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).

[Dogen]

Things I've had my private health insurance carrier deny:

1. Lab work ordered by my doctor.

2. An MRI ordered by my doctor.

3. My insulin. Several times.

Me: "My doctor has ordered an MRI of my head and neck, I'm calling for pre-authorization." (asking for permission)

Insurance person: "We've authorized the head MRI, but we don't believe the neck MRI is indicated."

Me: "... what? Are you a doctor?"

IP: "No sir."

Me: "So, who over there decides what I need? Is it you? Because my doctor seems to think I should have it."

IP: "It's standard practice, given the information submitted to us."

Me: "So you've decided you know what I need better than my doctor?"

IP: "No sir."

Me: "But you said I can't have the MRI my doctor thinks is indicated. Doesn't that imply that you know better than my doctor?"

IP: "No sir, and you can still have the neck MRI."

Me: "You just said you weren't going to authorize."

IP: "Yes sir. We won't authorize coverage, but you can still have the MRI if your doctor wants it."

Me: "Oh, so if I want to spend $3,000 dollars I can have the testing my doctor thinks is indicated but you don't?"

IP: "Yes sir."

Thank God we don't have the federal government standing between us and our doctors, deciding what healthcare we can and can't have, am I right?

For the record, I was experiencing some neurological symptoms that they were trying to diagnose, and they were concerned there may be damage to my CNS and wanted to visualize my brain and spine. I'm fine, there was no damage, but there was no way to know that then.

[Farawyn]

I thought her post was rather condescending.

Not everyone in the US spends their time waving the flag

Who is "her"?

[ixchel]

Things I've had my private health insurance carrier deny:

1. Lab work ordered by my doctor.

2. An MRI ordered by my doctor.

3. My insulin. Several times.

Me: "My doctor has ordered an MRI of my head and neck, I'm calling for pre-authorization." (asking for permission)

Insurance person: "We've authorized the head MRI, but we don't believe the neck MRI is indicated."

Me: "... what? Are you a doctor?"

IP: "No sir."

Me: "So, who over there decides what I need? Is it you? Because my doctor seems to think I should have it."

IP: "It's standard practice, given the information submitted to us."

Me: "So you've decided you know what I need better than my doctor?"

IP: "No sir."

Me: "But you said I can't have the MRI my doctor thinks is indicated. Doesn't that imply that you know better than my doctor?"

IP: "No sir, and you can still have the neck MRI."

Me: "You just said you weren't going to authorize."

IP: "Yes sir. We won't authorize coverage, but you can still have the MRI if your doctor wants it."

Me: "Oh, so if I want to spend $3,000 dollars I can have the testing my doctor thinks is indicated but you don't?"

IP: "Yes sir."

Thank God we don't have the federal government standing between us and our doctors, deciding what healthcare we can and can't have, am I right?

For the record, I was experiencing some neurological symptoms that they were trying to diagnose, and they were concerned there may be damage to my CNS and wanted to visualize my brain and spine. I'm fine, there was no damage, but there was no way to know that then.

What is "IP"?

Idiot in Phone

Isosorbide & Phenergan

India & Pakistan (is this a racist comment you've made here?)

I had an insurance refuse to pay all bills associated with birth. They didn't refuse them, they just simply wouldn't process them, for many many months, while I was threatened with collections.

[elkpark]

What is "IP"?

Idiot in Phone

Isosorbide & Phenergan

India & Pakistan (is this a racist comment you've made here?)

Dogen starts the dialogue by identifying "Me:" and "Insurance Person:" as the two participants, and then abbreviates "Insurance Person" as "IP" for the remainder of the dialogue.

(Although, I've gotta say, I like "Idiot in Phone" as an option ... :))

[Farawyn]

Dogen starts the dialogue by identifying "Me:" and "Insurance Person:" as the two participants, and then abbreviates "Insurance Person" as "IP" for the remainder of the dialogue.

(Although, I've gotta say, I like "Idiot in Phone" as an option ... :))

...she was being sarcastic! :)

I think.

[MunoRN, RN]

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?

The vast majority of people admitted to a hospital fall under EMTALA mandated care, there really aren't many people anymore that are admitted to a hospital that don't fall under EMTALA, mainly elective ortho surgeries. The point at which EMTALA no longer applies is usually the same point where patients would get discharged anyway, so most of the money we spend on acute care, which is our largest chunk of spending, is spent providing care that can't be denied to someone due to an inability to pay.

When that same condition isn't that severe yet, then we see no responsibility to treat it which is what doesn't make sense. There are the DKA frequent fliers who have trouble getting their management of diabetes paid for, so they end up in the hospital regularly with DKA, for some reason it makes more sense for us to pay for regular DKA stays rather then just keep them out of the hospital in the first place. Another example would be a patient with diabetes who is developing worsening PAD and needs vascular intervention. Not only do we not see the benefit of treating their diabetes initially, we don't consider the elective treatment of that progressing vascular occlusion to be something we should pay for, up until their foot goes cold and now all of a sudden it becomes everyone's financial responsibility, even though it would have been much cheaper to treat last week, last month, or last year.

In other words, pretty much every condition is guaranteed to be treated, but only once it becomes really, really expensive to treat. We believe in comprehensive coverage of diabetes treatment, but only in the form of limb salvage, dialysis, or complicated MI treatment. If we know we're eventually going to have to pay for that, why wait until that point.

[elkpark]

The vast majority of people admitted to a hospital fall under EMTALA mandated care, there really aren't many people anymore that are admitted to a hospital that don't fall under EMTALA, mainly elective ortho surgeries. The point at which EMTALA no longer applies is usually the same point where patients would get discharged anyway, so most of the money we spend on acute care, which is our largest chunk of spending, is spent providing care that can't be denied to someone due to an inability to pay.

When that same condition isn't that severe yet, then we see no responsibility to treat it which is what doesn't make sense. There are the DKA frequent fliers who have trouble getting their management of diabetes paid for, so they end up in the hospital regularly with DKA, for some reason it makes more sense for us to pay for regular DKA stays rather then just keep them out of the hospital in the first place. Another example would be a patient with diabetes who is developing worsening PAD and needs vascular intervention. Not only do we not see the benefit of treating their diabetes initially, we don't consider the elective treatment of that progressing vascular occlusion to be something we should pay for, up until their foot goes cold and now all of a sudden it becomes everyone's financial responsibility, even though it would have been much cheaper to treat last week, last month, or last year.

In other words, pretty much every condition is guaranteed to be treated, but only once it becomes really, really expensive to treat. We believe in comprehensive coverage of diabetes treatment, but only in the form of limb salvage, dialysis, or complicated MI treatment. If we know we're eventually going to have to pay for that, why wait until that point.

That's what I was originally asking you about. You stated earlier, "Healthcare has long been established to be a legal right in the US ..." Outside of the EMTALA, where and when has healthcare been "established to be a legal right in the US"?? Yes, if you need to be admitted to the hospital, in most situations, that is covered by the EMTALA. But what "right to healthcare" do people who need healthcare but don't need an inpatient hospital admission have? None that I am aware of. Is there some "right to healthcare" that I've somehow missed?

[ixchel]

...she was being sarcastic! :)

I think.

Nope, I wasn't. I'm apparently that tired.

[Farawyn]

Nope, I wasn't. I'm apparently that tired.

Hahahhaha!

Okay, sorry elkpark!

[TheGooch]

Who is "her"?

Heather.

[Farawyn]

Heather.

I THOUGHT SO!!!