The cost of medications and universal healthcare

elkpark · Oct 12, 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).

My understanding of the EMTALA is not that it mandates "acute treatment of any medical condition" but that it requires EDs (not any other healthcare providers) to provide stabilization of any emergency medical condition. Also, Medicare and Medicaid provide healthcare coverage for specific populations, but healthcare providers are not under obligation (that I'm aware of) to provide actual care to them outside of EMTALA requirements (lots of providers just don't accept M'care or M'caid clients). I'm not aware of any broader "legal right" to healthcare in the US, and would be happy to see any documentation of that.

MunoRN, RN · Oct 12, 2015

My understanding of the EMTALA is not that it mandates "acute treatment of any medical condition" but that it requires EDs (not any other healthcare providers) to provide stabilization of any emergency medical condition. Also, Medicare and Medicaid provide healthcare coverage for specific populations, but healthcare providers are not under obligation (that I'm aware of) to provide actual care to them outside of EMTALA requirements (lots of providers just don't accept M'care or M'caid clients). I'm not aware of any broader "legal right" to healthcare in the US, and would be happy to see any documentation of that.

EMTALA applies to all medicare and medicaid participating facilities and requires them to provide acute care to all patients under their care up until the point they no longer require acute care (the standard point of hospital discharge for all patients or transfer to a SNF or other acute care facility)

I recently had a patient, no insurance, who had a severe MI with cardiac arrest, went from the heli pad to the cath lab to the OR, spent a few weeks on ECMO, vent, CRRT, eventually getting an artificial heart as a bridge to transplant, when we eventually transferred him to a transplant facility he was still covered by EMTALA, many weeks and probably more than a million dollars later.

Pretty much any patient admitted through the ED is covered by EMTALA all the way up until they can be discharged from the hospital or the SNF they are transfered to, not just once they leave the ED, as well as direct admits and many elective procedures depending on their post-op course. In other words, pretty much all of our acute care in the US is EMTALA required, which makes up by far the largest chunk of healthcare spending.

elkpark · Oct 13, 2015

I recently had a patient, no insurance, who had a severe MI with cardiac arrest, went from the heli pad to the cath lab to the OR, spent a few weeks on ECMO, vent, CRRT, eventually getting an artificial heart as a bridge to transplant, when we eventually transferred him to a transplant facility he was still covered by EMTALA, many weeks and probably more than a million dollars later.
Pretty much any patient admitted through the ED is covered by EMTALA all the way up until they can be discharged from the hospital or the SNF they are transfered to, not just once they leave the ED, as well as direct admits and many elective procedures depending on their post-op course. In other words, pretty much all of our acute care in the US is EMTALA required, which makes up by far the largest chunk of healthcare spending.

Someone who presents with a "severe MI with cardiac arrest" obviously has an "emergency medical condition." So do lots of other people who get admitted to hospitals. Lots of people have health problems and need care, but their problems are not emergency medical conditions and they don't need an inpatient hospitalization. Where is their "long ... established ... legal right" to healthcare?

Tenebrae, BSN, RN · Oct 13, 2015

....
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.
....k.

Not necessarily. Not at all. I'm hearing more and more stories of naturalised US citizens ending up unwell some terminal, rather than return home to the US, where they would be leaving their loved ones a legacy of debt, they stay in NZ because all their health needs are taken care of including end of life care.

New Zealand is not a socialist country, and in terms of voting, women gained the vote in 1893, I believe approx 27 years before women gained the right to vote in the US around 1920

In terms of taxes, you may have a lower tax rate, however how much comes out of your weekly pay once you've paid for your health insurance?

Tenebrae, BSN, RN · Oct 13, 2015

Someone who presents with a "severe MI with cardiac arrest" obviously has an "emergency medical condition." So do lots of other people who get admitted to hospitals. Lots of people have health problems and need care, but their problems are not emergency medical conditions and they don't need an inpatient hospitalization. Where is their "long ... established ... legal right" to healthcare?

We have a scheme here which seeks to routinely screen kids for rheumatic fever. The cost of the test, plus a course of antibiotics runs to about $100

The cost of hospitalising kids with fully advanced rheumatic fever and ongoing costs ends up around $100,000 a kid.

Healthcare should not just be about picking up the pieces when someones had a CVA, MI etc but focus on preventing the things that cause these things in the first place and educating people on how to manage their conditions

TheGooch · Oct 13, 2015

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

I thought her post was rather condescending.

Not everyone in the US spends their time waving the flag

ixchel · Oct 13, 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.

I love it when the latest anticoagulant/antiplatelet reps come visit us. They bring giant and expensive massive platters from Panera, or wherever they felt like stopping. Hundreds of dollars in food, just for this one stop on the road. What blows my mind is they never bring it to us, the neuro/cardiac/surgical stepdown unit. No, they bring it to our ICU. Most ptatients are not started on anticoagulation usually until they get to us. If they need it there, they'll run heparin drips until extubation.

Idiots. They pander to the wrong units with their $70k+ salaries and their company-paid cars. Meanwhile the majority of the patients on my unit can't even AFFORD their drug once the 30-days free coupon runs out because insurance thinks warfarin works just fine.

ixchel · Oct 13, 2015

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.

Frequently I've heard the argument, "people in socialized countries have to wait weeks and often months to get in to see specialists! And then, the government can step in and tell you you're not allowed to get chemo/surgery/*insert life-saving treatment option here*!"

To which I respond, "how exactly does that not happen here? Only, HERE you have PRIVATE companies calling the shots, denying your treatments, refusing you coverage, and specialists definitely take months to get in and see. So how exactly is government funded healthcare changing this negatively?"

When the Affordable Care Act was getting tossed around and voted on, everyone hated Obama's socialized healthcare. States refused to be part of it when they wanted to reject the beginnings of what was obviously becoming Obama's New World Order. It was absolutely NUTS what these people were saying. They could have picked this sucker apart for plenty of legit reasons, but instead, they went off the deep end. (And no, it wasn't socialized health care.)

Anyway, yes, some of the things you'll hear about single-payer health systems sound straight out of a horror story.

ixchel · Oct 13, 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.

Listen to this guy. In particular, I want you to consider what he says about the buying power of the single payer system. You want innovation, research, find the products to be the best and be affordable. Innovation seems to never include reduction of costs. Instead, it focuses on ways to get more money out of the consumer. Who has absolutely no buying power whatsoever in the long run.

ixchel · Oct 13, 2015

Also, if you think all of the drug trials are being done here in the US, go do some research on that. Impoverished, developing countries' citizens are more than happy to sign consents with money attached for things they don't understand at all. Who needs an IRB when you have Romania? Estonia?

RNperdiem, RN · Oct 13, 2015

The US is different from the other places that have healthcare for all.

The USA is first world and third world. Any country that was founded with a heavy investment in slavery and conquest rather than real freedom for all will struggle with poverty.

Politically this is disunity is taken advantage of. Play upon fears of your hard earned money going to subsidize slackers, and you gain a political advantage.

Not that I am complaining, as an immigrant, I chose this place above all others. I pay all of my sometimes large medical bills on time.

elkpark · Oct 13, 2015

Frequently I've heard the argument, "people in socialized countries have to wait weeks and often months to get in to see specialists! And then, the government can step in and tell you you're not allowed to get chemo/surgery/*insert life-saving treatment option here*!"
To which I respond, "how exactly does that not happen here? Only, HERE you have PRIVATE companies calling the shots, denying your treatments, refusing you coverage, and specialists definitely take months to get in and see. So how exactly is government funded healthcare changing this negatively?"

I've heard the supposed horror stories about the "rationing" of healthcare in other countries, also, and I've made the same argument you do -- that the same thing is happening here. The difference is that, here, the private-for-profit insurance companies are making the choices and refusing treatment in order to maximize their profits, while limits and waiting periods put on care in other countries by the governments, to the extent that that is actually done, are done in an effort (usually fairly transparent and equitable) to get the best results for the most people from the amount of money they have to spend on healthcare.