Do you think healthcare and prescription meds in USA are still unaffordable for most people? How do we fix it?

The only way it gets ‘fixed’ is by legislation and price controls, and that will never happen. The problem with price controls is that it takes any incentive away from the manufacturer, because price controls ultimately mean profit controls. Price controls are themselves a distortion of the free market.

The best way to reduce the price of Rx meds is to reduce the exclusive patent ownership time from 17 years (what it is today) to something more like 5 years. That would draw new companies into the market, and presumably the competition would help keep prices down.

The other thing to do is to have competition from the get-go. The inventor gets the patent but by law at least two other companies would be immediately sub-licensed, again for competition’s sake.

But the end result of screwing with a market economy is that it has unseen and unplanned for consequences which sometimes work perversely to kill the principle they are trying to save.

@elbanditoroso See my answer here

I agree that patency keeps drug prices high. If all developers conjoined to foot the expense of bringing a drug to market and shared the costs, we could very well see generics sooner.

As it is now, there is no incentive to bring consumer price down. Not even on proven medications. My strongest example is Ondansetron (Zofran). This anti-nausea medication was created for cancer patients to combat side effects of chemo treatment.

It is so effective and so “safe” that it should be considered (and is being considered) for OTC status. But prices were set by insurance companies based on what patients expect to pay for cancer treatment drugs. The cash price is outrageous ($175 for 6 tablets), most insurance limits the number they will pay for (usually 15 tabs per 25 days, when the dosage is every 8 hrs as needed).
It isn’t even that expensive for a pharmacy to buy, but we’re bound by the Average Wholesale Cost.

If Ondansetron went viral as a “hangover cure”, we’d see it on the market OTC very quickly. It’s the new Alka Seltzer”

I just listened to the Republican debate. There was a lot of talk about Medicare, it’s skyrocketing costs due to government waste, that it is a failure, that it must be reformed, bla, bla, bla, bla.

Both parties say approximately the same thing about this program.

Excuse me, but I get really pissed when I hear this bullshit. I’ll tell what’s wrong with Medicare and why the costs are skyrocketing.

About three years, while in between jobs and therefore uninsured, I ended up in the hospital, then sent home with a foley cath inserted up my johnson until my next scheduled appointment with a urologist two weeks later. Not unusual. One morning, about a week later, I woke up in extreme pain. It felt like someone had rammed a white hot poker up there and my bladder was bursting. The foley bag was still empty. Usually there was about 800cc in there after a 7 or 8 hour sleep. The catheter was obviously clogged and I was unable to void. The burn was due to an incredibly aggressive UTI.

I had a flush kit and tried to flush the cath, but no go.

No problem. I had about ten days of broad spectrum antibiotic in my refrigeration that was issued to me by a dentist six months earlier which I didn’t take at the time because I don’t believe in eating antibiotics unless I really need them and these would take care of the infection. I took a loading dose and headed for the local Super Walmart.

I would simply get the pharmacist to sell me a 5cc syringe—sans needle—and before my bladder exploded, I’d go straight to the nearest bathroom stall and deflate the little water balloon that anchors the catheter inside my bladder. It’s a simple procedure. As a licensed nurse for the previous two decades, I figured the pharmacist wouldn’t give me an argument.

He did. Even upon presentation of my license, he refused to give me this harmless item without a prescription. He said that in the State of Florida, he could lose his license. I told him he was wrong and, while holding my burning cock in pain, that he was the biggest chickenshit medical motherfucker I’d ever met and that if I wasn’t so fucking pre-occupied with more important business at the moment, I would…. I jumped back into my car and sped to the nearest ER to have the cath removed.

I had to fill out the admissions papers even though I’d been to that hospital two years before for some suturing. Forty-five excrutiating minutes later, I was seen for two minutes by an ER doc followed quickly by a nurse who removed the cath, I voided like Niagara Falls, and went home in much better shape, but still feeling the burn. From doc through voiding, including the removal procedure. it took no more than 15 minutes. I was given nor did I want any medication.

I was later sent a bill. I have it right here.

Date of Service: 9/18/2011
Charges to Date: $5,146.15
UNINSURED DISCO Discounts: $4,374.23
Payments/Discounts to Date: $4,374.23
Remaining Account Balance: $771.92
Amount Expected from Insurance: $0.00
AMOUNT YOU OWE: $771.92
(Bold type is theirs)

—For less than fifteen minutes work.

I paid them the $771.92 just before I left the country. You people get to pay the rest.

There’s nothing wrong with Medicare. There is however, something wrong with a healthcare system that can legitimately bleed our country dry.

The patent process needs to be tweaked. Like if a drug company comes out in the last two years with a new drug that is a minimal variation of a previous drug, they shouldn’t get the same full patent time. An example of this is Zovirax and Valtex. They are invented to hold back a better drug (fewer dosages per day needed) and don’t spend near the dollars on development for the second drug.

Moreover, drugs that could be safe OTC are first put through the Rx route, because of the process, and it makes drugs less accessible to people. Needing a prescription typically means a doctor’s visit (expensive) and pharmacy fees added into the pricing.

I believe in patents to help give incentive to drug development, but somehow there needs to be better limits.

It really is immoral in my book to gouge the population when in need of life saving medication, and I believe it is arguably illegal, if someone would take up the fight to argue it.

Not all pharma companies charge outrageous prices, but way too many do. Thank goodness my daily drugs aren’t very expensive. If suddenly they decided to increase it 400% what could I do? I need the drugs to live. I wouldn’t die tomorrow, but going without them for an extended period would seriously risk my health, and probably eventually kill me. I would have to start taking other drugs to treat other conditions within weeks. I am at the mercy of the pharma company. It’s scary.

Earn more money until it is affordable out of pocket.

@Hypocrisy_Central I don’t take your answer seriously, but I will say that if they put a freeze on prescription insurance and we all had to pay out of pocket for 6 months I bet a whole bunch of prices would come way down. Pricing is too invisible, insurance companies can now blame Obama (people have amnesia prices were already ridiculously high) and the system of your job paying part of insurance premiums keeps the employee in the dark.

The Zofran example is a good one. It’s ridiculous how expensive that drug is. There was a report about some new cancer drug, I don’t remember the name, it was an actual treatment, not symptom reliever, that decided to charge an outrageous price. They were getting it, so the competitive older drug raised their price. We are talking thousands of dollars, not a few. Collusion! During this report an oncologist talked about another drug they won’t use, because it’s such an obvious rip off preying on the very sick.

We need more people to speak up! Doctors, patients, pharmacists, and lawmakers. It’s most impactful from doctors, but they enjoy double dipping and erroneous charges using the insurance system also. Not all of them, but enough. I think for many doctors it’s a love hate with the insurance companies. I also think many doctors are out of touch with fees for services.

Totes… First thing I do when I am really sick is crawl on the floor and vomit, find my bootstraps, wrap them around my neck to find I am to weak to hang myself and then pull myself up to go work while daydreaming about my parents fucking in Sweden so I wouldn’t have to worry about this shit.

Again :: Like with gun violence.. Keep proving that the United States and her citizens are very broken… At least our math scores are keeping Latvia on there toes.

The system of healthcare in this countrY is stupid and EVERYONE knows it, including those raking in billions BECAUSE it is stupid. It’s very existence is a virtual testimonial to open corruption.

You fix it by replacing the United States’ National Affordable Care Act with a SINGLE PAYER NATIONAL HEALTH CARE INSURANCE SYSTEM like they have in almost every other Democracy. The link I’ve cited gives a good description of what Single Payer is and who’s getting it, and how it is administered in each country. It also lists the states that have attempted to vote it in for themselves and how it went. It’s a Wikipedia article. I suggest every American read it.

The argument against Single Payer in the US is that it would become nothing less than a run-away medical insurance program like Medicare and thus break the economy. I agree, it would, if things remain as they are and we allowed hospitals, pharmaceutical and medical device producers to charge the system like they now do in the example I gave above in my last post.

I saw medicare abuses by the score when I was a community nurse. One example that sticks out in my mind, which wasn’t unusual:

An elderly patient was sent home from the hospital with a pair of pedi boots <like these. He was completely ambulatory and not in risk of foot-drop. Foot-drop is when a bed-bound patient’s Achilles tendon contracts from lack of walking and the foot points toward the down, making them unable to ever walk again without long, intensive, painful physical therapy. Applying pedi boots prevent this. The patient protested when being discharged from the hospital that he didn’t want them, need them, or would ever wear them. He was right. His doctor, my boss, agreed that he was perfectly ambulatory and later agreed that he shouldn’t have been sent home with pedi boots.

When I visited him in his home for initial follow-up after his release, I met a livid character. He had just received the medicare “bill”, which is an itemized accounting of hospital services, drugs and equipment that medicare patients receive after each service is rendered. At the top of these “bills” is a notice in large, bold type that reads, THIS IS NOT A BILL, so patients don’t have a heart attack when they read them. The hospital had charged medicare $7,300 for these, which he had cast into his wardrobe in their unopened plastic bag. This freaked even me out.

I took the pedi-boots, the bill, and the patient’s wrtten statement to the office of my local congressman. I told the young lawyer who interviewed me that I’d seen a lot of this stuff, and although financials are out of my scope, this was too outrageous to let pass. The lawyer, a congressman’s aide, seemed to be impressed by the outrage and said he’d look into it. I never heard from them again.

We live in a country where the company that produces only cure for Hepatitis C—the number one killer of healthcare workers—demands $840,000 for their therapeutic regime (which consists of taking a pill every morning for nine months). Not even insurance companies will pay that.

We live in a country where the Medicare program is charged $7,300 by a hospital for an item made of fake fleece, velcro, and hard plastic that is probably made in China for less than ten bucks.

We live in a country where a simple procedure performed by a thirty-dollar-an-hour Registered Nurse consisting of removing a foley catheter from an uninsured patient costs the taxpayer $4,374.23 and the patient $771.92.

Of course we can’t afford that. But the fault does not lay at the feet of the government programs that often have to pay for these. It lay at the doorstep of the hospitals and doctors who regularly gouge the system with impunity. You never hear this side of the argument, do you?

Our politicians are not interested in solving this problem or delivering affordable health care to the citizens of this country. If they were, they wouldn’t be yapping about how broken are the programs such as VA and Medicare are. They wouldn’t be talking about how wasteful and prohibitively expensive they are. They would be concentrating on the real problem which is rampant price gouging of the public and their government by the health care industry. Then they would do something about it. And then we could afford Single Payer like every other civilized nation.

One last note. In the 1990’s Big Pharma came up with retro-viral drugs which allows AIDS patients to live longer, more productive lives. But the regime costs over $250,000 per year per patient. South Africa, a single payer nation, had a huge bloom in AIDS at the time and wanted to provide these drugs to their inflicted citizens, but there was no way they cold pay the listed price. Negotiations came to naught. So, the SA government simply began producing their own retrovirals using the proprietary Big Pharma recipes (I always wondered how they obtained them). Fuck you guys, they said.

Single Payer, from a health care corporation’s point of view, is a very dangerous form of collective bargaining. They don’t want it in the U.S., their favorite gouging pit, and they would like it to disappear in other countries.

@Espiritus_Corvus

I agree. But dream on, it will never happen.

Yes it will.

It will happen. We’re going to be forced into it from sheer urgency

@stanleybmanly Everyone who? Do you know how many people talk about the YS having the best healthcare in the world, look at me like I’m a liberal liar when I tell them I sometimes have to pay more for services with my insurance than if I self pay, who don’t remember health costs were already ridiculous before Obama?

The biggest problem is so many people were on HMO’s and had no idea about the back office money changing hands. Slowly that is changing. My husband was the VP of Compensation and Benefits at his last job during the time Obamacare was first imposing it’s requirements and one thing during that time my husband’s company did was get rid of the HMO plans. He did an analysis, and although those plans had higher premiums each month for the employee, the lowest paid employees had chosen those plans. They were a little surprised by the data. After investigation they summarized that the people in the lower income brackets (not poor, lower middle class incomes) like to be able to predict their monthly expenses.

I went off a little on a tangent, but the point is a lot of people don’t give a damn nor understand the bigger picture. They have no idea how much money is changing hands.

“Everyone” capable of changing the healthcare system KNOWS that universal single payer health care is the best and most efficient way to provide health care to the greatest number of people at the lowest cost. Both the country and its citizens are in effect hostages to the obscene interests of insurance companies and pharmaceutical corporations.

@stanley Oh, that everyone. Ok, I agree most of them know. I do think some people at the helm, some politicians, really believe competition is the better cure for pricing.

@Espiritus_Corvus and @stanleybmanly – I don’t see how, despite your confidence.

We have a congress that values ideology over solving problems, and the concept of a single-payer is anathema to those ideologues.

They would rather see people die (in favor of the free market and reduced intervention) than back off their ideological and political positions.

Don’t get me wrong, single payer was a good idea 20 years ago, and it still is today. But in practical terms…. it isn’t happening in my lifetime unless some fairy sprinkles dust over the republicans and has them forget their political stands.

@JLeslie The health care situation and pharmaceutical pricing are the clearest examples you will ever see of who it is that REALLY owns the government. They are textbook examples of laws being passed which are ON THEIR FACE clearly against the public interest.

@stanleybmanly I’ve wanted socialized medicine since the first year I had to experience unsocialized medicine when I graduated from college.

I do think without socialized medicine, it would be better for health insurance and health care be done directly with the end consumer and not through employers. The whole industry is full of good ol’ boy bullshit.

A recent win is a new federal law that we regular people can now get lab results directly from labs.

@elbanditoroso It’s exactly the same situation we faced regarding cigarettes. The expense of our healthcare system is unsustainable. The inefficiencies of dozens of insurance companies with CEOs clearing multimillion dollar salaries are just plain indefensible. As with cigarettes, studies are going to come out, and folks are going to concentrate on the big task involved with progress -beating it into the hopelessly ignorant heads of the citizenry that we are being robbed. The thing is that the insurance/pharmaceutical cartel knows this reality, and basically are banded together. The financial muscle of the 2 of them appears unassailable, but already the insurance companies are pissed at excessive drug prices cutting into their obscene profits. The crusade will arrive. The question is when?

@JLeslie I don’t take your answer seriously,…]
Really, is it not true? Do you think the top 5% or even the top 15% sit around and worry about the price of the pills they have to take or if they are getting overcharged, if they need it and they can pay for it, they do, that is what everyone does with everything else.

@Hypocrisy_Central Absolutely. The top 5%, or even 15%, are at the top because they aren’t irresponsible with money. I am the top 5%. We care about value, we tend to have high deductible health insurance and HSA accounts, so we actually pay full price for the first $2k-$5k of our health costs every year depending on the plan. I get blood drawn every 3 months more or less, and I have a standing order for 8 things. I delete a couple sometimes if I think it’s over kill to repeat so soon. I save maybe $25—$50 doing it per blood draw. Most middle class people just do whatever their doctor prescribes and pay the $30 copay. They are more oblivious to health care costs in general. There are exceptions in every group of course, every social class. People who are lower income, but not low enough to get Medicaid also are aware of costs, although, they often are charged a self pay rate, which often times is lower. Not always though. Doesn’t matter what it is, it’s a hardship for those people no matter what the cost.

We’ll just have to wait and watch, but the only reason we have Obamacare is because the insurance companies saw the writing on the wall. Like cigarettes, the horror stories keep piling up. The tipping point approaches.

@JLeslie We care about value, we tend to have high deductible health insurance and HSA accounts, so we actually pay full price for the first $2k-$5k of our health costs every year depending on the plan.
If your household was raking in 12 mil a year that 5k is chump change, even if you have to pay out of pocket 60–120k for a lifesaving procedure it will not break you. Depend on how close you lived on consuming the 12 mil yearly, you may not feel it any worse than John Q does when he has an unplanned flat tire and has to replace it.

@Hypocrisy_Central Why are you talking about $12million? The top 5% starts at a much much lower income than that. Even a much lower total wealth if that’s what you’re going by.

It still doesn’t change that someone won’t want to pay $30 a pill, and know the company makes $7Billion on that pill per year. Many people with money care about their own pockets and also the pockets of society at large when it comes to healthcare.

Plus, many people take medicine daily, not just 20 pills once every 7 years like a flat tire.

Thank you all for your well considered responses. You all outline, very well, my own concerns the medical care in this country.

The people in control of our country’s healthcare (our elected servants) argue most fervently against a single – payer system, and yet, they are the ones who benefit from a single – payer system.

Keep Tricare & veteran benefits. Those who actively serve deserve the highest levels of benefits.

Abolish state and federal employees from having the same benefits as armed service members. Congress and Senate lose their insurance status and sign up in the marketplace like everybody else.
Let them battle for a 2nd MRI or to take the Oracea their MD prescribed. Our elected officials are not entitled to better care than they legislate for us!

Time to fight that bullshit dichotomy.

We need to stop asking, as if the govt is our parent, and start demanding demonstration of fair legislation. They can live by their own rules.
Remember. They, individually, need our support. It’s gang bullying that gives them power.

@Blueroses Oracea?! Oracea is scamming the patent system in my opinion. That drug is soooooo old, they just put out a lower dose and tested it for that use. I would assume they only have to do phase 4 testing for efficacy. I can’t imagine they have to start from scratch with the typical safety measures—and they get a patent? As far as I know the patent is for the typical amount of years. If anything it should not be for the same amount of years as usual. Was there not already a lower dose available for children or even animals? I honestly don’t know. Doxi might be like tetracycline, not good for young children? I don’t know, I’m just thinking in terms of drug class.

My husband was prescribed it and got it fairly cheap so I didn’t balk about it, but it still annoys me.

How do we fix it?

I’ll keep this brief since there is a lot to be mentioned here. Issues with costs are a symptom. The best way to fix any issue is to treat the fundamental cause. The main cause is America has too many sick people – hundreds of millions. Even those who can afford care are sick. Statistically, most illnesses and injuries are self-induced or parental. The remaining small % are due to reasons beyond human accountability. The most prevalent cause is unhealthy behaviors, such as: substance abuse, poor dieting, obesity/overweight, inactivity/lack of exercise, toxic environments, and chemical exposures. On an even more fundamental level, the root causes are incompetent parenting, mixed-race breeding, poverty pregnancies, and illegal immigrants.

Efforts should be placed on these troubling areas which in turn will resolve or diminish the symptoms. The conversation should be steered towards a detailed methodology.

…mixed-race breeding… Hmmm. Miscegenation. Hmmmm…. Do I need to worry about that Joo who snuck her way into the family line a few generations ago? Maybe I’m a second-class citizen after all.

WTH?

@jleslie yes, Oracea is a patent scam like many other drugs.
When the patent expires, re-release with a different salt and re-patent and advertise the shit out of the new, superior drug!
Prescribe the new formulation to people who never tried the old one… see if you can bankrupt them! Partial score for merely making them cry.

Every day, I request doctors to consider older drugs first or to break down “NEW” combination drugs to the cheaper, generic components.

@Blueroses I think Oracea is just the dose, is there actually a chemical difference? I didn’t know that. Although, I agree, they change one little chemical structure and can get a patent, I just didn’t know that was the case for Oracea. I just thought possibly the only other dose is the 100mg capsule of doxi.

Do you think the doctors are ignorant, or lazy, or buy into the pharm sales person’s sell? Why don’t they prescribe the old drug that has a history of being safe or is cheap? Some doctors do, I’m not saying all doctors are the same.

I don’t buy generics half the time for various reasons, but even the old brand hopefully is cheaper than a new drug.

@jleslie You’re correct. That example is just a patented dose. It’s an odd dose & has weird payment. It is just doxycycline and when I enter it, I get an automated generic sub for doxy 40. The generic is outrageously priced, because it’s unnecessary, yet available. Insurance won’t pay for the generic… They contract for brand Oracea.

Now the pharmacy is stuck with the auto-ordered generic (made by the same company as Oracea) & it’s opened to fill the script that insurance won’t pay, & the pharmacy also has to order and fill the brand Oracea.
We can’t return the opened generic stock bottle; we had to pay for both the generic and brand as stock. That generic will sit on the shelf until it expires and we, consumers, get to pay for the overhead cost.

@Blueroses Wow. That’s ridiculous. So, after that experience a few times does your staff put a request through insurance before actually breaking open a bottle? I’m surprised it’s not usually prescribed so the patient gets the whole bottle. It seems like something like that would be prescribed for a month. I don’t know how many are in a generic bottle though.

It seems the biggest problem is this automated generic sub. I’m annoyed to often that a generic is automatically given to me. I know my doctor needs to write do not sub, but they screw it up all the time. I can have a long history at the drug store of taking the brand of a drug, and they still substitute. Just two months ago I went through it with my thyroid meds. The pharmacist actually called me about something about the scripts just sent in, and I thought to say the Unithroid must be Unithroid, no substitutions. He was glad I told him (I have taken that drug dispensed by Walgreens for over 7 years!) and then he told me it will probably take 48 hours to get it. Also, prescribed with it was Cytomel, first time taking it, and they gave me the generic. Ugh. I took it, I didn’t have the strength to refuse it, and I think it’s less crucial than my T4. Why when I was telling the pharmacist about my Unithroid didn’t he think, “do you want everything as written, no substitutions?” I don’t understand. I also take some blame that I know I have to say it 100 times. Whether it be to the nurse writing my script or the pharmacy.