(Getty Images)OK, look, I've avoided this whole health care issue, right? In fact, the hideousness of the debate over this subject led (in part) to me quitting blogging for, like, totally, like, three months last year (an eternity in blogtime). Ick. Blecccch. Uck. Such an annoying thing on the TV and the blogs and the facebooks.
So whatever, but I fully noticed something today! I went to the pharmacy to pick up a prescription. Oh, I know, boring. But! You all know I'm a fed. That means I've got this, like, what do they call it? A Cadillac plan? With leather interior? Right. Actually, it's Kaiser Permanente, a plan that sounds fancier than it is, because it sounds vaguely European. My prescription is no big deal other than it totally stops me from dying 'n' stuff. Fun!
Here's what I finally noticed today at the bottom of my receipt for drugs:
KP price: 3147.65
You pay: 60.00
Holy shit. Is that for real? Is that just marketing? Yes? No? Gosh. I'm not playing dumb; I really am dumb when it comes to things like this.
So what if you're not me? What if you don't have health insurance? If you can't afford health insurance, I'm figuring you can't afford 3147.65 for two months worth of drugs that you have to refill every two months for, like, forever, to totally stop you from dying 'n' stuff.
So I guess if you're not like me, you just go ahead and die, because staying alive is too expensive. Bummer!
This message has been brought to you by Kaiser Permanente. Haw, kidding.
WTF? OK, I honestly don't understand this stuff. Really! My eyes glaze over. Am I getting something wrong? Seriously, it's fine to tell me I'm misunderstanding this. Either I'm just utterly missing something here or I'm late to the "something is terribly wrong" party.
I know this post is stupid and naive. I know I'm stupid and naive about certain things. Damn, though, fuck! At least I admit it.
Maybe this is why the confusion, you missed a line:
KP price: 12.95
You pay: 3147.65
KPal price: 60.00
I admit I didn't care what drug company claimed their medicine cost. I HAD a reasonable co-pay. Now instead of a set co-pay, I have to pay 20%. I don't think I could afford over $600 for meds.
It is a good thing the drug companies make lots of sleeping pills. How else could they sleep at night? Oh, that's right. No conscious, no sleepless nigts.
When you don't have health care and you go to the emergency room, they send you the bill for what they call the total amount. I went a few years ago and they said they gave me $17,000 of care for about as many hours, most of those hours spent being ignored and told to wait. When I made it clear I couldn't pay that, they decided it was $2,000. Such a bargain!
They make numbers up. It's all smoke and mirrors and worse. At least when you have health care, you usually have some idea of what you are going to pay in advance instead of getting stuck with an insane bill afterwards. This isn't true if major surgery is involved. Even with insurance, the bills can go absolutely nuts.
And, by the way, right now I have insurance and it's Kaiser Permanente, too. Not exactly a Cadillac.
P, I'm guessing that the pharma folk reckon it's your fault for your particular situation. Hard to imagine what someone w/o insurance does about it. Damned sad.
Were these generics, by any chance? I have one of those Cadillac plans, state guv'mint edition, and I got two generics filled last night for $10 each. The little Target receipt said I would have paid $300 and $200 out of pocket without insurance. For generics. Something is seriously fucked up.
Nope, not generic.
Matty, I must say that Kaiser has been just fine for me. I got sick last year and received excellent care.
There aren't generics available for everything (and, if I'm not mistaken, there has been a increase in time before a drug is made available for generic distribution).
yeah, I pay $60 a month for heart meds (no generics; I'm one of that .5% who gets the unremitting cough side effect...not good for client-facing work).
Don't forget the "required" dr's visits for ongoing, stabilized conditions before getting the 'scrip re-upped. Hey, what's another co-pay?!
nancy in mn
Peteykins, I've had good service with Kaiser and my dad liked it well enough until he realized he was entitled to service at the V.A., which he thinks is a little more Cadillacky. I also have a friend who died young and an early misdiagnosis at Kaiser may have made her situation worse.
I had Kaiser as a kid -- another perk of being a faculty brat. It's the closest you'll find to socialized medicine in the USA, and it's very much unlike the peculiarly exhilarating combination of anxiety, disappointment, frustration, anger, and torment that your usual mid-priced health insurance offers. (I should thank my health insurer for providing me with such excitement!) I pine after those carefree days with Kaiser practically every time I walk past a hospital.
For your particular scrip, how someone else might handle those really depends. For ARVs, decades of activism have pretty much ensured broad access through a combination of state subsidies and pharmaceutical-company writedowns, even for those who aren't on Medicaid and don't have fancy private insurance. For most other people who need expensive medication and don't qualify for Medicaid, well, that's where you get those nice "it was my pills or my food" stories.
Basically, it's like an extended game of poker where everyone bluffs and no one ever shows their cards, nor has to. There's a lot of money in the pot on the table, and everyone thinks it's theirs, without quite saying so out loud.
The only way you know someone's lost is when they've either been caught with a spare Ace up a sleeve (e.g. cooking the books, underpaying or over-billing). Or someone reaches for the loot, and the table is upended and the guns are out.
I realize that's not a helpful metaphor in clearing up your confusion so much as describing it, but I was going to post all this other stuff about contracts, pools of risk, and capitalism and stuff, and I realize I'd probably only make things worse for you because I'd get a lot of it wrong.
So . . . metaphor it is!
P.S. I have Kaiser too, and I'm happy with the care. They're probably happy with me, since I don't really like going to the doctor if I don't have to. But when I did, they took good care of me.
When I lived in the U.S. I had Kaiser Permanente and I liked it. Later, I had Blue Cross, which was terrible. Here in Panama I can go to a clinica and see a doctor for only fifty cents, but the medicines cost a lot more. Also, I don't have to have prescription to purchase my meds here. This created a problem when I was in the U.S. last year and ran out of my Panamanian meds. Them gringos, er, estadoünidense doctahs gotta have a prescription for EVERYTHING! I finally had to go to a Doc-in-a-box to get a prescription.
oh, us people with crappy individual plans with big deductibles can go to a patients advocate (if you know what is wrong) and usually order tests right from the labs, then google around to see what is normal, abnormal, etc.
When you have a pre existing condition and they will not insure one of your vital organs this can be a plan. You usually dont have a real doctor, or you do not like your doctor and the whole thing is a big pain in the ass.
Most good doctors are never taking new patients. The doctors that are, they like your 'insurance ' card even if it does not pay any bills for you. they will send a collection agency after you.
Forget about annual checkups or any preventative care, it is better to spend the money on good food.
So you buy organic food and stop eating CAFO meat, take some vitamins, exercise and pray you dont get sick or injured because even with your 'insurance' it is going to cost you a hell of a lot of money.
My son's ADD med is now provided in generic form. We use mail order to get a 3-month supply at a time.
We pay $20 for the 3 months; the full price of the generic is $900+ per 3-mo.
Imagine a family with no insurance and even one seriously ADD kid. Not pretty.
Always get a quote from them; you might like the product better, as well.
Recently, I had to fill a prescription (my cadillac plan hadn't "printed cards" yet, but promise to reimburse me...). At the pharmacy, the brand name was $350/month. At the local, compounding pharmacy it was $30/month.
That said, my guess is that my employer based plan negotiates a much better rate at the pharmacy and pays far, far less than we would out of pocket.
Sorry to comment hog. I am suspicious of anecdotal evidence, but when EVERYONE I know has an anecdote that happened either to themselves or someone close or maybe a neighbor, I'm amazed that a protest that wants to keep health care just the way it is can get enough people to fill a phone booth. Being uninsured can be nasty, but the worst stories I've heard are people who had insurance plans that screwed them when their health problems got expensive, like a neighbor of my dad's who got a brain tumor and lost his house when his insurance stopped paying the bills.
People going bankrupt due to health problems only happens in the U.S.A. How can any non-scumbag defend this?
Monopoly pricing and cartel pricing
The more obvious reason that Big Pharma can get away with selling pills that, as people have pointed out, probably cost about six bucks to manufacture, for <3 kiloBucks, is that they probably have the medications in question still under patent protection. Yes, there is a legitimate role for granting companies that build a better mousetrap a monoply on their innovation, for a limited time, so that they can have an incentive to innovate. But Big Pharma, as most of us are aware, has used its ownership position in the Congresscritter market to get the rules changed so that this form of monopoly protection extended to the point that is essentially permanent.
But that shouldn't be the end of the story on the price of these pills. However powerful a position that a monopoly gives a seller, the buyer still gets a say. It isn't true that, in the absence of competition from other sellers, the monopolist can raise his prices without limit. If he sets them too high, he will lose business, as potential buyers can't afford the price, or don't find the product worth that high price, and do without, or find some alternative. If a buyer controls a hefty segment of the market, represents a large portion of the potential buyers, as your health insurance plan does, the buyer has the very potent bargaining tool representd by the threat to deny that segment of the market to even a monopoly seller.
Thus we see the Canadian health service, which represents over 30 megaPeople, able to dun significantly lower costs from Big Pharma, than the US prices, and to do that across the board, for patent-protected as well as non-protected, medications. Thus schemes to re-import Canadian meds to help lower our costs.
But why should we need to parasitize off of the Canadians to dun these lower prices? Wellpointe alone has signed up over 35 megaPeople in its plans. It has more market power than all of Canada. If it used that power, it could get meds for at least as good a price as what Canada gets. And if it did that, it would be able to compete against other insurers much more effectively, by offering plans at lower premiums yet higher profit margins. Why don't they use their power?
Look, the reason, in theory, that we let the health insurance industry skim that 30% off the top for being the intermediary between us and the providers of medical services (one of which is medications), is that these middlemen are supposed to get us the best prices possible from the providers. That's their job, their sole job, the only value they add to the health care. They are, systematically, not just with Big Pharma , but with all the big providers (most notably, the big hospital chains), not dong their job.
This clearly is not a problem of lack of assertiveness, lack of willingness to throw elbows around in using their market power. Set the insurers against little providers, like primary care, and you see them cut, not just fat, but deep into bone and muscle. You owe the wonder of the 8-minute appointment to the industry, as primary care was much less "efficient" before The Great Managed Care Revolution hit the fan.
Merciless against small providers and against patients, but strangely meek where the real savings potential is, against the big providers, where all the fat is, and where asserting their market power would reap huge competitiveness advantages. Maybe there is some other explanation for this situation, but I am stuck with the idea that the health insurers and the big providers must be simply one big cartel
Free markets are a grand and glorious thing. But for them to be able to work their cost-lowering, quality-raising, magic; they have to be, you know, free. Yes, free of intrusive govt control, but you can do govt control appropriately and unintrusively, setting groundrules for competition, but not interfering in the market after it's set in motion. But more fundamentally, a free market has to be free of monopolies and cartels, because they cannot be limited and controlled, and they have no legitimate role in limiting and controlling a free maket from the outside. A cartel simply kills a free market. That's exactly what the health insurance industry has done to health care financing in this country.
One of my scripts costs about $1400 a month without insurance. Since my job and I parted ways, my doc's been giving me samples; without him (he also hooks me up on office visit costs) I'd be well and truly screwed.
I've been HIV postive for over 25 years. My meds cost $60,000 a year. That's correct, $60,000 a year. I'm not sick, I am surviving and doing fine as long as I take the drugs. If I didn't have my "cadillac" plan how in the hell could I afford that? I take 5 different meds a day, and NONE of these meds is available as generic. NONE. In fact, over 20 years of AIDS meds, NONE of them are generic. Big PharMa loves me and my kind. They probably have a cure, but they make so much damn money keeping us alive at $60,000 grand a year...
For-profit health care is just plain evil, period.
My favorite thing about Kaiser Permanente is that after they rejected me with little to no explanation, they kept sending me ads and applications. (I have other coverage now.) Some people I know like KP, but their major complaint is that they sometimes need to see a specific in-network doctor who's far away. There's no doubt that drug prices in the U.S. are massively inflated, though.
Yeah. What Princess and everyone else said.
We're self-employed and I'm afraid to look at the latest "open now!" envelope from Anthem Blue Cross, which is gonna raise our rates up to 39% (you may have heard about them. Been in the news lately. California.)
Thing is -- our business is in the toilet right now & we'd probably be eligible for Medi-Cal, but we're afraid to drop our current insurance for that because what happens if business picks up and we start makin' money again so we're no longer eligible for Medi-Cal and private insurers turn us down? We're in our mid-50s fer Chrissake and are trying to be responsible citizens.
Lots of fellow self-employed musicians/artists/weirdos I know (who aren't in unions) are in the same boat.
Gah! And yes on the weird pricing discrepancies.
When you're alone on health-care, you're really alone.
This thread just makes me much more satisfied with my decision to leave the United States and move to a second world country. I live in a place that is closer to third world than second world.
I live in a tax free zone. I take exactly the same high blood pressure medicine that I have taken for 20 years. It is over the counter, it costs less than 23 percent of what the exact same English medicine costs in the US, not counting the doctor cost to prescribe it. All but two of my 9 meds are OTC.
I have six major medical problems as well as multiple mental problems.
I have six doctors. 5 speak excellent English. All of them do house calls.
They have even gone and gotten a new drug for me and waited to see if I have an allergenic reaction.
They all listen to me. If I say that I am allergic to something, they don't say, well, we will send you to an allergist. They simply find something else for me.
I spent 7 weeks in hospital and 2 more months on total bed rest. I had 24/7 7 days a week RNs that were better than the ones I dealt with in the US. Total cost about $15,000.
Last year I was in the United States to straighten out something. My appendix burst. I was in the hospital for less than 18 hours. I was out of the hospital in less than 45 minutes after I came out of anesthesia. Hospitals are sinks of chemicals, I am allergic to most chemicals. I literally felt my bronchial tubes shutting down and "my" doctor would not let me have my inhalers since they "needed" a specialist to prescribe them.
I called the hospital when I got home to find out what the bill was. The only thing they had was the room charge, no nurse, no doctor, no meds, no anesthesia cost, just a damn bed was $39,000+. You think that I am going to pay them anything?
I paid for an american to go to central america for cancer surgery and chemotherapy. I flat told the person that I would not pay a nickel for any american to examine the cancer or even to go to a "specialist" for diagnosis.
It was you go, otherwise you die. It has cost me well over $15,000. Big deal.
I left my soul in Vietnam but I try to pretend to be human.
You usually dont have a real doctor, or you do not like your doctor and the whole thing is a big pain in the ass.
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