The cost of medications and universal healthcare

[macawake]

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.

Glivec® - FASS Vårdpersonal

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).

[macawake, MSN]

MunoRN is right on the money

Pharmaceutical industry gets high on fat profits - BBC News

Rest assured that pharmaceutical companies have their R&D and manufacturing costs and a profit covered even at the prices their products are sold at in the European countries. They simply make a much larger profit when they quadruple the retail price for the US market.

From the BBC article:

Last year, 100 leading oncologists from around the world wrote an open letter in the journal Blood calling for a reduction in the price of cancer drugs.

Dr Brian Druker, director of the Knight Cancer Institute and one of the signatories, has asked: "If you are making $3bn a year on [cancer drug] Gleevec, could you get by with $2bn? When do you cross the line from essential profits to profiteering?"

(my bold)

That's a very good question.

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.

When I was in the US I encountered some folks who expressed similar opinions. The way you perceive how our society is organized sounds like something spawned in a propaganda mill and doesn't accurately portray how our countries are actually run. I'll ask you the same thing that I used to ask them.

First of all, please walk me through why not being one serious illness away from wiping out your life savings is a bad thing? Every person I know seem to find the thought that they will remain financially secure and are guaranteed medical care if disaster strikes, comforting. My patients certainly do. It offers peace of mind.

You are actually wrong when you call my country and my neighboring Nordic countries socialist. They aren't. They are hardly planned economies, they are mixed economies (like the US). But I'll play along :)

You think I should study history. All right. Please give me concrete examples of which countries that I should study that are/were Socialist and are/were "horrid" and "haven't worked". After naming these countries could you please tell me why you consider Sweden, Norway, Denmark, Finland and most other European countries (with universal healthcare) equivalent to these horrid non-functioning examples.

Exactly what freedoms, civil liberties, opportunities or whatever is it that you believe that you have and we lack? I'm genuinely curious.

[MunoRN, RN]

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.

I think you're confusing universal/comprehensive health coverage with socialism, which are two different things. Of all industrialized nations, we are the only one without universal/comprehensive coverage, and of those countries only a few have government systems that qualify as socialist, in Europe for instance the only socialist country is portugal. My all major measurements of healthcare quality, we are one of the worst while also the most expensive by a large margin.

[MunoRN, RN]

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.

And that's the problem; a "sellers market" is what makes an economy unhealthy. In a free market both sellers and buyers have influence over the price. By necessity, healthcare is a largely shared expense, which is why it makes more sense for the buyers as a group to exert it's market forces on prices, which would include us establishes the prices we are willing to pay through payers (CMS, insurers, etc).

[Tenebrae, BSN, RN]

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.

Take some of your own advice and stop listening to the propaganda mill

I live in a country with universal healthcare, while its far from perfect. I can rest in the knowledge should I become unwell, I wont have to sell a kidney or take out a second mortgage on the house just to pay the bill.

[NurseGirl525, ASN, RN]

These are two separate systems of government. I do not believe in socialism at all. My hard work should not be spread around to those that feel entitled to do the min and nothing more. Many people do not understand the government here and the way it works and why our healthcare is so expensive. I will give a little insight.

In the US you can get treatment regardless of your ability to pay in two instances. Emergent purposes and those who are pregnant. But our ERs do not turn away people who can not pay for say the sniffles either. The ERs here do not require money up front. If you go in because of a runny nose, you get treated. Many, many people just do not pay their medical bills here. Therefore, they are essentially getting treated and medicated for free. Guess who has to pick up that tab? Those of us with insurance and who pay their medical bills. So now, one tiny Tylenol costs about $8. Because the hospitals have to pay their doctors, nurses, techs, housekeeping, dietary, respiratory therapists, and so forth. It all costs money. But if I need an MRI for something, I do not have to wait 6 weeks for one. I can get one in a couple of days. This catches lots of illnesses much earlier than other countries. Those 6 weeks can be critical.

I love how other countries like to criticize our system here but you know what, when someone in another country is desperately ill, who do they look to save them? The US. We get everyone taken care of because we do have the top of the line equipment and physicians. But with all of that, we do have poverty and homelessness just like everywhere else. We are not immune to that.

Other countries like to believe what Hollywood spews out every year on the big screen. We are not all rich here and live in fancy houses. There are many people who believed they are entitled to everything, and I'm sorry but sitting in your government funded housing and doing nothing but smoking and shooting up drugs and drinking alcohol all day does not entitle anyone to better benefits or as good of benefits than those who work for it. Medicine is expensive here. All of the development and testing is done here. It is manufactured here. My taxes are lower here also. Some countries income tax is way higher than what I pay.

My heart has broken for elderly people who cannot afford the $70 copayment for their heart medication before. I wanted to just give it to them. But then I think about how I have been working my butt off to save for my retirement and all that good stuff. I know times were different this country but knowledge is power. Arming yourself with understanding and hard work is important.

I will often tell people to move to a socialist country if they want to benefit from the hard workers. But that also comes at a cost. Don't expect the freedoms you experience here. You can't always say what you think or feel in a socialist and communist country. It's a trade off. I like the way my country is. I know I can express my opinion without fear of retribution from the government. As a woman, I have equal rights and am equal to what a man is entitled to. I can vote and know that my vote counts. So my freedom does come with other things that are maybe not fair to other countries, but there are things in their countries I don't view as fair. I plan and work for the things I want in life. I want good insurance? I find the right company to work for. I want a decent house? I get my education to make a decent wage to work for it. I can't pay all of my bills this month? I may have to find another job. I'm spending too much? I cut back. I know at some point I will have to retire. I know I will have more medical bills. That is where the planning comes in. Medicare is not bad insurance. You can get a supplement policy to pay for what regular Medicare doesn't pay for. It can cost you nothing if you choose the correct plan. Yes, it's an HMO, but it doesn't cost a dime and you get prescription coverage. You can work with your provider and insurance company to find medications to work for you. Many drug companies do help those in poverty with their drug costs. The problem? Most people are too lazy to fill out the paperwork.

[iluvivt, BSN, RN]

No worries there Muno,I am well aware of what socialism is and I just spent the last school year as a learning coach in Economics for my daughter..lots of fun! It is a centrally planned economy where industry, natural resources and the associated goods and services, are owned collectively by the people. The goal is to give the working class ownership over the means of production. Production is centrally controlled by the government and therein is the root of the problems created IMO, leading to lack of product and services, severe shortages and lack of incentive by all types of workers. Every county has some programs that can be considered socialist and I was making the jump that socialist want to provide universal health care although there are different forms and degrees.

[Atl-Murse]

I am amazed how about 50 % of the country is fooled into voting against their self interest. Half the country pays no federal income tax and yet they want Flat/fair/ tax. This would would increase their tax from zero to ( pick a number ) while decreasing tax for the super rich. Take the 9/9/9 as an plan example, Trump would go from paying 20ish % to 9 % while Joe the plumber would see his tax rise from zero to 18%. SMH . Universal health care is not some socialist dream, it gives everyone a path to decent care they otherwise would get at the ER for inflated cost

[ThePrincessBride, MSN, RN, NP]

Heather,

While I do think that you make a couple of fair points, the question is this: is healthcare a human right or a privilege for only those who can afford it?

I work with a very rough patient population who are what you describe. The majority have spent most of their adult lives unemployed and taking and taking for a system without giving anything in return. From my personal experience, they are the most entitled, mean-spirited people I have come across. They demand a hotel experience and disrespect the staff more than the patients who are paying for their care.

It is infuriating. I am worked like a slave and see so much of my money go to taxes. I get it.

But making healthcare, the most basic fundamental need in the hiearchy (next to food and water, etc) is a dangerous line I do not wish to cross. I say this as a black woman whose ancestors were deprived of basic human rights and dignity...all because of the color of their skin. It is great that you feel privileged here in the US, but do not forget that not all people feel or experience the same as you.

America is a baby in comparison to other countries. It is very young and it has much to learn. We fail at so many things, and affordable and accessible healthcare for ALL citizens is a big one. Everyone should be able to see a doctor without worrying about having to file bankruptcy or lose their house and savings....even those alleged moochers of society.

These are two separate systems of government. I do not believe in socialism at all. My hard work should not be spread around to those that feel entitled to do the min and nothing more. Many people do not understand the government here and the way it works and why our healthcare is so expensive. I will give a little insight.

In the US you can get treatment regardless of your ability to pay in two instances. Emergent purposes and those who are pregnant. But our ERs do not turn away people who can not pay for say the sniffles either. The ERs here do not require money up front. If you go in because of a runny nose, you get treated. Many, many people just do not pay their medical bills here. Therefore, they are essentially getting treated and medicated for free. Guess who has to pick up that tab? Those of us with insurance and who pay their medical bills. So now, one tiny Tylenol costs about $8. Because the hospitals have to pay their doctors, nurses, techs, housekeeping, dietary, respiratory therapists, and so forth. It all costs money. But if I need an MRI for something, I do not have to wait 6 weeks for one. I can get one in a couple of days. This catches lots of illnesses much earlier than other countries. Those 6 weeks can be critical.

I love how other countries like to criticize our system here but you know what, when someone in another country is desperately ill, who do they look to save them? The US. We get everyone taken care of because we do have the top of the line equipment and physicians. But with all of that, we do have poverty and homelessness just like everywhere else. We are not immune to that.

Other countries like to believe what Hollywood spews out every year on the big screen. We are not all rich here and live in fancy houses. There are many people who believed they are entitled to everything, and I'm sorry but sitting in your government funded housing and doing nothing but smoking and shooting up drugs and drinking alcohol all day does not entitle anyone to better benefits or as good of benefits than those who work for it. Medicine is expensive here. All of the development and testing is done here. It is manufactured here. My taxes are lower here also. Some countries income tax is way higher than what I pay.

My heart has broken for elderly people who cannot afford the $70 copayment for their heart medication before. I wanted to just give it to them. But then I think about how I have been working my butt off to save for my retirement and all that good stuff. I know times were different this country but knowledge is power. Arming yourself with understanding and hard work is important.

I will often tell people to move to a socialist country if they want to benefit from the hard workers. But that also comes at a cost. Don't expect the freedoms you experience here. You can't always say what you think or feel in a socialist and communist country. It's a trade off. I like the way my country is. I know I can express my opinion without fear of retribution from the government. As a woman, I have equal rights and am equal to what a man is entitled to. I can vote and know that my vote counts. So my freedom does come with other things that are maybe not fair to other countries, but there are things in their countries I don't view as fair. I plan and work for the things I want in life. I want good insurance? I find the right company to work for. I want a decent house? I get my education to make a decent wage to work for it. I can't pay all of my bills this month? I may have to find another job. I'm spending too much? I cut back. I know at some point I will have to retire. I know I will have more medical bills. That is where the planning comes in. Medicare is not bad insurance. You can get a supplement policy to pay for what regular Medicare doesn't pay for. It can cost you nothing if you choose the correct plan. Yes, it's an HMO, but it doesn't cost a dime and you get prescription coverage. You can work with your provider and insurance company to find medications to work for you. Many drug companies do help those in poverty with their drug costs. The problem? Most people are too lazy to fill out the paperwork.

[Alisonisayoshi, LVN]

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.

But how do I stop buying insulin? I'm a type 1 diabetic. Eli Lilly has a proverbial gun to my head. Pay up or die.

[Fiona59]

If universal healthcare is so bad, can you explain to us why so many Americans cross the border and buy drugs in Canada? Why many who travel here on vacation don't purchase travel health insurance an present to our emerg departments for healthcare?

One we that lives in memory, came in with a detached retina. When asked about her last eye exam, she replied "knew I needed surgery but decided to get it done for free up here on vacation". Is that not the definition of freeloading? Yes, surgery was done and we heard a bill was mailed. Will never know if i was paid thoy

[margin261]

The US can't have a universal healthcare system that will work for several reasons.

The main reason is, as has been stated, the pharmaceutical industry is out of control. The people that could change that- politicians- won't because the big pharma lobby threatens to pull donations for their next campaign, donate to their competitors, etc (all that political stuff that goes on...) and they cave and the pharmaceutical companies carry on as they wish.

They claim the prices are necessary for R&D- and it is to some extent, but not nearly to the point of charging what they do.

As this thread started out talking about Gleevec- I just did a quick search- (very quick, so if anyone comes up with different info that's perfectly fine). Novartis makes Gleevec. The CEO makes a bit over 14 million with salary, bonuses, etc.

Don't think executives raises, bonuses & perks don't figure in to deciding the price of a drug. And the more necessary the drug, the more they charge.

When you or you're loved one has a terminal illness you'll do whatever it takes to save their life. That 14 million dollar CEO knows that very well.

This isn't the only reason we can't have a healthcare system that will work decently for most people- but fixing that would be a start!

[ACNP-Ray]

Once again you ask your doc/np/pa to change you to Novolin R instead of Humulin R and go to Wal-mart and pick it up for 27 bucks. There are usually always other alternatives. That was one of the first things I did at my last job, going through and finding the most low cost alternatives for my patients. Never once did I prescribe Humulin R at 130 bucks a vial compared to the 27 for Novolin R. A large percentage of my patients were non-workers who relied on the government. But as I stated before it will always remain a sellers market and they are free to charge as they wish because they are in business to make money. People will always be sick and in need of medicine. It may sound callous but I understand it and I'm alright with it because we live in a free market society. I don't like the fact the Mobil oil made 4 Billion in profit while charging me 3 bucks for a gallon of gas but it's their price to set, I don't like it then I go to the Wal-mart down the street and pay 2.75 for a gallon. You start price regulation and then where is their incentives for making new drugs....It would kill innovation.