The cost of medications and universal healthcare

margin261 · Oct 9, 2015

I do understand that, I get it. I'm honestly not saying drug companies should provide medications at no profit "out of the goodness of their hearts".

But while people can shop around for lower priced insulin, statins and other routine meds- for things like Gleevec they usually can't.

I bet the CEO could still feed his family, educate his children and maybe even take them on vacation if he took a salary of say, 7 million/year and lowered the cost of the drug in the US.

But this is just my simplistic opinion of the situation.

ACNP-Ray · Oct 9, 2015

I do understand that, I get it. I'm honestly not saying drug companies should provide medications at no profit "out of the goodness of their hearts".
But while people can shop around for lower priced insulin, statins and other routine meds- for things like Gleevec they usually can't.
I bet the CEO could still feed his family, educate his children and maybe even take them on vacation if he took a salary of say, 7 million/year and lowered the cost of the drug in the US.
But this is just my simplistic opinion of the situation.

Was actually responding to Alisonisayoshi, LVN response to my initial "rant" and I hear what your saying about him/her taking a lower salary but honestly who wants to make less money. I know I would balk if my employer came to me and said "Ray, I want to offer botox to everybody at 50 bucks a pop but in order to do that I can no longer pay you 120k but I will pay you 90k per year. Well if you know me or anything about me then you know I'd tell him where to put his botox and go find another position paying me my original 120k or more. Yes newer drugs are more expensive I understand that but due to the marketing and R&D that goes into that drug they are free to set their price. Now getting back to Gleevec; there are a ton of Kinase inhibitors on the market. If your doc thinks you need one ie Gleevec and you cant afford it, find another thats less expensive or have them find one. When I run into docs that are pushing "New" drugs I often raise an eyebrow at them and wonder if they aren't on the payroll of these corporations. I have been to several "educational dinners" at fancy restaurants paid for by the drug companies and the educational portion is by a Doc on their payroll. Doesn't mean Im going to prescribe it just because it's the newest thing on the block. One big thing Texas Tech hammered into us as NP students was that you always look for less expensive alternatives for your patients. At times it can be a balancing act of what the pt can tolerate, the efficacy of the medication and cost.

Alisonisayoshi, LVN · Oct 10, 2015

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.

If I'm desperate, and without insurance, I will use R and NPH. I have in the past. I've also been a diabetic long enough to remember when that's all we used. Heck I remember learning carb exchanges. As a provider you must know what a roller coaster of coverage those older insulins actually provide, and how using them significantly impacts both my quality and possibly quantity of life. The newer insulins aren't simply more convenient, they work much more in step with how my actual pancreas would work, thus providing for a better control, thus keeping my feet, eyes, and kidneys intact. So, shall I choose a possibly shorter life span for a cheaper price? Should my quality of life be sacrificed for a CEO bonus? Again, it's a gun to my head kind of choice isn't it? I know how my control looked on R and NPH. I know how it looked on lantus (that was a godsend when it came to market) and I know how it looks on a pump. I'd like to live long enough to see my grandchildren one day (should I have them). So, I restate, they give me a life and death choice. It's not a free market. I have no other choice but to buy from them.

Dogen · Oct 10, 2015

Now getting back to Gleevec; there are a ton of Kinase inhibitors on the market. If your doc thinks you need one ie Gleevec and you cant afford it, find another thats less expensive or have them find one. When I run into docs that are pushing "New" drugs I often raise an eyebrow at them and wonder if they aren't on the payroll of these corporations. I have been to several "educational dinners" at fancy restaurants paid for by the drug companies and the educational portion is by a Doc on their payroll. Doesn't mean Im going to prescribe it just because it's the newest thing on the block. One big thing Texas Tech hammered into us as NP students was that you always look for less expensive alternatives for your patients. At times it can be a balancing act of what the pt can tolerate, the efficacy of the medication and cost.

You should probably read about imatinab (Gleevec) before suggesting anyone switch to another kinase inhibitor. The human body has hundreds of kinases (518 to be exact), and imatinib targets a single one. You can't just go grab another kinase inhibitor and expect it to effectively treat 90% of people with chronic myeloid leukemia or to cure about 40% of them. Imatinib is unique among kinase inhibitors... partially because CML is also unique (read the Nature link)... but there is no other drug like it.

Though in good news it will be generic in 2016. Fun fact, Brian Druker, who helped discover Gleevec? I've met him. The Knight Cancer Institute isn't far from me, we have a lot of friends in common. Nice guy. Thinks drug prices are too high. That's apropos of nothing.

Anyway, I have a lot of reasons why I prefer universal healthcare. I think it's inherently humane (ask me about Thomas Hobbes to hear the long version of this). I think placing the health of people in opposition to the profit motive of corporations is the closest thing to evil I come into contact with on a daily basis. I think it's a cruel irony that people like to say we have the best healthcare in the world without following it up by saying that's really only true for a slim percentage of Americans, and that our system is only the best if you happen to be wealthy (as an aside, ask me about "two Americas" for more information on how people of color experience a different healthcare system). I think it's obvious - from literally every other industrialized nation on the plant - that universal healthcare is both cheaper and produces better results. Somehow countries like Canada, the UK, Germany, and Japan manage to encourage people to have jobs, get educations, and get **** done without hanging the fear of getting sick over their heads to make them do it.

ACNP-Ray · Oct 10, 2015

You should probably read about imatinab (Gleevec) before suggesting anyone switch to another kinase inhibitor. The human body has hundreds of kinases (518 to be exact), and imatinib targets a single one. You can't just go grab another kinase inhibitor and expect it to effectively treat 90% of people with chronic myeloid leukemia or to cure about 40% of them. Imatinib is unique among kinase inhibitors... partially because CML is also unique (read the Nature link)... but there is no other drug like it. Anyway, I have a lot of reasons why I prefer universal healthcare. I think it's inherently humane (ask me about Thomas Hobbes to hear the long version of this). I think placing the health of people in opposition to the profit motive of corporations is the closest thing to evil I come into contact with on a daily basis. I think it's a cruel irony that people like to say we have the best healthcare in the world without following it up by saying that's really only true for a slim percentage of Americans, and that our system is only the best if you happen to be wealthy (as an aside, ask me about "two Americas" for more information on how people of color experience a different healthcare system). I think it's obvious - from literally every other industrialized nation on the plant - that universal healthcare is both cheaper and produces better results. Somehow countries like Canada, the UK, Germany, and Japan manage to encourage people to have jobs, get educations, and get **** done without hanging the fear of getting sick over their heads to make them do it.

Very interesting article on Gleevec and yes your correct about the kinase inhibitors, not all of them will work in all instances. Some like Gleevec are very specific, fascinating how they went about developing it. I also agree that drugs are too expensive, but where I disagree with you and a lot of others is I don't see healthcare as a right, it's a commodity to be bought and sold. I recently went to the ER for a kidney stone and for my 2.5 hrs in the ER the bill was 8900 for a bag of saline, a shot of Toradol and an ER nurse who took my vitals, started an IV and a doc who I told my symptoms too that wrote the orders for the saline and toradol and my discharge orders. 8900 bucks. Now my insurance paid all but 1869.00 which was my cost. Wrote them a check today...why? Because I was sick and I received a service. I could gripe and complain but to what end? Will the hospital forgive my bill? Not hardly. They did their job and I was happy to pay the bill because pain is a strong motivator. Now I could move to one of those other countries you mentioned and have all the universal healthcare I could ever want but I am still going to pay for it through a much higher tax rate than what I am taxed here. Being prior military I've been to all the aforementioned countries and I will take the USA every day and twice on Sunday with all her faults and jacked up politicians. And I have to ask, why are Canadians coming here for operations. As you mentioned they do have Universal Healthcare, why are people flying in from all over the world to come to the Cleveland Clinic or the Mayo Clinic to be treated when they have Universal Healthcare in their countries. I know our health system is far from perfect as I can see it from both a patient's perspective and a provider's perspective. So if people want universal healthcare I think they have two options; 1. move to one of those other countries and pay their high income taxes, or 2. do something to make a change. The government has already pushed Obama Care down our throats so it wouldn't surprise me if that was next.

elkpark · Oct 10, 2015

I also agree that drugs are too expensive, but where I disagree with you and a lot of others is I don't see healthcare as a right, it's a commodity to be bought and sold.

This is the fundamental issue. Does one consider healthcare a commodity, like a car or a washing machine, or a basic community service, like the police or fire department? I buy a nice a car as I can afford or that I feel will meet my needs, and, if my neighbor can't afford a nice car, or can't afford a car at all, that's not my concern. However, if your house catches on fire, you call 911 and the fire department comes and puts out the fire. You don't get a bill for that. You don't pay a different amount based on how big your house is, or how big the fire was. You call 911 and the fire department comes and provides what you need, and you don't get a bill because we all pay taxes so the fire department (and the police, and the roads, and the bridges, etc.) will be there for everyone when we need them. The US has, for the most part, always considered healthcare a commodity. Every other civilized country on the planet considers it a basic, necessary public service. And, as a result of our ridiculous view of healthcare as just another commodity, like cars or washing machines, we have a system in which we pay more than twice as much per capita on healthcare than the next highest-spending country on the planet, and quite a bit less to show for it -- we have morbidity/mortality statistics that are down there with some Third-world countries. Totally apart from the morality and ethics of this issue, even if you don't give a flying !@#$ about your fellow human beings, doesn't it seem obvious that that's just stupid economically??

And, every time universal coverage gets discussed, the people against it always raise the ominous specter of higher taxes. Well, yeah, taxes would go up. But we would no longer be paying thousands of dollars a year in premiums to private insurance companies, much of which gets siphoned off the top to line the pockets of company executives and shareholders. I would much rather pay that money in taxes to provide a fair, equitable system that ensures everyone in the country can get the healthcare they need than pay it to a private, for-profit insurance company that is paying out as little for healthcare as they can possibly get away with in order to turn the largest possible profit.

Dogen · Oct 10, 2015

elkpark hit the nail on the head. A person either believes healthcare is fundamental, or doesn't. My personal view on the role of government (something I talk about a lot, but which I use to examine whether my thoughts on government actions are consistent) is that the minimum role of the federal government is to provide for the health and safety of its people. This makes sense to me. Roads, libraries, banking systems... none of that matters if we're overrun by space aliens, burned to death in our homes, or dead from a preventable disease. So, from an individual perspective, those are my most basic needs that I require in order to enjoy the benefits of society (Maslow's hierarchy, social contract theory, etc). From a societal perspective, a healthy populace is a productive populace. We lose billions a year in lost productivity to preventable illness, and who knows how much in reduced lifespan (live longer, be more productive).

On medical tourism. Yes, it's a thing, but it's a pretty small thing. Some people from Canada come to the US for treatment: rich people who can afford care out of pocket (their Medicare doesn't pay for services here). The majority don't come to the US for healthcare, and they still manage to live longer. On the other side, people from the US also travel for medical tourism. India has a booming market that targets Americans, Canadians and Europeans to travel there for care, often provided by a physician trained in the US or Britain for ridiculously less money. I've had several friends who flew to India, spent a week traveling around, had major dental surgery, and then flew back to the US for less than the cost of the surgery here. In one case, my friend and her Indian dentist went to the same graduate school in Seattle. Medical tourism is actually part of India's economic plan. If you stop by the Indian Ministry of Tourism office in LA or NY you can find stacks of pamphlets advertising state of the art hospitals providing world-class care at 15% of the cost, etc.

MunoRN, RN · Oct 10, 2015

.... Now I could move to one of those other countries you mentioned and have all the universal healthcare I could ever want but I am still going to pay for it through a much higher tax rate than what I am taxed here.

In total you'll actually pay a lot less in any other country. The annual per person healthcare cost in the US is about $9,000, all other industrialized nations range between $3000 and $5000. We pay that much higher amount through different forms, not all of them taxes, but personally any money I'm paying for healthcare is real money, whether we call it taxes or not.

Being prior military I've been to all the aforementioned countries and I will take the USA every day and twice on Sunday with all her faults and jacked up politicians. And I have to ask, why are Canadians coming here for operations. As you mentioned they do have Universal Healthcare, why are people flying in from all over the world to come to the Cleveland Clinic or the Mayo Clinic to be treated when they have Universal Healthcare in their countries.

They don't actually come here for healthcare, at least not in numbers sufficient to measure. On the other hand, the number of Americans who feel the need to seek healthcare outside of the US has been quoted at 6 million in 2008, and 1.2 million in 2014. I've worked at a hospital which should have been where many of these Canadians were heading for healthcare and never had a single Canadian patient who ended up there intentionally.

This myth seems to be based on a single story of a woman diagnosed with a benign space-occupying mass in her brain. This doesn't require urgent surgery and in the US you'll typically wait 3 months or more to have it removed. She got a second opinion from the Mayo clinic who offered to do it sooner for more than $100,000 (the surgery averages $14,000 in the US).

. I know our health system is far from perfect as I can see it from both a patient's perspective and a provider's perspective. So if people want universal healthcare I think they have two options; 1. move to one of those other countries and pay their high income taxes, or 2. do something to make a change. The government has already pushed Obama Care down our throats so it wouldn't surprise me if that was next.

What would you do if it was up to you?

MunoRN, RN · Oct 10, 2015

Healthcare has long been established to be a legal right in the US and as a result we already have partial universal healthcare in the US. We legally require acute treatment of any medical condition to be provided (EMTALA) as well as coverage of care of the elderly (medicare) and poor (medicaid). If you were to intentionally design the most idiotic way of providing partial coverage and care, it would be hard to do it better than our system. If someone has diabetes and high blood pressure, we don't consider it our responsibility to help make sure those conditions are well managed. But when the fact that those conditions weren't well managed presents itself as a patient having an MI in the ER suddenly we're offering to cover the bill. I think people falsely assume EMTALA only applies to what's done in the ER, when actually it requires treatment be provided up until that patient no longer requires ongoing care, which after open heart surgery, CRRT, ECMO, etc could easily exceed $1 million. So, in the name of financial constraint we didn't want to help cover the basic management of this patient's conditions we're now spending many times what that would have cost.

The problem with our current system is that it doesn't recognize the connection between that patient's expensive acute care costs, and management of their contributing conditions, which as nurses we should find offensive. If we were smart we'd be going out of our way to treat these conditions when they're cheap to treat, or get rid of EMTALA, one or the other.

**LibraSunCNM, BSN, MSN, CNM** · Oct 10, 2015

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.

This is so full of fallacies I don't know where to start. Do you really believe that citizens of the U.K., Switzerland, France, Denmark, the Netherlands, Sweden (I could go on, but all countries with universal healthcare...some in fully socialized medicine systems and some just with universal coverage), experience restrictions on freedom of speech or face retribution from the government? Where people can't vote and women have no rights? I'm not sure if you're aware these are all industrialized, democratic nations, not communist dictatorships. Many of them are specifically much kinder to women in terms of workplace flexibility, maternity leave, etc. And they all tend to think our healthcare system is insane. Also, as MunoRN has pointed out, the amount of people coming from other countries to get American healthcare is relatively insignificant, but the number of Americans who head elsewhere for more affordable care is growing. Elderly people who can't afford their copays should have armed themselves with more "understanding"? Are you kidding me?

macawake, MSN · Oct 11, 2015

I do not believe in socialism at all.

This will probably come as a surprise to you, but that makes two of us.

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.

I don't get my information from Hollywood, I use completely different sources and I have actually lived in the US. Why don't you take look at your GNP per capita and compare it to the rest of the countries in the world. You are a rich country. You're certainly rich enough to provide medical care for all your citizens/residents. You're not lacking the money, you're lacking the will. (When I say you, I don't mean every single one of you. There have been several posters in this thread who seem to think that providing medical care for all is the decent, humane and smart thing to do).

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.

I don't think that you can find a single child and ask them what they want to do when they grow up and have them answer " I want to sit in my government funded housing, shoot up drugs and leech on society". I don't think that this is anyone's dream.

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.

(my bold)

Good grief. I actually rolled my eyes so hard when I read this that I think I might have burst a blood vessel or two. The capital of my country is Stockholm, not Pyongyang.

What do you know about the world around you? Do you actually believe that people in European countries have less freedom of speech and fear retribution from their governments and that women are oppressed and have fewer legal rights than you do? If you do, you need to do some research or perhaps travel a bit.

When I was in the US I encountered others who were similarly misinformed. I actually do believe that it's deliberate propaganda spread by some who are financially and ideologically invested in maintaining the status quo. Don't fall for it. It's utter rubbish.

Gender Inequality Index 2013:

Table 4: Gender Inequality Index | Human Development Reports

Global Gender Gap Report 2014:

Global Gender Gap Report 2014 - Reports - World Economic Forum

2014 Corruption Perceptions Index:

https://www.transparency.org/cpi2014/results

World Press Freedom Index 2014:

https://rsf.org/index2014/en-index2014.php

We also have longer life expectancy and significantly lower infant mortality rates in my country and in most North and Western European countries (and Canada, Australia & New Zeeland) compared to the US.

Elkpark, Dogen, LibraSun and Muno, thank you for your eloquent, astute and hope-inspiring posts.

odaat · Oct 11, 2015

Now my insurance paid all but 1869.00 which was my cost. Wrote them a check today...why? Because I was sick and I received a service. I could gripe and complain but to what end? Will the hospital forgive my bill? Not hardly. They did their job and I was happy to pay the bill because pain is a strong motivator. .

Surely you realize that one, having insurance to take care of that large portion of the bill and two, being able to just stroke a check for the difference puts you in the minority in this country in regards to obtaining healthcare. You are correct, pain is a strong motivator. How long did you writhe in pain, praying to anything that it would just go away before you sought treatment because you knew you'd be paying for that treatment for many many years to come? How long did you agonize over how you could afford to get that treatment? How much worse did your condition get because you put off seeking treatment until you couldn't bear it one more minute? This is the reality many people face, not the one you experienced.