We get into this sacred idea that you _must_ have the best healthcare and treatment. Once you declare something as a _must have_, it becomes extremely expensive. Think education, healthcare, automobiles.
In reality, you don't need the best treatment, just very low cost "pretty good" treatment. Taking an IV shouldn't cost $900 using some advanced equipment. It should cost $50 with a cheap plastic bag hanging from a wall hanger.
We also need to scale medical malpractice lawsuits wayyyyy down. IMO doctors aren't out to get or harm you. Most of them want to help. It's impossible not to make mistakes as human beings. You should be able to take that risk, give that you're ok with driving on the road which is one of the riskiest things you have accepted
But, aren't those things determined by medical boards and not insurance companies?
I'm also not sure you've visited small town/rural doctors. While perhaps in the city (and under private coverage), doctors have natural competition with other professionals to provide the best service. Whereas doctors under relatively "public" coverage and in small areas without competition/alternatives, they really don't need to offer good, or even ethical service. It may not even be hugely unethical, like pulling wisdom teeth, when they're not causing issue or doing unneeded surgeries for "preventative" measure, or liberally prescribing medication under the guise of "quality of life improvement."
This post gives off a very strong sense of disassociation from the reality of things for the not-so well-off, i.e more than 90% of the population.
You need to back this up with some citations.
Do you want evidence that generics manufacturers fake their equivalency tests? This is going to be harder, because the FDA doesn't publish the private sector data. I can try to see what I have on hand.
Do you want evidence that the FDA doesn't prosecute these huge problems? I can only point to the routine handing out of the equivalent of "yellow cards," i.e warnings of misconduct, but still allowing repeat-offenders to sell in the U.S.
The generic drugs also do not have to have the same excipients (inactive materials used to make the final drug product like a pill or capsule). Normally this doesn't matter, but if you have an allergy to an excipient, the branded might be the only one you can take.
Finally, there have been issues with some generic drugs, namely generic Wellbutrin. The FDA asked for bioequivalence data on some dosage forms, but not the 300 mg pill. That pill released drug much faster than the branded and patients had some nasty side effects as a result. I've also heard the same with some generic anti-epileptics. Epilepsy is a disease where drug levels need to be very tightly controlled.
[1]http://www.pharmacytimes.com/contributor/timothy-o-shea/2016...
For example, their "Great Value" brand LED light bulbs have been excellent for me. They would be great at their normal $2 price for 8.5 Watt 800 lumens with a claimed 18 year life bulbs. I happened to get them when there was some sort of instant rebate going on (sponsored by my power company, I think) where they were $0.17 per bulb. I got something like 30 and replaced pretty much every incandescent I had.
Only about 12 of these are in places where I use them heavily. Of those, I've had no failures [1], and no noticeable apparent dimming over the first year. I also have some Cree bulbs with similar specs that are a year older and cost an order of magnitude more than the $2 Walmart bulbs when I bought them (but now are only about 4x as much). The Crees lost a lot of brightness over the first year, and 2 of my 4 died within a couple months.
[1] I'm not counting one that I dropped onto concrete in my garage when trying to screw it into a fixture in the ceiling. The bulb is plastic and was not damaged, but it broke something on the circuit board inside.
That said, I still buy from Walmart, but I'm much more careful about what I get. I've gotten good use out of kitchen ware, household goods, LEDs, etc.
They aren’t Costco, but they deliver exactly what they promise - minimal quality for the best price.
But I’d never buy non-consumables from them.
>But I’d never buy non-consumables from them.
I'm curious, would you get a Wal-Mart xray or MRI? Depending on the issue, I think I might.
The other factor is packaging and longevity. Generics e.g. tend to have bits of foil that are too easy to detach and swallow.
And shelf life -- a quality of packaging and ingredients issue -- is less certain.
For instance, I would run the fuck away from a Muro 128 generic sold by Walmart.
https://www.fiercepharma.com/supply-chain/bausch-lomb-blames...
> Bausch + Lomb began recalling 850,000 tubes of Muro 128 ointment--plus 35,000 tubes of an unbranded sodium chloride product sold by Major Pharmaceuticals--after users complained of a "gritty, sandlike feeling" in the eye, The Wall Street Journal reports. The Valeant Pharmaceuticals ($VRX)-owned ophthalmic specialist was unable to find the source of the problem at the manufacturing plant, leading it to conclude that the extreme cold experienced over the winter may have caused crystals to form in the product during shipping.
Do you really trust the logistical capabilities of Walmart's supply chain to properly control for temperature?
Countless people buy temperature controlled groceries from Walmart and I'm not familiar with rampant outbreaks of food poisoning.
I was shocked to find that some of my prescriptions that were costing me $20 out of pocket with insurance at Rite Aid where $4 cash price at Walmart. I've moved everything I can to cash at Walmart, even in some cases where the Walmart cash price is a little higher than my with-insurance price elsewhere, just on the general principle that I don't want my insurance company to know what drugs I take [1].
[1] This stems from a time once when a condition I had improved to the point that I could stop taking drugs for it. A few months later it returned, and I asked my doctor to renew my prescription. He did so...and the insurance company rejected it. They were treating it like I was a brand new patient, and they no longer allowed that drug unless you had first tried a couple other newer drugs and they were not acceptable. I'd never had those drugs, but I'd had others in their families and they were either not very effective or had annoying side effects. I was willing to try the new drugs eventually, if this relapse turned out to not be temporary, but in the short term I wanted what we already knew worked well.
Wait, you thought that info was confidential? Ha, this is the USA!
Knowing this changed my use of pharmacies.
I think they are great for communities. I lived in a rural community as a kid for many years without Walmart. We had no book store, no music store. Small under 1k people and one stoplight. They literally had only one science fiction book in the library (broken lands from empire of the east by saberhagen, super awesome book. Weird that that was the one)
Walmart opened close-by and all of a sudden I could buy books. They had so many more options. We didn’t have to drive 40 minutes for groceries. About 1/3 of the Main Street stores closed but they really sucked. Interestingly their employees had zero benefits and zero sexual harassment protections.
It was a small town where if you worked for the dime store you got no vacation, no benefits, got paid 50% if you were black. Lots of lame stuff. At least wal mart paid you some benefits.
Walmart isn’t some all positive entity, there are negatives. But they aren’t horrible and are a huge positive force for the poor by lowering prices.
It’s very frustrating to hear a rich person complain about Walmart when they haven’t had to need their groceries being 20% cheaper than Kroger or 50% less than Whole Foods.
There is so much cost to be saved all over the system if we could break some of these anti-competitive thickets. Walmart is an excellent choice for doing that sort of thing.
> Actually, in many cases, we slap an authorization requirement on the fancy imagining or deny the claim for a lack of medical necessity. (Source: I work for an insurance company)
You want to improve healthcare? Fix drug prices, fix the adversarial model between insurers and providers and do whatever you have to to get patients more facetime with clinicians. Connect and coordinate care - especially post discharge. Worry about things outside of medicine like food or social isolation or financial health.
> You want to improve healthcare? Fix drug prices, fix the adversarial model between insurers and providers
What does 'fix drug prices' mean though? And why would 'fixing the adversarial model between insurers and providers' help things? In every other setting, adversarial models push costs down. These seem more like aspirations than solutions.
Read some scary charges: https://www.rd.com/health/wellness/wildly-overinflated-hospi...
"Charge for a nurse to hand you medicine taken by mouth.
Charge to patient: $6.25 per instance, for a total of $87.50 during average patient stay"
They have also been a major player in getting dairies etc to become organic.