of increasing demand as a fix for a supply shortage. You're just shuffling around how who gets what is decided. Why is a government agent deciding any more ethical than your bank account?
And creating a public market necessarily diminishes the private, driving up costs, as purchasers are now competing with government for the same supply.
Of course healthcare isn’t and can’t be free. Unless by free you mean free at the point of usage. I support government provided healthcare and government runs off of tax revenue. Denying a person cancer treatment for no other reason than because they can’t pay $x at the point of usage is an immoral system. An analogous situation occurs with federal courts. Those who can’t afford filing fees have those fees waived and those that can pay them do so. This is done because the court system recognizes that access to the court system based on the ability to pay at the point of usage is a bad system.
That's a bad comparison. The filing fee is small compared medical treatment, and it's in support of the government itself. The cost of doing that for people is tiny and doesn't really take away from anyone else.
Medicine is a scarce resource at this point, and, generally speaking, giving care to X often means Y won't get it. The fundamental problem with medical care is supply, lowering barriers for demand isn't a solution to that.
The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage. In the U.S. system denials of care by insurance companies are not done so another person can get said care. They are done to increase profit margins and profiting from denying someone care is immoral.
> The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage
That last bit is exactly what we're in disagreement about, and I haven't seen a good case for it yet.
> In the U.S. system denials of care by insurance companies are not done so another person can get said care
True.
> They are done to increase profit margins
Indirectly, sure. Its a business where money out must be less than money in.
> and profiting from denying someone care is immoral.
Again, this is the disagreement, and I'm not really seeing a good argument for that being the case. Some people should be denied care. I don't see why performing a necessary function shouldn't be profitable, especially when it's beneficial to everyone in times of scarcity, like now.
Police, most roads, and certain aspects of the legal system are free at the point of usage. It’s bad to have for profit police, court system, and Air Force. Some things ought not be profit driven. It’s quite disconcerting that someone sees no problem with a person profiting from denying healthcare. I should not be able to enrich myself by denying you health care. Tough decisions need to be made and the motive for the decision should not be profit.
I am not more important than you or anyone else. I don’t deserve health care before you just because I have more money. That’s a perverse idea. Unfortunately too many Americans embody the Bible’s warning regarding the love of money.
Ahhh, ok. I see where we are disagreeing. You're assuming some equivalencies in what I'm saying that I do not.
> Police, most roads, and certain aspects of the legal system are free at the point of usage.
Sure, and those generally work well because the overhead is low. The per person cost of all of those services combined is extremely low compared to medical expenses. If giving everyone healthcare cost the same as giving every 911 service, this conversation wouldn't be happening.
> It’s bad to have for profit police, court system, and Air Force.
I think government and the monopoly on violence are generally good so long as the government is democratic, so sure.
> Some things ought not be profit driven
Totally agree. Executions and jails for instance. Anything were the service involves inflicting violence or removing rights is probably better left to a democratically elected organization.
> It’s quite disconcerting that someone sees no problem with a person profiting from denying healthcare. I should not be able to enrich myself by denying you health care. Tough decisions need to be made and the motive for the decision should not be profit.
You're confusing the role with the action. I think 'being the organization that prioritizes care' can be profitable and ethical. That's different from saying 'an organization should get paid for saying no to someone'. Those are two different things and you're assuming that you can't have the first without the second. The insurance company doesn't make money off 'saying no', it makes money off codifying rules that distribute healthcare and enforcing them on a set of people buying into those rules. When more people are denied they make more money, but they aren't 'denying to make money'. It's a different incentive structure from you're describing. Also, nobody in that scenario is 'denying care' they are denying paying for the care. You're still free to go receive the care and pay for it yourself. You can also find a charity and convince them to pay, or crowd fund. That's actually a benefit of the market driven system: there is no such thing as a 'hard' no.
> I am not more important than you or anyone else. I don’t deserve health care before you just because I have more money. That’s a perverse idea.
Totally agree. Having the ability to purchase something is not the same as 'deserving' that something. Two entirely different concepts that live in different systems. One is grounded in the philosophical idea of fairness, and the other in the physical process of voluntary exchange.
> Unfortunately too many Americans embody the Bible’s warning regarding the love of money.
Totally agree here too, as an agnostic, although that's kind of a tangent.
In countries with public healthcare it’s still based on ability to pay. You pay out of pocket and cut the queue, have decent time allotment with the doctor, get best medication available without money-saving algorithms etc.
In Canada private health clinics can not legally provide care that is covered by the Canada Health Act.
EDIT: After further reading it appears that private health care is a murky area in some provinces. My above stated belief appears to be wrong at least in terms of how things actually work there. Here is my view. Private medical care should be banned.
Here in backwater Europe we had no private medicine for a long time. The outcome was massive healthcare black market. Semi-official price list you've to pay to nurses/doctors/etc to „premium“ care.
On top of that, official medical staff wages were crap. People were forced either work for peanuts (IMO nurses and doctors jobs are damn hard and they have to be paid well), take money under table or... emigrate.
Now we have mixed system and it's definitely better than it was before. Doctors gets paid well. Elite doctors tend to work 2-3 days in private clinics and then 2-3 days in public hospitals so you can still get hold of them for free. Those who have an inch for premium services can pay local&legal, so local economy wins.
So the downsides don't affect the rich because they use a premium secondary market. That explains why so many US politicians support it.
Do they? I was under impression that all US politicians aside from Sanders support current system.
Anyway… I think both systems are very similar in the end. Rich (or even middle class) gets great service in premium facilities. Average folks get OK service with some downsides, likely paying out of pocket in various ways. The only difference may be poor people coverage which is subsidized by upper tier payers. Who themselves may never use public service and go to premium only.
Also, another major difference may be the big expensive procedures. Aside from the 1%, people would do the procedure in public hospital because it’s crazy expensive otherwise. But everything else leading up to it and recovery after it more likely to happen in premium market since it’s much more affordable.
Right. The rationing should be based on ability to lobby, and the decisions should be made by politicians and agency bureaucrats.
My insurance did this for my kid’s eczema. Except the $5 one was an immune suppressant. For my toddler. For eczema. During a pandemic.
The only sane response to that is “okay, I won’t give my kid either of those; we’ll just stick with OTC lotions”. Which is exactly what they intended.
A topical steroid I assume? Sure it’s an immune suppressant, since eczema is an immune condition. Topical steroids are standard of care.
It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.
That’s exaggerated. Generics are well known to be effective, and exceptions are unusual. Here’s some commentary to that effect, talking about research to the contrary: https://www.health.harvard.edu/staying-healthy/do-generic-dr...
It’s reasonable to expect people to exhaust lower cost alternatives, that are reasonably expected to work, before stepping up costs.
Part of the issue is that insurance companies often “reset” this process. I know a friend with really hyper specific health conditions that requires a fairly expensive, experimental treatment. They need this because they’ve tried everything already. But sometimes the insurance company seems to forget that they already tried everything, and refuses to pay and tries to get them to go through it all over again, a process which destroys their ability to function and leaves them seriously disabled for months at a time.
This also happens if the employer switches insurance.
So no it isn’t as innocent not as simple as saving costs for generics. This makes sense for the first time the patient seeks treatment. This doesn’t make sense if the patient already has a treatment plan that works and the insurance company decides they want to do the whole pony show again, fucking in peoples life for months.
Speaking of genetics, screening for the genetic profile of variable liver enzymes for known mutations and their associated drug interactions could actually save on the shotgun approach to dispensing medicines.
The problem is, you won't be able to hammer down the health of the patient to the lowest cost option, only the most effective.
Ha! My keyboard autocorrected generics to genetics! Fixed in the original comment.
My bad. You are correct. I misspoke. What I meant to say that at times generics (and similar drugs, but not generics) won't work as well as the original drug. Not always, but sometimes they just aren't effective in certain circumstances. The doctor may know this, but can't immediately prescribe what is effective in the name of "saving money"
> Generics are well known to be effective, and exceptions are unusual.
A [relatively] well known exception is anticonvulsants. My younger brother paid for that with his life. I hope the FDA figures out how to properly evaluate generic equivalence.
It can also just be a matter of convenience. When I was first put on testosterone I was prescribed AndroGel, which is a gel you out on once daily. It costs $400 a month. Insurance gave a bit of hassle but with my test numbers they acquiesced.
They shouldn’t have, though. Injections (what I’m on now) work better. They’re easier to maintain the correct dose, you don’t have to worry about getting it on your partner/kids, you only take it once every week or two…and it’s maybe $20 a month.
That’s not just a few dollars saved. There are probably hundreds of thousands of men out there that take it. I see there’s a generic gel now but it still costs anywhere from $60-$150 a month.
As I was looking up current AndroGel prices I discovered there’s now a twice daily pill. That’s even more convenient than a gel!
Too bad it’s $1,000 a month. We’re all paying that so people can avoid sticking themselves with a needle.
Thousands of dollars per patient times many different patients and drugs quickly adds up to a substantial proportion of all healthcare spending. Countries with universal healthcare have specific programs in place to move people over to generic drugs for exactly this reason, or at least the UK does - along with policies that intentionally give people less effective treatments if the better ones are a lot more expensive. It's one of the ways they stop costs from ballooning as much as they have in the USA.
Bc Canada it just covers the equivalent generic cost, if you want to get brand you pay the difference, can be 5$, can be 50$
No, sorry “the doctor knows it won’t work” is complete BS.
We don’t spend 100x on a drug because a doctor “has a feeling”.
The insurance requirements are typically quite limited for 1st line failures. Doctor just needs to prescribe then 2 weeks later attest that it didn’t work.
Seems reasonable to save the healthcare system thousands of dollars when tens of dollars would do?
Which doctors know? Insurers have doctors too, that's why they have these rules. What do the doctors treating the patient know that the insurers don't know or are refusing to acknowledge?
Well at least in Europe pharmacists always tell you about generics, that they are cheaper and work the same. Not sure who is spreading misinformation here.
Maybe you're talking about different medicines that people are using (like different insulins), the generics use the same formula as the original.
If you have a past knowledge that the generic doesn't work and you also save money by withholding the real treatment, then that seems perverse.
>those at the top are morally bankrupt.
These seniors should vote for and advocate for a more expansive social safety net then.
What twisted fucked up naive world view does this come from. These people are poor, vulnerable and sick. You should be ashamed of yourself.
Why don't I throw you in a cage, and then you can try voting for someone to advocate for your release.
The point is the seniors need help now, not being told to go organize. The healthcare system is broken, and until you get sucked into it, you don't understand the extent of it.
It's different for people less fortunate than ourselves. We all mostly work tech jobs with great pay and decent insurance. These people don't have that. A lot of them can't pay for food.
So yeah, I'm doubling down. Downvote away.
I think the point was that seniors as a demographic generally vote for politicians that don’t support those policies, against the wishes of the majority of the rest of the population.
Yeah, but that doesn't mean we should be denying care to anyone.
Why is it so hard to say the healthcare system is broken instead of blaming the seniors.
That dude's throwaway is doing real damage by normalizing the deflection of blame onto the patient.
This is an overly paternalistic point of view that robs these people of their agency.
They've spent their lives participating and interacting within the current political framework. Blaming all problems at the feet of "morally bankrupt leaders" is hyperbolic populist rhetoric to absolve personal responsibility.
Sounds like the morally bankrupt trying to defend themselves.
What's your ideal healthcare situation and how do we get there from the current one?
Broad platitudes like "everyone should have access to healthcare" doesn't count
Above my pay grade. Would be good to look at the countries that have a lower death rate per 100k and see what they are doing.
Most likely we need to reform the insurance industry, but systemic changes are definitely needed.
sounds they they should have had a better investment strategy when they were working. some people.
Really hoping that's sarcasm
Aside from someone being denied life-saving medication, the most awful thing for me in these stories is the relentless Kafkaesque quality. We never get any answers to our basic sense-making questions about the bureaucratic process:
- What did the insurer expect to happen, in order for this person to keep getting their medicine?
- Why did those things not happen?
- Whose job was it to make sure those things happened?
- Did that person know it was their job?
- ...etc.
I get that it was about prior authorization, but whose job was it to make sure the prior authorization happened? Why didn't that person do it in a timely fashion? Why isn't there an understanding within the insurer's system that Type 1 Diabetes is a life-long condition and not something that will just go away when the insulin runs out?
Was there a "happy path" here or does a scenario like this invariably degenerate into a scramble involving dozens of calls and day-destroying last-minute errands?
I find the article written in a circuitous way, that does not clearly lay out the timeline.
This statement about what a prior authorization is is also incorrect:
> They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment.
Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with the treatment option and will pay for it (subject to deductible/copay/oop max).
The theory here is that the end user has no idea what they are getting since they are not knowledgeable about medicine. Doctors could be prescribing unnecessarily expensive medicine or treatment, so the managed care organization (MCO, or insurance company) “manages” the healthcare for the uninformed buyer by having the healthcare professionals employed by the MCO double check things.
In this specific person’s case, it looks like the biggest delay was in getting a doctor’s appointment when he needed both a new MCO and a new doctor. Technically, you can pin this on undersupply of doctors, MCOs tied to employer, MCOs not hiring good people and causing unnecessary delays, incompatible electronic documentation systems that do not talk to each other, and I could go on and on.
Ideally the doctor should be able to see what medications the MCO will cover on their computer while the doctor is seeing the patient so before they even leave the doctor’s office.
Another concern in the long list of concerns is the MCO is not necessarily the one deciding the rules for what treatment/medications to pay for or not. Many, many times it is state government (e.g. Medicaid), federal government (e.g. Medicare/Tricare), or other entity that is actually paying for the healthcare who will hire the MCO and give them the rubric on how much to pay for people’s healthcare/what treatment courses or brands of medications will be covered. This is how poor people (Medicaid) can be restricted access to healthcare by limiting the reimbursement for their healthcare so fewer doctors accept it while older people or members of military get access to better healthcare because their healthcare gets reimbursed at higher prices (Medicare/Tricare).
The system allows for a lot of opacity to allow for a lot of price segmentation while also providing political cover for such decisions due to the complexity of understanding it.
We went through this with a relative recently. She needed a surgical operation. We were asked to either
1. Wait for prior authorization and allow our appointment to be canceled and rescheduled (for the fourth time, having already wasted several weeks)
2. Pay out of pocket
We decided to pay out of pocket, since we knew that the prior authorization could delay us by an arbitrary amount of additional time and had recently read that the insurance might not even help us anyway.
The twisted thing is that you can't just get the operation done and let the prior authorization work itself out later. It truly has to be prior or you get stuck paying out of pocket, even if the operation is obviously medically necessary.
This structure seems expressly designed to screw the patient over. Maybe it doesn't prevent the doctor from prescribing, but it has a similar impact in the end.
And regardless of my anecdote about prior authorization, there is the question of why someone with Type 1 Diabetes is being denied their medicine. I feel like the only potentially valid excuse would be if the insurer literally didn't know the person had Type 1 Diabetes.
> The twisted thing is that you can't just get the operation done and let the prior authorization work itself out later. It truly has to be prior or you get stuck paying out of pocket, even if the operation is obviously medically necessary.
I have had doctors collect payment, and then refund me once they get paid by the MCO.
One more thing that would help here is decoupling employers from your MCO. That way, when you change employer and location at the same time, it does not mean you change your MCO. If the person who wrote the article had the same Blue Cross Blue Shield MCO (or other MCO part of a nationwide network) with old and new employer, then he would have had no reason to seek out a new doctor and new medication.
Well, we were told this is impossible, so either everyone involved lied to us or your experience isn't universal.
While insurance tied to your employer sucks, I think the best thing to do here is for the law to iron out the data interchange between MCOs. In a "marketplace" like the US, insurers must be under a dire legal obligation to transfer your data in a comprehensive and timely fashion to whoever is currently administering payment for your care. Especially when lifesaving medication is involved.
The patient should not be held hostage by the incompetence of MCOs at communicating medical data.
> , there is the question of why someone with Type 1 Diabetes is being denied their medicine. I feel like the only potentially valid excuse would be if the insurer literally didn't know the person had Type 1 Diabetes.
I forgot to respond to this in your prior reply. The answer here is because insulin is not just insulin. There are many different formulations and brands with many different prices.
Even the federal government does not want to pay for all of them:
https://www.healthline.com/diabetesmine/new-medicare-program...
So one could say it is about money, or how much extra money is politically available to spend for the marginal benefit (population wise) of certain insulin.
If the problem is around different insurers paying for different brands, then yes, I think the solution is for the consumer to have the choice of MCO rather than it being tied to the employer. But I'm sure this would create other problems and snarl the system with even more complexity.
That's ignoring the fundamental cosmic absurdity of this entire system, with its pretense to be some kind of competitive private market with the usual benefits of such. When in reality, insurers are just a bunch of hogs at the trough that you're shuffled between as you change employers. The private market does not seem to create any sort of incentive for efficiency or a better consumer experience.
The hogs at the trough have net profit margins of 5% or less, and pay out 85%+ of premiums they collect to healthcare providers. You can remove MCOs from the equation, and their function will still have to be done by whoever is paying. For example, the approving/denying is still done in the UK even though they have taxpayer funded healthcare. Or even within the Kaiser health system in the US.
It does make life easier for providers and patients when there is one system that provides quick definitive answers rather than back and forth. On that front, there is much improvement to be made in electronic communications between healthcare providers and MCOs.
On a positive note, this is happening via electronic prescriptions and integrated EMRs. I have seen my kids’ doctor pull up covered medications in their system and then quickly sending the electronic prescription to the pharmacy.
> But I'm sure this would create other problems and snarl the system with even more complexity.
There is absolutely no reason for employers to be involved in your healthcare. They currently are able to use it as a leash around your neck because paying for MCOs via your employer means you get to purchase with pre tax dollars. Paying yourself means you have to pay with post tax dollars. I am looking at my box 12 code DD total, and for me that is $32k of insurance premiums I was able to pay with pre tax dollars.
More importantly, it gives employees an additional hurdle and fear of changing employers, because what if they have to go through what the person who wrote this article did? Maybe they should not shop around to see if they can sell their labor at a higher price, and just stick to their current employer. Another unnecessary chip for employers to have over employees in the US.
> More importantly, it gives employees an additional hurdle and fear of changing employers, because what if they have to go through what the person who wrote this article did? Maybe they should not shop around to see if they can sell their labor at a higher price, and just stick to their current employer. Another unnecessary chip for employers to have over employees in the US.
This is horrifying to contemplate... do employers just love that chip so much that they see it as worth all the terrible customer experience and inefficiency it causes? Do they lobby to keep it this way?
Someone must be lobbying for it. I would like to be in the room when the Senate panel discusses things like this.
Let us let businesses pay for MCOs with pre tax dollars. But not individuals, that would be undesirable….why?
Let us let businesses select retirement fund options for employees, and then let employees save $21k to $50k per year of pre tax money if they invest in their employer’s retirement savings options (401k).
Let us only let individuals save $6k pre tax in their own retirement account, without the meddling of employers. Let us go one step further and phase this benefit out if one employee works for an employer with 401k and the other does not.
As of 2020, let us let employees pay for student loans with pre tax money if they pay through their employer. But not students who pay themselves.
Let us pay for public transit with pre tax money, but only if via employer.
And so on and so forth. You see TONS of laws that explicitly give an upper hand to employees of well funded employers, effectively giving a competitive disadvantage to employees of poorer employers (small businesses, immigrants) and simultaneously incentivizing those who do work for well funded employers to not seek other options, such as starting their own small business.
Yeah, the retirement one is very telling, isn't it. Probably a strategic advantage for large companies that already have the bureaucratic infrastructure to administer complex benefits.
And if they want to grift their employees by giving them bad fund options because of some kickback the fund provider gives them, they can.
The people that are most concerned about insurance before quitting are generally the ones that have expensive, known health issues.
Which self insured employers pay for directly.
So the barriers to switching aren't necessarily good for the employer either, because the more reliant someone is on their health insurance, the more they cost the company, and the less likely they are to ever leave.
> They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with the treatment option and will pay for it (subject to deductible/copay/oop max).
To the consumer, the experience is the same - they can’t get a necessary drug before spending hours or days playing telephone tag with their doctors office and insurance company. Often, this happens for a drug they’ve taken their whole life. Insulin, thyroid hormone, etc.
I'm not seeing an important difference between the way you describe prior authorization and the quote from the article. Nobody in the world thought that doctors need to get permission from insurance companies to practice. This was about getting coverage. I doubt that many people were confused about the rationale from insurance companies for prior authorization: so the insurance company can decide if they approve of the doctor's action. That's the traditional definition of authorization.
>Technically, you can pin this on undersupply
Well said overall, but the supply of doctors isn't the issue here (regardless of if it's a separate, bigger problem).
1) This case is what mid-levels are ideally suited for. Routine and can be seen within a day or two. Would have moved the whole timetable forward.
2) It's the supply of doctors participating in any given insurance plan or govt reimbursement scheme, not overall supply.
It's pretty easy to find a doctor to see same-day if you pay cash (either straight cash or front cash and submit your own reimbursement).
Which is itself more an issue about regulation being so burdensome and costly that doctors can't afford it without joining a large group or hospital owned practice. Especially the cost of required electronic records.
Which is why it seems like all the small private practices are being bought out by hospitals. Because they either are, or their docs are retiring, or they are opting out of all insurance and govt plans and going concierge/prepaid/membership/cash-only.
What I'm curious about is #1: why couldn't this person get in to see a mid-level sooner? They rarely book more than a few days out.
It's exactly the type of issue that they are meant to help with to reduce demand on the doctors and get patients seen quicker. A routine refill without any nontypical complexities or changes to report.
Did approval specifically require a physician? That would be more of a system problem that needs resolving.
Honestly doctors don’t have enough time to juggle all this along with treating the patient. Many times it is the case that the patient cannot afford the medication and/or their insurance will not cover it. Shifting this burden on the physician and patients to figure out these economic problems interferes with healthcare.
Definitely, but it is a result of the mismatch in costs relative to expectations of quality and quantity of healthcare with current supply of doctors and medicines (out of patent).
I am in favor of the US federal government to spend money on R&D for medicines resulting in fewer patented medications resulting in lower cost medications. And also reforming the process to becoming a doctor because obviously people want more doctors. Not necessarily making doctors less qualified, but the whole spend your 20s torturing yourself is unnecessary, along with wasting 4 years on a bachelors.
None of this is making any sense. There is no cure for T1 Diabetes and it is lifelong. There is no reason to have any of these requirements, middlemen, authorizations or whatever.
There are many different kinds of insulins at different prices, and apparently, in the US there is not though political will to pay for any choice of them as even the federal government restricts which one it pays for.
https://www.healthline.com/diabetesmine/new-medicare-program...
Health Insurance is a political scam of epic proportions. There is no indemnity involved. It is not real insurance. You don't use insurance to pay a monthly bill, you have it for black swan events. Nor should insulin be 1000/mo, on paper or otherwise.
The whole thing is performance politics to distract from the "insurance" companies running everything from medicine regulations to your kids playgrounds (so they don't hurt themselves and need care).
> The whole thing is performance politics to distract from the "insurance" companies running everything from medicine regulations to your kids playgrounds (so they don't hurt themselves and need care).
This is also a consequence of our legal/tort system. At one of my business, a person claims to have stepped on a landscaping rock and damaged their ankle or knee or something. They took pictures of this roughly 2in x 2in x 2in rock in the parking lot, maybe a foot away from the curb that separated the landscaping rocks and the parking lot surface.
This lawsuit has been going on for 3 years now, and I can only assume $10k+ in lawyer time has been spent asking the employees if they saw a rock there and when they last checked the parking lot to see if it was clear of rocks, etc.
With the courts accepting cases like these, and businesses needing to protect themselves from cases like these, it is no wonder as a society, we end up wrapping ourselves in insurance. Specifically in this case, the person or family suing has been found to have a history of these types of lawsuits. And yet still, the case drags on.
Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families:
https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family.
The fact that most Americans probably cannot afford this is a separate matter, but it is more insurance than it has ever been in the US.
> you are protected from expenses above $17.4k per calendar year per family.
Given that this applies to in-network costs only, as you noted above, it seems very inaccurate to describe it as genuine protection. Any random provider in your current care situation can be out of network, it is very hard to know or have any control over especially in a crisis situation, and it is these providers that usually end up billing you through the nose.
It would be irresponsibly misleading to call your life insurance "protection" if the insurer just rolls a dice or consults the day of the month to determine if they'll pay your claim.
The relatively new surprise billing and emergency care from out of network providers to be treated as in network providers legislation changes that:
https://www.cms.gov/nosurprises
https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule...
For non emergency care, it should be easy to login to insurance company’s website and see if doctor or doctor group is in network or out of network.
Sort of. You get to initiate a fight with the insurer through an unaccountable arbiter.
Insurer websites have lied to us in the past, claiming X was in network (zero cost!) and then sending us a denial resulting in a giant out of network bill for that exact X. Same service, same provider.
Truly incompetent and evil system. Fills me with rage.
This is the problem with the US system, all the crap falls to the patient to deal with in the end.
It won’t help you now, but before any expensive visit, you should call your insurer and confirm they are in-network (doctor and clinic). A note will be made in your file as proof.
That is ridiculous. I have not had such blatant negligence / corruption happen to me yet.
The worst part is we only got this service because it was represented to us as free. It was a genetic test that was nice to have but not strictly necessary. We would not have gotten it if we'd known we would be billed $6k.
Now I feel like I will have to screenshot and archive every digital representation that is made to us about whether X will be covered and be prepared to initiate a lawsuit over it.
In the meantime we will simply not be paying the bill. I've been thinking about doing this for many other medical bills we receive as well. It's all so arbitrary and uncontrollable. I simply don't feel I have an obligation to pay a bill in a made-up amount for made-up reasons I have nothing to do with.
I am a very reliable bill payer and normally see it as a basic matter of personal responsibility, but this broke me.
If this is NIPT don’t pay the bill. The companies will write it off.
You can't indemnify health, only property. Personal costs related to health have no bounds; for instance if you lose your job because of health, your "out of pocket" is your whole salary. Which real insurance would cover.
Your example is leagues of laws and regulation on top of a scam, a pyramid model that affords top care for those who can afford modest premiums and really do get expensive care for $5 copay, at the cost of everybody else who has to fight their employer via federal politics for the right to go bankrupt.
Indeed, I would say that using insurance to pay your insulin bill is coming out on top of the scam, because some books are getting cooked (+/- paper costs) at the expense of mutual indemnity (taxes, social security). An insulin user is a health insurance voter, but that is a weak expediency for actually fixing the price of insulin and ending the tyranny of insurance companies over healthcare, and it turns whole populations into do-or-die partisans.
Thanks, Obama!
> Thanks, Obama.
Yes, thanks for getting the only legislation passed in the past 30+ years that expanded access to healthcare.
FYI, ACA is what made it possible for people to even purchase healthcare coverage without an employer. And also, taxpayer funded healthcare (“public option”) was preferred by the Obama administration, but had to be whittled down to meet the compromises needed since there was basically zero support from across the aisle.
The tax benefits of health coverage via employers is a separate matter, and while it should have been addressed, I am not surprised nor would I blame Obama for that, since it was already hard enough to get what we currently have passed.
To your last point I wonder what the effect of not allowing a provider to charge a different price for the same service/product would be.
This is a really interesting idea. Seems like it would kind of level the playing field and might help guide us toward what I think is the ideal situation - no one needs health insurance other than for a catastrophic event because prices are known and reasonable and you just pay them, like literally every other service we need and consume.
That is supposedly the goal of high deductible health plans and HSAs.
For reference, in NL I believe I have about €250 out of pocket maximum. Could be €500 now, not sure.
It is a spectrum of course, but a 500 Euro out of pocket maximum is probably better described as taxpayer funded healthcare.
The US is pay $400 to $1,200 per person per month from age 0 to 64, and then pay up to $8,700 individual / $17,400 family per calendar year.
At age 65, the government starts paying for your hospital care assuming you or your spouse paid Medicare taxes for at least 10 years, and you then have to buy a nebulous blend of subsidized care / insurance for other things like medication, doctor visits, etc.
Health insurance premiums are between €125 - €150 / month here.
The parent is referring to known condition vs an unknown emergency event.
As an analogy in the case above the car owner is having their insurance company pay for their gasoline - where you are referring to an insurer paying for a car accident.
Yes, it is difficult to pin down an exact definition of insurance in cases where the cost is all but guaranteed.
I can see their point now, but at the time I was thinking relative to other taxpayer funded healthcare systems.
Price aside, the biggest problem with American health care system is the administrative black hole at every stage.
Wife was on some serious (and expensive) medical treatment. After many months, the medical provider was at the final stages of the treatment. As usual, the provider needs insurance approval for arcane codes that constitute that segment of the treatment.
Get this, the medical provider applies for approval using a FAX. There is no acknowledgement or online tracking. And the authorization is received back using FAX. What a joke!
My wife didn't hear about the treatment for 3 weeks. Under pressure, she called her insurance. Insurance says, they didn't receive any request for authorization.
Why the fuck didn't the medical provider follow up? Exact question asked by my wife. Medical provider's explanation was that they faxed and were just waiting on insurance. They just sat on their fat bums while the time was running out.
So, wife patiently asked medical provider to apply for authorization again. The provider said they sent another request right away.
Another week later, wife had to call insurance again to find out that they STILL DID NOT receive any request.
Distraught wife asked insurance rep to call the medical provider immediately. Of course the call went to voice mail.
Wife then called the medical provider and left a scathing voicemail, threatening to sue. Only then this system worked miraculously. It still took a day for the medical provider to figure out what was wrong with their fax system. It still required my wife to follow up with insurance asking if they received the authorization request. Then 3 days later, the insurance provider approved the authorization and my wife had to call the medical provider again to confirm that the authorization was received.
All good now? Ohhh Noooo. Now the medical provider placed an order for medication that needs to be shipped from a pharmacy in another state. And they do place it. Now my wife gets a call from the shipping pharmacy to schedule a delivery. The delivery happens after 3 days.
Wife checks the delivery. Oops, it is missing a few items required for treatment. Guess what she needs to do to get the missing items delivered? You guessed it. Have the medical provider do the authorization process ALL OVER AGAIN.
Oh, and every call to the medical provider goes to a voicemail to which they take a minimum of 8 hours to reply and every call to insurance has a 30 min elevator music. Imagine all this 10 times in 3 weeks and that was just one round of shipping and nervousness.
Fuck American Healthcare.
Some countries have been jumping so far ahead. IIRC Slovakia, Iceland have ultra lean administrative processes in lots of places. Minutes instead of days or more, and non hassle. UK has some of that too.
France is starting.
Someone in the US should get funding for this. It's a 300M people's "market".
I highly recommend healthcare in Asia. In most asian countries, healthcare is pure market driven. Aka, most people are uninsured so there is no insurance bureaucracy. No contracts, no lawsuits. The reputation of service and doctors matters. Appointments for this afternoon? No problem, you got it.
American healthcare is what I would wish on my enemies.
All asian countries ? china ? japan ? india ?
Any book about their systems ?
Systems and prices vary between countries. No idea if there's a book but my experience in Indonesia, India and Vietnam was stellar. Working with a medical facility was as simple as doing something in a mall.
If you are going from America, you can't go wrong in any major Asian country. India has the benefit of having English speaking doctors.
And how do they implement quality control ?
Who is they? And define quality control.
they, the medical professionals
QC = not dying, not having more side effects ..
when you say pure free market, I'd like to know how you get access to this market and who ensure you're not "selling" bad stuff/practice/ideas
The medical professionals are bounded by law and medical certifications. That said, the real quality control happens by virtue of the incentive system of free market of millions of patients over many years. Their reputations depend on doing "the right thing" - fix the medical issue, give prevention strategies and keep medical costs as low as possible for the customer.
When a medical professional does "the maybe not completely ethical thing", word spreads and they lose future patients to competition. Business declines. The professional loses standing in the community and current employer would terminate their employment. Future employers need good references. They are socially shunned and have legal proceedings on them.
The doctors there are like chefs in a restaurant. The quality of their work determines their standing and future business. Medical facilities are like restaurants. The quality of their service matters.
One thing to note though is that you want to visit medical professionals in cities and not some rural village doctor. Rural doctors are more likely to have "quality control" issues more as their reputations are not discoverable easily without learning local languages.
And to make matters worse, all this bureaucratic nonsense for coding, billing, authorization costs a stupidly large amount of money that gets baked back into the bills somewhere.
Oh yes, you get to pay $500/mo insurance premiums and $2000 deductible and lots of copays for the privilege of using this masochistic system.
> Some suggested I go to Walmart for $25 insulin, an older type I have no idea how to safely use.
I'm sorry but this erodes my sympathy significantly. Learn about the options that exist if your first choice treatment isnt available. Learn about mitigation when no treatment is available. This is your life, act like its your responsibility already.
It takes weeks to get comfortable using a different insulin to manage your blood sugars, and the results on older NPH insulin are going to be much worse than a more modern one. Doing that, and damaging your body, just to avoid avoidable bureaucracy is not reasonable. In fact, it's mildly tragic.
These threads always talk out both sides of their mouths. First people say, insulin was invented 100 years ago and the patent was gifted away to help patients, so it should be free. Then people say, it is stupid to use anything but the most modern formulations, because they are way better than the old ones.
I have no love for pharma price gouging, but if insulin was free, everybody would be stuck on the 1921 formulation.
You need to manage a chronic condition, either you need a spouse or a child who has a chronic condition or you need one yourself.
Science can help, alloxan destroys the islets of Langerhans, it is used to create diabetic mice. Go ahead, take a dose, lead by example. The Walmart insulin comes up here on this website from time to time, and the overall conclusion is that long-acting insulins prevent blood sugar excursions.
> You need to manage a chronic condition,
I am. I expect to be dead before the decade is out, the doctors offer ways to make that more comfortable but shorter. I disagree with their priorities and am thus on my own for other treatment options.
"I do not need to know about other options" seems inexcusable to me, and seems to be what the author assumes is the correct attitude towards their treatment.
> The price of my prescription without insurance was $339 per vial of insulin
In most countries insulin price is around $30. I remember it was cheap in US too.
Seems like another problem created by US kleptocracy. Make something prohibitively expensive, and "solve" problem by providing handouts to cover costs.
For reference, in Sweden we have a ceiling for hospital + medicin costs per year at less than half of the cost of that one insulin vial.
Almost the same here in Norway, the ceiling is a little higher.but still less than that one vial.
You are comparing an insured price to a cash list price (most of which does not go to the pharma co and a price which effectively nobody pays). As an insured American, I would pay 0$ for insulin.
False. 5 doses of Novorapid insulin (first one I found on Google) is 22.07 EUR in France. After the public insurance scheme, that's 7.72 EUR (or 2.20 EUR in my region). And then you can get further reimbursement from the employer's (or your own) private insurance.
Edit: I just remembered that diabetes is recognised as a long term condition, so you would be 100% reimbursed by the public insurance scheme.
No, cash list price of insulin in most countries is around $30. As uninsured person you can still buy insulin for this price in Mexico or order it from India.
That's not really a good counterpoint if the non-insured prices are patently insane. How on Earth is it justifiable for insulin to cost 300 dollars? Here it seems to be around 20-40 euros before the deduction you will get from our national health bureau (which can vary from 0% to 100% depending on your diagnosis and the medication you need.)
On top of the national mandatory health insurance, there's also optional private health insurance and private hospitals and such, but even for those the prices are nowhere near the insane numbers I see whenever US healthcare is discussed, and I frankly can't understand how people aren't revolting over there.
Is it 20 to 40 euros for any and all insulin or specific insulins?
Didn't look that closely; there seems to be variance depending on how large an individual dose is and how many doses are included. I suppose the "price of insulin" is ill-defined without mentioning the dosage.
We (Americans) are in this situation simply because we have avoided making hard decisions in our healthcare system, and in many cases created actually done things that break the system further (limited to no healthcare rationing in Medicare, mandatory acceptance of pre existing conditions, attaching private insurance to one’s employer rather than the individual, etc.)
In short we haven’t come to a consensus as to derivation of the engineering axiom, you can have 1) broader access 2) quantity/quality 3) affordability —-pick two
Dude should have called 911 when he was at 12 hours of insulin left and let the hospital and the insurance company fight it out.
That's seriously f'ed up.
Have you ever gotten an ER bill for something you didn't absolutely have to get an ER bill for, in retrospect? It's a few thousand dollars worth of regret.
Yeah, that's what the mandatory price lists in hospitals are designed to do. Instead of going to the hospital to get treated for cancer and get stunned by the huge bill after you now conclude that you can't afford lifesaving treatment and stay home.
If you don't believe that's the purpose of the new regulation you are insufficiently cynical. Where's the revolution?
Or you start cooking meth.
I hear that hijinks ensue when you do that.
Best case scenario, though, you win an Emmy
Then you sell the Emmy, and you'll have enough money for one month worth of insulin.
Ironic that he works at Kaiser, I wonder if he has Kaiser Permanente insurance?
Kaiser Health News and Kaiser Permanente are independent organizations, through they come from the same original funder.
Here's a page going through the story.
An Arm and A Leg is a really interesting podcast partially funded by Kaiser Health News that does similar stories to this one, going through the ridiculousness of the whole US Healthcare system and how people have successfully navigated it.
https://armandalegshow.com/about-x/partners-and-supporters/k...