The cost of medications and universal healthcare

**LibraSunCNM, BSN, MSN, CNM** · Oct 6, 2015

You're preaching to the choir with me, macawake. Completely agree and have been sickened recently by articles like these:

http://www.nytimes.com/2015/10/05/business/valeants-drug-price-strategy-enriches-it-but-infuriates-patients-and-lawmakers.html

http://www.nytimes.com/2015/09/21/business/a-huge-overnight-increase-in-a-drugs-price-raises-protests.html

As a midwife I'm also particularly concerned by our completely inefficient maternity care system, its lack of utilization of midwives for the majority of low-risk women, and its gross overuse of technology that has no positive effect on outcomes.

DoGoodThenGo · Oct 6, 2015

I just read a thread that saddened me. I didn't want to hijack that thread with somewhat off-topic comments so I decided to start a seperate thread.
The thread in question was started by a person who takes 800 mg imatinib per day (trade name Gleevec (US), Glivec (Europe)) which in the US according to the poster retails at $24000 per month. The retail price for the same medication in my country is $5605. The retail price in the US is slightly more than 400% higher than the retail price in Sweden. That's simply outrageous.
I've included a link below to the drug guide for imatinib. It's in Swedish so you probably won't understand most of it but at the bottom of the page is the retail price in the in SEK, the local currency. One package of 30 400 mg tablets retails at SEK 23339, two are needed per month for a daily dosage of 800 mg which is SEK 46678 = USD 5605.
GlivecÃ‚Â® - FASS VÃƒÂ¥rdpersonal
Why do you pay so much more for the same medications in the US compared to Europe and most other first world countries? Here are a few articles that I think are worth reading.
Medscape: Medscape Access
Why Drugs cost More in U.S. - NYTimes.com
Costly cures | The Economist
We have universal, single-payer healthcare. Single-payer means single buyer of pharmaceuticals. It's a lot easier to apply pressure on a seller (of pharmaceuticals) and negotiate a better deal for a large (volume) single buyer than it is for several smaller buyers.
Another reason why we spend less on healthcare per capita is that since healthcare is single-payer we've eliminated the effect that insurance companies have on the price of healthcare. There's simply one less player looking to make a profit.
In our system medications are subsidized by the government. The maximum cost per year for one individual is SEK 2200, the equivalent of USD 264. That's slightly over $20 per month. (Of course since we pay for healthcare through taxes the real cost is higher than that but since the burden of paying for the individual's medication and other medical treatments is distributed across the entire tax-paying population, the financial burden is managable on the individual level).
I've spent some time in the US. I appreciate and love many things about your country. But for the life of me I can't understand the mistrust or reluctance towards universal healthcare that I heard expressed by many I talked to. (I guess I could have understood if they were financially independent and large shareholders in insurance or pharmaceutical companies, but they were just "regular people"). No one I asked could really put forth a persuasive argument against universal healthcare. Most had never experienced it firsthand and the most common answer I got was that the person didn't want the government in "their business". I'm not even sure what that means. I don't feel that my government is in mine :)
Our system isn't perfect but it does ensure that all people have access to healthcare and that no one has to take out a second mortgage on their home or file for bankrupcy due to health problems or simply do without much needed medications for financial reasons.
I'm aware that some of you struggle with health issues and that this might mean financial hardship and stress caused by the need to pay for/afford treatment and medications. I'm not writing this post to gloat about our affordable system and I sincerely hope I haven't caused anyone any distress.
As you might have guessed I'm a staunch supporter of single-payer, universal healthcare. I think that it's beneficial for the entire nation. I think that you guys deserve it.
As I started of by saying, I was prompted to write this thread because I was deeply saddened to read that an individual has to pay exorbitant sums per month for their necessary medications. Beyond that I'm not sure why I posted this. I guess I just feel that it's a deeply unfair system not worthy of a rich nation, and that no one individual should have to struggle so when trying to regain and protect their health.
Edit: The Medscape link doesn't seem to work. The name of the article I tried to link is Why Are Drug Costs So High in the United States? (in case someone wants to look it up).

Answer to your main query is simple; other nations with universal healthcare systems have some sort of national government formulary that sets costs for pharmaceuticals, devices and so forth. No such national system exists in the United States. One of the largest US federal government funded healthcare system Medicare is forbidden by statue from using their buying power to lower costs. Medicaid being a state and federal government program does "negotiate" prices for drugs.

There are tons of arguments for and against allowing the US federal government to "negotiate" drug prices. Drug companies are Big Money over here and they know how to throw it around to get their way.

https://www.nationalcenter.org/NPA550MedicareDrugPrices.html

http://www.aei.org/publication/the-real-dangers-of-medicare/

Oh'Ello, BSN, RN · Oct 6, 2015

And socialism is so totally horrible...

DoGoodThenGo · Oct 7, 2015

Can see both sides of arguments for and against the federal government getting more involved in healthcare than it already is. OTOH the American public has been so brainwashed by drug companies and weak "cops on the beat" so to speak that we all are paying vastly more for meds than we should.

Generic versions that should come to market aren't because drug companies work behind the scenes to delay or outright prevent that from happening. Scores of so called "new" medications are often no better than drugs that are ages old. But the new versions are patented and thus can bring in big bucks. Meanwhile the older medications aren't and thus while in theory their lower cost should make them attractive try getting someone to produce.

If nothing is done we shall just have more situations like this: Report: wide variance in Medicaid use of costly hepatitis C drug

That Guy, BSN, RN, EMT-B · Oct 7, 2015

There is no money in a cure/healthy people.

SmilingBluEyes · Oct 7, 2015

Citizens of the USA bear the majority of costs associated with research and development, also. Many other countries contract to buy these drugs and are not paying the burden of these costs, which are huge.

That is another reason drugs manufactured/developed and used in the USA are so out-of-control expensive.

MunoRN, RN · Oct 7, 2015

Citizens of the USA bear the majority of costs associated with research and development, also. Many other countries contract to buy these drugs and are not paying the burden of these costs, which are huge.
That is another reason drugs manufactured/developed and used in the USA are so out-of-control expensive.

That's what Big Pharma would like us to believe, but it's not actually true. Drug companies do spend massive amounts on R&D as well as regulatory approval, but they actually spend even more on marketing of prescription drugs, which just adds immense cost to medications and probably causes more harm than good.

While countries that regulate their prices pay much less than we do, those prices still cover the cost of development as well as some extra for a profit. The difference is that in the US, profits are much, much higher. Successful companies, like Nike or Dell for instance, turn about a 6% profit. Extremely successful companies like Apple profit about 22%. Drug companies however turn a profit as high as 45%, which is obscene.

iluvivt, BSN, RN · Oct 7, 2015

Cradle to the grave entitlements.....NO THANK YOU. History proves Socialism does not work. It just sounds good, but in practice it is horrid. Do a little studying of history and it's easy to come to this obvious conclusion.

ACNP-Ray · Oct 7, 2015

Not to mention the fact that healthcare and "big" pharm is a business. It's simple economics. As an NP I expect to be paid for my services, if I wanted to do charity work I make that choice for me and my two little ones. Drug companies are in business not charity. They don't make drugs out of the goodness of their hearts, they make them to make a profit. People stop buying them at the outrageous prices and make their docs/np's/pa's give them the more affordable choices eventually big pharm will get the message. But it will always remain a sellers market.

toomuchbaloney · Oct 8, 2015

That's what Big Pharma would like us to believe, but it's not actually true. Drug companies do spend massive amounts on R&D as well as regulatory approval, but they actually spend even more on marketing of prescription drugs, which just adds immense cost to medications and probably causes more harm than good.
While countries that regulate their prices pay much less than we do, those prices still cover the cost of development as well as some extra for a profit. The difference is that in the US, profits are much, much higher. Successful companies, like Nike or Dell for instance, turn about a 6% profit. Extremely successful companies like Apple profit about 22%. Drug companies however turn a profit as high as 45%, which is obscene.

well said

I believe that our current government is more in the business of supporting and promoting capitalism than it is in promoting or supporting democracy or personal liberty. It would seem that Congress is more interested in those things which create more wealth for the wealthy than they are those things which promote more justice, or more security, or more opportunity for the individual citizen.

subee, MSN, CRNA · Oct 8, 2015

And socialism is so totally horrible...

Please explain what socialism has to do with universal healthcare. If you are going to equate the two, please explain why universal health care if so totally horrible and why the American system is so outstanding.