The Reality of For-Profit Healthcare

[goldberry]

Here's my thought on how high prices are related to an insurance mandate - If I'm paying out-of-pocket for a drug that's hugely expensive, I may balk at the price, complain, get online and make a fuss or ask for alternatives. If my insurance company is covering it, I'll probably just go with it, thanking my lucky stars that it's covered. The insurance company covers it by jacking up premiums, which have historically been covered in large part by employers (though this is changing). Everyone is passing the buck and no one feels it the same way an individual does when he has to pay. So drug companies can overcharge without direct consequence. I found this to be true when one of my sons was hospitalized and on his line item bill we found out things like a dose of Tylenol cost $15. That was outrageous, but I only found out because we were paying much of it out of pocket. If my insurance had covered it we wouldn't have even looked at the line item. 

 

 

My mother pays $1200 per month for her prescription (yes, that's singular). Her insurance only kicks in when she meets the $7,500 deductible. She basically works (at 65) to pay for her prescription. Thankfully her husband still works full time and can support them, but retirement is literally never going to happen. 

 

This is valid about people not paying attention because of insurance companies just paying for it.  But I don't think it's the mandate per se as it is just the general insurance company system we have developed with a lack of transparency. The entire country (or a large portion of it) would be having to "make a fuss" for it to have any impact. Previously the uninsured were such a small portion of the whole anyway, that it didn't make any difference if they complained or not, everyone was still making their money. 

 

Everyone knew there were people out there who couldn't afford prescriptions or doctor visits. And that there still are.  It just never made any difference because the group wasn't large enough to cause an economic impact.  The moral impact is not sufficient under our system.

[Bluegoat]

Except wouldn't your economy benefit?

 

Capitalism here would mean more sales, stronger company, more production, more hiring, more jobs, more folks spending money.

 

Wouldn't an increase in sales lead to an increase in profits and lead to positive effects?  It isn't as though there is a limit on production, just that they would need to ramp up production?  There is a lot I don't know and understand about the Canadian economy so I would truly like it if you correct my thinking?

 

The thing is, in a lot of cases the drugs aren't really a Canadian product.  We do have some pharmaceutical manufacturing here, but many drugs have a fairly limited number of places where they are manufactured, and then they are exported.

 

Here in Canada, the main way we keep costs of drugs down is that they are bought in bulk based on estimates of how many people will need those drugs.  Parmacies aren't ordering them directly from the manufactures. So while we may pay somewhat less than Americans because of legislation about drug costs, mostly its a matter of bulk purchasing.  (So, our prices for the drugs in the OP are also going to go up astonishingly, it just might not be as high.) 

 

So - it might do something for the mail-order pharmacy, but that isn't particularly beneficial for the nation as a whole, which is how we think about medical care.

 

The other thing is, it is often the case in drug manufacturing that supplies are allocated to countries that need them without much extra in reserve.  They are expensive, and many have a shelf life, so in a lot of cases there will not be reserves. This is why when there is a problem with manufacturing, you can have whole regions that don't have access to a drug, they just don't get a shipment out..  This has happened from time to time with vaccines in particular, where some areas just didn't get sent lots, and then they have to look at transferring what is required between regions.

 

So, if you suddenly have a bunch of medicine that was allocated for Canadians being sent out of the country, it could potentially impact our own supplies.

 

[goldberry]

So, if you suddenly have a bunch of medicine that was allocated for Canadians being sent out of the country, it could potentially impact our own supplies.

 

 

That's what I'm saying though, the drug is being shipped directly to me from UK, or other places.  It doesn't even get shipped from Canada.  Basically, the Canada pharmacy is just acting as a billing and ordering center.  That sounds different that the way Canadians usually get their own drugs.

 

[Bluegoat]

That's what I'm saying though, the drug is being shipped directly to me from UK, or other places.  It doesn't even get shipped from Canada.  Basically, the Canada pharmacy is just acting as a billing and ordering center.  That sounds different that the way Canadians usually get their own drugs.

 

 

I'm not sure how that works in terms of what the company will send where.  If it is a Canadian pharmacy doing the ordering, does the manufacturer consider those Canadian drugs?  I don't know, it would probably depend on what sort of drug it was, if it was something in limited supply.

 

I do know that one of the concerns with arrangements like that is that Americans usually feel safe ordering from Canadian pharmacies because our drug system is considered safe.  But it is less clear how true that would be when the drugs were not in fact really ever part of our domestic drug supply.  And maybe especially if supplies were limited so they went to ordering from less reliable manufacturers for American prescriptions, say ones in India.

 

It's all part of a huge stupid mess anyway though.  We're the only country with a universal health care system that doesn't also have a universal drug program, and that is crazy and so expensive.  And then the US is pretty unique in terms of being well off but not having universal health care, which is also really crazy and expensive.  So IMO its all just all evidence of idiocy.

[Miss Marple]

Don't know if anyone has posted this link yet, but it is quite informative about another aspect at play here:

http://www.latimes.com/business/hiltzik/la-fi-mh-the-little-known-fda-program-20150923-column.html

[Serenade]

Don't know if anyone has posted this link yet, but it is quite informative about another aspect at play here:

http://www.latimes.com/business/hiltzik/la-fi-mh-the-little-known-fda-program-20150923-column.html

 

Wow. Thanks for linking that article.

 

This paragraph is telling, bolding mine:

 

"The program "should apply to drugs where there's a signal it's unsafe or that it just doesn't work," Biskupiak said. "If doctors have been using it for 50 years with no problems," he said, then the FDA is just giving drug companies "an arbitrage opportunity" to turn a profit."

 

I think it's revolting that drugs that have been used for hundreds of years are then barred from competing with the new-fangled version of the same drug.

 

From the article:

 

"The most notorious case is that of colchicine, which was first used to treat gout 3,000 years ago and has been in generic use in the U.S. since the 1800s. Following a 2009 FDA order awarding exclusive rights to a branded formulation of colchicine to a Philadelphia drug maker and barring competing generics from the market, its price rose 50-fold.  "

 

Disgusting.

[Murphy101]

All of the drug companies supposedly have programs in place to provide medication to poor patients. But in my experience from way back when dh was unemployed, they make it almost impossible to actually get the free/cheap medication. And I'm guessing there are a lot of people in the middle class who don't qualify for the programs, have no or crappy insurance, and couldn't even begin to afford that much money for one pill.

This. Even when dh was unemployed and we had zero income coming in, it was a nightmare of paperwork that never seemed to end or get approved or anything. And of course, it presumes you have months to wait to get the medication. Unlike hospitals that will bill you into bankruptcy after the fact, if you can't pay for your medication at the pharmacy, they don't hand it over.

 

Unless it's an emergency, we buy nearly all our medications from overseas now. Either way it is out of pocket, but at least this way we can actually sorta afford them and have a say in what we get based in our needs and our doctors recommendation instead of insurance. And I know there's lots of talk of making this illegal. Not because the drugs are unsafe. I kid you not, there are times when the bottle he might have to run out and pay a bloody fortune for here is literally the coding and everything as what we get from overseas. But to protect the companies here selling at ridiculous prices.

 

And our government DOES give a tremendous amount of subsidies to medical research and development. We actually give more in those subsidies to big pharma and other sources than many countries with universal healthcare. But what we subsidize is often not serving the best or most pressing needs of the public.

 

And it is not just this medication. Some of the worst offenders of sudden inflation of medications are for medications most often used in hospitals, where it's a lot easier to hide it among the already horrifying sticker shock.

[Murphy101]

Health insurance =/= healthcare.

 

It never has and it never will.

 

Most people did have health insurance before the ACA. And medical was still the number one cause of bankruptcy.

 

It is the #1 reason I never supported the ACA and still don't. It's a bold faced lie.

 

Insurance does not equal healthcare.

 

Healthcare equals healthcare.

 

Anything else is just a double speak to hide the diversion of funds and resources that could be used to actually provide and regulate healthcare.