Arthritis drug that cost $198 in 2008 is now more than $10k
axios.com
axios.com
That essentially means it's literally 10x cheaper to take a two-way ticket to France, have a doctor prescribe it there, buy 3 months worth of treatment and come back to the US.
I wonder how Americans can tolerate this situation.
Not so long ago I had seen a documentary about how American diabetics couldn't afford insulin and had to purchase their insulin pens in Canada. It's quite a shame for a first-world country with one of the highest per-capita income to have people give up healthcare because it's simply too expensive
Imagine a charter bus that takes a full load of people once per month from the US to Canada from regionally close cities (e.g. Chicago, Cleveland, Seattle, and New York) for insulin and other critical but expensive prescription drugs. The bus takes them to a pharmacy, everyone unloads and picks up their prescriptions, then loads back into the bus. Everything is called in, pre-arranged with the pharmacy for a streamlined operation.
It's a really stupid situation and possible solution that shouldn't be viable. Unfortunately, it probably could be done.
So I think doing so as a foreigner shouldn't be a problem provided you can speak French or English depending on the practitioner.
Presumably they just don't want the hassle of figuring out regulations or dealing with stuff confiscated at borders.
For drugs that are legal to import into the US surely there must be online pharmacies willing to deliver, though.
Several reasons this terrible system continues to exist but it essentially boils down to entrenchment.
- The private healthcare industry pays politicians to maintain the status quo. The alternative government run solution does not.
- The private healthcare industry creates propaganda and pays the media to spread it. An improved government run solution does not.
- Many Americans have decent coverage from their employer. For them, it’s not worth upending the system for what might be moderate gains. More over, propaganda has made them expect worse coverage from any alternatives.
- ACA gave many without employer coverage a good enough solution. It’s still expensive as fuck but it subdued enough voters.
So, after considering voters who are happy enough with the devil they know, you don’t have enough votes left to overturn the system.
I never understood why there are no independent national health insurers (read Allianz for example) providing health care for self employed people like in Europe.
Edit: A classic by John Mackey (Whole Foods Inc.) but still valid: https://www.wsj.com/articles/SB10001424052970204251404574342...
Quote: „Repeal government mandates regarding what insurance companies must cover.“
The issue in the US is that the system is hugely inefficient compared to the models in Europe. There is an absolutely massive administrative layer between care providers and payers, price negotiations aren't transparent or efficient, the whole system is hugely complex, and the vested interests are incentivized to keep it that way.
Shopping for plans on the marketplace is already terrible when they all cover the same stuff. It'll be way worse if I have to decide between terrible options for what's covered. Especially since we all know none of that is going to be clear or easily comparable, and certainly not pick the things you want covered.... It'll be like broken bones are in the package that excludes cysts, and brain cancer coverage is not available with any other cancers, and to get coverage for any sort of dermatology, you also need coverage for skiing and parachuting incidents.
As-is, I can take my list of prefered facilities, look and see who has them in network, and then add the premiums to the out of pocket max to find my rough worst case cost and pick the one with the least worst case cost and call it a day. This is usually also the one with the least premiums, so it's also the least cost if I don't visit the doctor at all.
Which is to say it's not just propaganda.
As for the VA system's woes, I would say: yeah, it's definitely possible to build a system that doesn't work well. But that doesn't mean we shouldn't be trying.
> Which is to say it's not just propaganda.
No public or private system anywhere in the world has a uniformly good track record.
The difference of course between Medicare and less popular plans like VA coverage and Medicaid is that people on Medicare have political power, veterans and the poor do not.
Nobody is arguing that you can run a healthcare system badly, but to only point out the worse case is not arguing in good faith.
It's not irrational for people to look at the risk of making a worse system and judge for themselves if they think it's a risk worth taking. Examining a worst case that's within the scope of possible outcomes is a reasonable part of a good-faith process.
That said, the person I responded to was to my reading optimizing for getting away from the private health care apparatus as much as possible. Medicare For All does not accomplish that.
The VA was under-budget even before the two wars started in 2002/2003.
Then the ruined bodies and psyches rolled in, and VA wasn't given additional funding to handle the aftermath.
It's pretty clear how that ends up. The wars above cost $Trillions but the aftermath costs a few more Trillions that VA and other agencies didn't have.
Here's a first step to solving the US problem: Remove the legal restrictions on Medicare preventing it from negotiating best possible prices, and reinvest whatever it manages to save on expanding coverage.
That I know of, the US has either 5 or 55, depending on how you count the Medicaid programs run by each state + DC in cooperation with the feds, socialized healthcare systems (Medicare, Medicaid (1 or 51), TriCare, VA, and the Puerto Rico public healthcare system.)
At 9 million covered beneficiaries, the VA system is smaller than Medicare, smaller than Medicaid, and even smaller than California's state Medicaid plan (Medi-Cal).
It’s kind of weird to pretend VA is the socialized healthcare system in the US. (Actually, you can argue that TriCare and VA aren't even true “socialized” systems but employment-based plans for current and former employees, for a subset of federal government employees.)
Pregnant women, indigent, long term disability, orphaned children, and others are programs w/in the Texas Medicaid programs, for example.
Negative gains I may say. In my experience of the Canadian healthcare and US healthcare systems, the latter, IF you are well insured, feels like a Rolls-Royce whIle the former is like driving a Lada in Pothole City.
I remember the first time I called my provider in the US to book an appointment with a dermatologist. She said "Wednesday", I said "What month?" I couldn't believe it was that same week. I used to wait 2-3 months in Canada. And I had to first get a reference from a ER/generalist doctor.
Also don't forget the US spends on medicare/medicaid/VA about the same % Canada spends on healthcare.
If you have good work based coverage, our care is excellent. Fast access, and low out of pocket costs.
I do want to improve it for everyone, but I have 0 complaints about my personal access to health care. I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
We have pretty long wait times in the US for elective surgeries as well. Not as bad as canada, but it can take a bit to get you scheduled for a hip or knee replacement.
The fact they pay less for some procedures is irrelevant
Many doctors either do not see or see limited numbers of patients on medicare. This means that wait time is longer for these folks.
You are arguing real hard/loud, but it doesn't sound like you have talked to actual doctors about the issue.
Do all doctors take it? No, but I feel like they are in the minority and frankly, if a doctor doesn't take it, I feel they are more motivated by money than caring for their patients.
There’s no way to pay for better/faster treatment if it’s publicly covered.
EDIT: Edited to clarify I'm speaking specifically about Canada as there is some confusion in the replies.
They do let you pay for a private hospital room though oddly enough.
This is an outright lie, here in Uruguay and in Chile both with social Healthcare you can enter onto different private plans and that will expedite surgeries, doctor meetings etc
It is something that depends on a country per country basis
Easy there, cowboy. Based on the conversation, I believe OP is still referring to Canada, not every country with socialized healthcare.
“Assuming CAN is like NZ…”
“It’s (Canada) not.”
I can't speak to the situation in Canada, but in the UK this is not true. You can get private insurance and go to private doctors.
The clinic then fucked up billing, overcharged us, and it took another few months for all of this to get sorted out.
The first part of this story isn't too different from the Canadian[1] system, the second is a pile of unnecessary stress added on top.
Between mine and my employer's share, our 2-adult health insurance costs ~$15,000/year, by the way. And what do we get for it? Months long waitlists and clowns that can't even get billing right the first few times.
This may indeed be the Rolls Royce of healthcare, in the sense that it costs a mountain of money, finds expensive ways to break down all the time, and spends half its time in the shop.
[1] Actually, each province in Canada is responsible for running a provincial healthcare system.
> The first part of this story isn't too different from the Canadian system, the second is a pile of unnecessary stress added on top.
IMO the cost in stress and time of the American system is under-appreciated. We pay way more than other advanced states and have to deal with a whole bunch of companies, all of which seem to be either incredibly incompetent or actively trying to screw us, every time we actually need healthcare, which is precisely when we really don't need more stress or to have extra demands on our time. It's awful.
I've been getting bloodwork done at my physician's office for two years and Labcorp started sending me bills again. Same insurance, but they just randomly stopped filing with them until I spent long enough on the phone for a few of my hairs to grey.
When I was younger, I got a nasty infection after my wisdom teeth were removed. The ER bill, which was close to $5k for a doctor to look at me for roughly 5 minutes and write me a prescription for antibiotics and some pain meds, bounced between health and dental insurance for months, both saying the other should pay for it, before they kicked the can to my parents.
My mom had connections in the hospital's administration, so she was able to get it coded properly for health insurance to pay it. But I am probably the only person in this thread who can say "my mom is on a first-name basis with the people who can get billing issues resolved by the next day." Everyone else gets to sit on the phone for hours trying to sort it out, hoping that insurance will show mercy or that the hospital will bother recoding, or at least give them a bill they can stomach.
You'll reach a lot more people without that kind of language. I for one almost instantly dismiss anyone who talks like that. I didn't even read the rest of your post.
The word "privileged"? That's apt. Most on HN are privileged.
Or is it the way that statement was posed as a question? It's probably not the most diplomatic way opening a post but it's far from being offensive.
I don't know why you're commenting, since you're not the original commenter, and your very comment shows how you already recognize the generic accusation-of-privilege to be the problem (and how the word privilege is heavily coded with political affiliations and a whole pile of antagonistic/moralizing dogma at this point). You already knew how and why it would be inflammatory.
You recognized the problem, and opted to try to reframe it in more favorable terms to deny the possibility for improvement.
If the original commenter wants to reach across that Red Tribe / Blue Tribe divider and have an actual discussion (or even convince a neutral 3rd party of their views), their first sentence (and general tone) is quite counter-productive, and you know this.
This is a multi-user forum not a peer2peer chat client.
> and your very comment shows how you already recognize the generic accusation-of-privilege to be the problem
No, I'm saying the accusation of privilege is correct and it's not a problem to point out to people on here that we are privileged. Because we are.
> You already knew how and why it would be inflammatory.
If you're in the top 10% and can't stand being called privileged then the problem isn't the tone of the accuser, it's the person receiving the comment. The sooner privileged people stop acting like the victims, the sooner we can start fixing the worlds actual problems.
> their first sentence (and general tone) is quite counter-productive, and you know this.
Actually I was arguing that it's not counter-productive. It was the point of their post and a point very much worth making.
I've seen both sides of the social scale and we are definitely not on the side that should be getting offended when people should "privilege" ;)
"Worse healthcare for you and your family because you are privileged" is not particularly compelling to the roughly half of Americans you are yelling at.
Maybe at your specific doctor. But there are many, you could try another?
This isn't sustainable for me in the long run and I'm definitely considering leaving the US because of it.
Mostly of the 'making fun' is due to the fact that millions of US citizens have no or little health care and choose not to have treatment because they can't afford it, are limited about what treatments they can have, or have it and are made homeless or live under huge debts.
Just about every country which has some kind of health care system also has private health care/insurance that means you don't have to wait for treatment or have more choice about what, when and where things happen. Because of the competition of the 'free' healthcare systems these policies are usually much, much cheaper that the US.
I work in a company that gives me private medical insurance (which means I might get treated a little early for a non urgent condition, perhaps in a swanky private hospital) but feel good that people that can't afford it won't die, and that I can quit my job and not worry about getting ill.
“There is a deep group of rural american's who refuse health care, even when provided by their job at extremely low cost.”
Particularly the part about those with insurance not seeking care. The articles cited are concerning vaccine takeup rates, which reasonable people can differ.
The media, pundits, and politicians only focus on the sticker price, not what people are actually paying, which is often much lower. http://greyenlightenment.com/2021/10/17/why-healthcare-is-so...
We hear about patients being stuck with $6000 bill but did said patient actually pay 6k? Absolutely not, even if uninsured.
also they ignore the role of employer healthcare, or how the NHS is paid for by higher taxes, so Americans are effectively paying less for healthcare in this regard.
So much misinformation and misleading info in the healthcare debate, driven by partisan politics.
They paid $1500, then, while in any other country, it would have cost, maybe $50
Sadly this opinion underlies a lot of America's problems.
The top 50%ish get coverage through jobs that is mostly fine.
The bottom 25% get heavily subsidized plans (often free) from both state and federal programs.
There is a hole there in the middle, but it may be possible to tweak a few programs without throwing out everything. This is basically what ACA tried to do with the backing...
The US health care system is by the far the most complex of any nation state and punishes the losers the worst. It strikes me as something badly in need of disruption. And it's not like we're talking about removing private health care entirely -- if that's what you're scared about?
> And it's not like we're talking about removing private health care entirely -- if that's what you're scared about?
I'm personally concerned with the 50 Stalins sort of sentiment surrounding health care. We legislated the current system into existence and its outcomes are perfectly predictable. Why not fix the causes instead of trying to legislative more effects and doubling down on government interference yet again?
The problem isn't regulation. Many other countries are far more regulated in the health care industry and operate a private market just fine. In fact some might even argue that some of the problems with the current US model is a lack of regulation.
The problem I've observed isn't a lack of competition, it's that all of the competition play by the same broken rules. You basically have an industry where people need your service. It's not luxury, it is literally life and death in many cases. People have to use your service, whatever it costs. And you then allow those companies to regulate themselves, companies that will almost always put profit ahead of welfare. That is never going to turn out well. But because libertarianism is very much a core part of the American ideology, whenever the question of how to fix the problem arises you argue that the market needs to be deregulated further. Basically just doing more of the same, as if it will suddenly fix things despite decades of proof that it hasn't already.
Now I'm not going to pretend that other counties have a perfect system. But I do believe the only way you are going to get a health care system that works for everyone is for voters and politicians to want something that is, at least on the surface, very "un-American".
> I'm personally concerned with the 50 Stalins sort of sentiment surrounding health care.
And here lies the problem. People are so brainwashed into thinking any form of social health care is communism and bad. Quite frankly, it's ridiculously misinformed. In fact most of the rest of the developed world has a social health care system AND private health care, capitalism, etc too. On this particular occasion you can actually have your proverbial cake and eat it.
> Why not fix the causes instead of trying to legislative more effects and doubling down on government interference yet again?
Because you're fixing the wrong thing. You're looking at a broken faucet causing water to leak constantly, and instead of fixing that faucet you go and break more faucets thinking that should some how change the behaviour of the first faucet. Then when the flow of water gets too expensive you then start arguing that it's not the leaking faucets at fault, it's the water rates instead. If this weren't a political problem then I'm sure most on here would throw their hands up shouting "learn some basic root cause analysis!"
[1] https://www.pbs.org/newshour/health/these-3-charts-show-how-...
Are you factoring in premiums? Once you factor premiums from both sides (employer and employee), healthcare in the USA is far from low out-of-pocket. Good family coverage is on the order of $2,000 or so a month.
That's not even getting into the garbage plans offered at some places. I've had plans that covered visits to exactly one region hospital system, any other hospitals needed preauthorization, and even those had the potential for rejected claims.
Which brings up another often missed point. When dealing with the lower cost plans, there's a huge risk of having a claim denied. I know for a fact that at least one major insurance provider has a policy to deny every claim and make the hospital rejustify it. If the hospital fails to justify the claim (to the insurance company standards), either the hospital system has to eat the cost, or they bill the patient instead. This is used to get around those "out-of-pocket maximums" cheap insurance is sold on. So you may only have to pay the first $8,000 of the bill, but that only applies to the first $8,000 of what the insurance company agrees is covered.
My out of pocket + premium for my entire family is MUCH MUCH MUCH less than I save in taxes by being an American over European. Pretend health insurance is a "tax" and add it to your total tax rate. Now compare your total tax rate with someone in Germany/Sweden/Norway making similar pay. For most developer type jobs, I think you are going to find that even a $2,000 a month insurance plan a steal.
But the further you fall down the income ladder, the worse the American system is.
There’s also the moral cost of participating in and supporting a system extorting the less fortunate.
“Not my problem” is where we are divided - and pay an extraordinary price, becoming complicit in the extreme violence of poverty.
* There is a base rate of 14.6% from your gross that split between the employer and employee. The split is not important for our calculation as it will come out of the same budget an employer has for one employee I guess.
* Public insurance providers can demand an additional contribution that was on average additional 1.3 percentage points. The highest I could find is 2.5 percentage points extra.
* There is an upper limit. You only have to pay for your first 58050€ ($67564) a year. For everything you earn above that you do not pay more.
* Family members that do not work or do not earn more than 450€ per month are included for free
So that means from the money your employer has available to pay you a maximum of (14.6 + 2.5) * 58050 / 100 = 9927€ ($11556) a year or 827€ ($963) a month.
Regardless of your delusion, let's not forget the fact that most of those employer-provided policies come with a shitton of asterisks.
then you're stuck with your work. Because other work might not provide the same coverage. It's not too bad for programmers because they are spoilt for choice. For many other people it becomes servitude.
You have some outlier coverage if your story is factual.
The reason a doctors visit is 0-$20 and an ER is $500 is because the insurance company is trying to steer you towards the more cost efficient treatment place.
Yes you can go to the ER for a sprained ankle, but often you can wait until the next day and go to the doctor for better treatment for 1/10 the cost.
Incentivizing you to make more budget friendly choices if capitalism. We like capitalism here right?
I like to think we like objectivity.
Your analogy about ERs is based on situations that aren't emergencies, so I'm not really sure how to square that with reality.
Even following that analogy, you shouldn't delay medical attention to save money, and the insurance company shouldn't be dictating or steering any part of your medical treatment, period.
Incentives only work when you have good information and time to make decisions. When you're in an emergency situation, you can't hop on your phone and shop around for the best deals on trauma surgeons and ambulance rides, and frankly that shouldn't be the expectation.
One way to think about it is that there are low wait times on the US because nobody can afford the care. You can skip the queue because all the poor people are kicked out of line.
Our care might be excellent but the administrative burden is not.
> Fast access, and low out of pocket costs.
Have you ever had to challenge a bill? or find out that the provider you used sent your labs to another provider that was out of your network and now you owe the other provider full price?
> I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
And you don't need to mimic their process. You can have single payer and privatized medicine. If you're wealthy or a company wants to offer a premium insurance then so be it. There will be a market for those "speed lanes" if you want.
Even the low out of pocket costs are vanishing with the introduction of the newer high deductible healthcare plans.
I think something a lot of people don't realize is that their care plan is often dictated by the insurer and employer, not their doctor. Your employer and insurer negotiate annually on your coverage with little input from employees. What medicines and treatments are covered is dictated not by the doctor.
If you want to know what truly excellent health care is like, visit Mayo Clinic. Because of the concentration of doctors in one location, I saw around 12 doctors in a week. That would have taken a year or more through the regular medical system.
Where "excellent" includes shorter length of life, and over-testing, over-diagnosis, and over-treatment (each of which causes harm) because you've got to have something to show for all that insurance spending.
The cost have gone up a lot.
Currently, the industry is also facing a labor shortage, so this is making the scheduling even harder. A family member in high school was diagnosed with obstructive sleep apnea (affecting school performance! You only get 8 semesters to mess up!), and it has been (so far) 8 weeks and we still don't have a formal intake for medical equipment. We have a prescription. We just can't get the equipment supplier to process the prescription and send it to us. I ended up paying out of pocket (and doing some crazy shit) to get a machine and supplies. Note: this is with doing what is basically a part-time job squeaky-wheeling everyone I can to try to get things happening. It is the worst.
Blue collar medical workers are quitting in droves because the work sucks and it has garbage pay, and you see the executives making huge salaries. And you get yelled at by people like me trying to make the system move faster. I try to stay friendly, but... I have lost it a few times. Of the seven people in my family, five of us have chronic medical issues.
I was just talking the other day with a friend wishing there was a medical consultancy I could hire. I give them my health insurance info and family demographics and all of the healthcare shit we need done, and then they find the providers, make appointments, file reimbursements with insurance/hsa/fsa tell me how much to put in fsa/hsa each year, deal with the full time job of having a family that needs to deal with the totally bonkers american medical system. They get some commission of whatever comes back to me, and also just some baseline monthly payment for service. PLEASE GOD LET THIS BECOME A THING. Or, you know, a not insane medical system.
The idea of a same-week appointment, especially as a new patient, seems like fantasy to me.
Hopefully you don’t end up with a medical condition that exhausts your PTO and you get kicked off insurance. My neighbor’s go fund me staved off foreclosure for 6 months when his wife had cancer.
Where I live, 95% of medical practices belong to 2 networks. Step two after consolidation is reduce costs. Long story short, if you don’t have cancer, you’re looking at 90+ days for an appointment.
Dermatologists are a little different in that they can make money selling bullshit spa services. So you may see more variance by region as being cut out of hospital networks isn’t as big of a deal.
My experience with a dermatologist (in the US) ended up being the same as you anticipated it being. Trying to book a new patient appointment myself I was getting quoted availability 2-3 months out.
I was able to get that sped up a bit by having my primary doctor refer me (which my insurance didn't require) and set up the appointment on my behalf. But even then, it ended up being almost 6 weeks out.
I've also had to book GI appointments in a few different locations, and have had some get me in within a week and others that had a multi-month wait.
And some insurance plans in the use are HMO plans[1], which generally have the requirement of going through your primary care doctor for everything and requiring a referral from them to see other physicians.
The biggest gripe I have about the US healthcare system is how impacted it is by employer decisions. Having decent coverage today doesn't mean the coverage will stay decent, even if you stay with the same employer. I've had awesome insurance unexpected swapped out for crap insurance due to an acquisition, had good plans that I took into account when determining whether to take a job disappear the year after during open enrollment season, had the "same" plan change year to year in subtle but impactful ways (like keeping per-person deductibles the same, but adding a condition to meet a minimum family-level deductible in addition to any individual before you actually hit the threshold).
And an industry - not a service - aiming to find and charge the highest prices in a market where the buyer cannot refuse the service.
We have the worst of both worlds.
1) The conservatives (political right) have eroded public health care any chance they can, such as through cutting budgets to any health-related service over the course of at least the last 20 years. They do this so that they can stand up in front of people and argue that “Wait times are long! If you let us implement private health care you could simply pay for better service!”
2) Even with the reduced budgets and constant attacks by conservatives, if I limp in to emerg with severe pains I’m getting looked at immediately and might be successfully out of surgery by the end of the hour. On a smaller note, I just had this convo this morning: “Can I book an appt to get my prescription refilled? I know the Dr has to talk to me before writing it” “For sure. I can get you in Nov 28th. Are you completely out?” “Yes I am, I miscalculated and I’m concerned.” “Ok, I’m putting you in for tomorrow afternoon. Does that work for you?”
Is it propoganda or lived experience? Everytime someone has come around saying they're going to fix my health insurance for me, it's ended up costing me more for the same service as before.
Come to think of it, I've yet to have an increase in positive experiences concerning my health insurance. Every doctor's visit feels like a new surprise lurking in the dark.
I have heard that European Healthcare, especially in places like Denmark, is top notch and somehow free of this evil: I would love to know how they achieved this.
If so, the cost of medicine is just borne elsewhere: the average tax wedge is 38% in France vs 18% in the USA for a married couple with 2 children:
https://www.oecd.org/tax/tax-policy/taxing-wages-france.pdf
Sales tax is also 20% vs less than 10% in all US states.
But even taking that into account, the US still pays more:
https://www.formulary.health.gov.on.ca/formulary/results.xht...
Indomethacin can be bought from four different companies at $C0.12 per tablet.
The real crime is calling bribes “campaign contributions” and pretending that our politicians (of all parties) aren’t selling their votes to the highest bidder.
Both sides were really shady, with lots of evidence just disappearing. My opinion, as someone from a Soviet country with actual widespread voting fraud, is that the way your election went was a bit suspicious. It was weird in the same way we see when the side that's supposed to win stuffs ballots from dead people, people who didn't turn up, etc. The large sudden bump in votes for Biden also seems suspicious. The fact that Trump got a record number of votes during a pandemic in which his voters almost all voted in person and still lost, is a bit suspicious. The fact that you need to only rig a few counties with a few votes to secure the thin margin by which Biden won, is suspicious. Many things are weird and suspicious. It is possible actual well intentioned people rigged the election to "save America". Whether they did and if it was right, I cannot say, I am not an American, I cannot judge your country.
All that said, based on actual available evidence, I cannot conclude that the election was rigged. It was probably the most scrutinized election in recent memory, leading to us seeing a bunch of suspicious events that probably happen pretty often. Similar to how the 2000 election, Bush vs Gore, was a bit suspicious.
"suspicious" is used here for cognitive priming.
The government or a charity should fund another line, and should in general provide incentives to companies to not shut down existing approved lines if it would leave only one company standing.
If I was uninsured in the US for whatever reason and needed elective surgery for something with a short enough recovery period, I'd look up UK hospitals.
They're often similarly cheap enough to justify a flight and a hotel stay. Especially as many of them leverage excess capacity at NHS Trusts (some are even operated by NHS Trusts, as the trusts are allowed to offer private services within certain constraints)
I believe that this may be what pushes the American system to change.
I know of several not-rich people, sometimes who have decent or good insurance, who have chosen to go abroad for medical care. The care they get abroad is typically cheaper as well as better.
Given the amount of money the US spends on healthcare, this should rarely be true.
The insurance companies have set up a good gig for themselves, but I think that they may be feeding at the trough a bit too aggressively. When the economy has a big downturn, I think some hard questions will be asked.
[1] https://www.fahorro.com/indometacina-100-mg-15-supsension.ht...
> Indocin's list price (what uninsured patients would pay) was $198 for 30 suppositories in 2008.
I would not be surprised if they've hiked the list price a ton to game the insurance "what we'll pay" formulas and get more money from insurance companies. As trimbo notes [0], if everyone is paying list price then only 225 people are using this drug consistently. That seems unlikely.
So perhaps the drug companies are just responding to demand from their biggest customers.
Two companies reaching an agreement to supply products at reduced price, but not making the terms of that agreement available to a third entity (uninsured customers)?
As for "should it be illegal", most people seem to agree the healthcare industry should be regulated more tightly than commerce in general, but there's plenty of debate about exactly how far we should go.
Seems to be standard business. ONE of my prescriptions for rheumatoid arthritis costs roughly $5000/month without insurance. My insurance, plus additional assistance from the drug maker makes the medication "free" for me. It's clearly a giant, legal insurance scam.
Indomethicin is an old drug without much use and then narrow it down to suppositories it’s an even smaller market. Plus there are a dozen plus alternatives you could use.
Think of like producing a microprocessor design from 1970 where alternatives exist. Super niche. Demand is maybe 100 units per year. What would you charge?
I don't know the market, but it appears that it may be patented until 2030 (https://www.pharmacompass.com/patent-expiry-expiration/indom...). That being said, drug patents are complicated, and there might be competitors for this drug.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/01...
https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=a...
Take it to the extreme: you have a very, very rare life-threatening illness. Since only 20 or so people a year are diagnosed with this, the drugs to treat it would have to cost 1.5MM just to be decently profitable.
Is that a just healthcare system? A kind of inverted lottery in which the “luckier” you are the more likely to go bankrupt.
One might reasonably conclude that trying to run the entirety of the healthcare system as a capitalist enterprise is perverse and trades the misery of the many for the profit of a few. In such cases, we should rightly consider all possible alternatives.
Costs are typically socialized by the federal government.
Instead people view health “insurance” as a healthcare plan. Which is not how the us system was designed.
For those with health insurance the idea would be it cover the 10k+ per pill cost for your rare disorder.
If it cost 1 trillion to add a year to the life of just one person, should society pay it, even if that trillion is then not able to be used for lots of other societal needs?
Arguing for policy while ignoring opportunity costs leads to more human suffering than would otherwise result.
Perhaps capitalism is not the best strategy to apply to healthcare. Folks in need of healthcare will always be a minority - a niche market - after all. The most prolific diseases typically only have 3-6M cases at any given time in the US.
Should a person go destitute to pay for their care, just so some company's supply/demand curve is properly fitted?
(There are so many examples of this, including for this case that Medicare/Medicaid are government programs where they pay whatever the drug companies ask.)
i.e. don't let the supply chains fall over and provide "insurance" for everyone.
This really isn't that crazy in the grand scheme of things. The US right now today does basically this with dairy products.
This has little to do with the cost to produce something, other than to set the lowest bounds of the sale price (which by itself is a simplification given the concepts of loss leaders and non-monetary gains).
I'd honestly much prefer if they were charging according to their costs and not market forces.
I'll come out and say it: Pricing people out of your medicine so you can increase your profit margin is capital-E Evil.
E.g. in the UK a quick check shows me I can buy a pack privately online for $40.
(UK online pharmacies can sell a number of prescription-only drugs privately if they have a doctor carry out an online consultation, which means you basically fill in a form and a doctor will look at your answers and provide a prescription as part of the sales process, or you can send them a prescription you already have).
For that you have regulatory upkeep, cost of manufacturing, and legal liability.
It seems pretty clear why several of the past owners of the brand have gone bankrupts or sold off the product line.
https://s28.q4cdn.com/742207512/files/doc_presentations/2021...
https://www.goodrx.com/indocin?dosage=50mg&form=capsule&labe...
https://www.goodrx.com/indocin?dosage=50mg&form=suppository&...
Maybe the generic can't be sold as a suppository, and the suppository version works better?
This appears to suggest that there are people who take enormously expensive theraputic drugs who don't need them, and that Martin Shkreli gave away those enormously expensive therapeutic drugs away to those who actually did.
Whether propoganda, misinformation, or a bald-faced lie, that's not what happened. That never happens, and never will. Shame on you for implying that was the case.
He meant "needs it for free" not "needs the drug".
"‘My other piece of advice, Copperfield,’ said Mr. Micawber, ‘you know. Annual income twenty pounds, annual expenditure nineteen nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds nought and six, result misery."[0]
[0] David Copperfield, Charles Dickens
Even if a highlighted instance of predatory behaviour was papered over due to said highlight, and even if that papering-over resulted in greater drug availability at lower cost, I think that might have been a result of the spotlight, rather than proof positive that the behaviour isn't awful and doesn't hurt those unlucky enough to fall ill.
30 50mg capsules of Indomethacin (generic indocin) is $8.87 at Giant Eagle.
60 75mg capsules of Indomethacin ER (generic indocin sr) is $29.08 at Giant Eagle.
Who is paying that much for this drug?
Here's the tale: If you have obstruction of your bile ducts below the liver or gallbladder, usually gallstones or sometimes neoplasm, you need an endoscopic retrograde cholangiopancreatography (ERCP) for extraction or sampling.
ERCP is sticking a tube down the throat, stomach, small intestines into a tiny opening at the ampulla of Vater to access the bile ducts. Sometimes this process causes inflammation of the ampulla and associated ducts leading to blockage, and can lead to pancreatitis due to back flow and pressure, because the pancreas also excretes its digestive enzymes via the ampulla).
A few trials circa 2015 showed rectal indomethacin reduced the risk of post-ERCP pancreatitis, and eventually it made its way into the guidelines. It is the only proven preventative treatment, so they have a natural monopoly.
Hope that helps.
The drug was approved in 1965 and the company selling it holds no patents on indomethacin.
If I had to hazard a guess, it may be the market isn't attractive enough for competitors to establish a national supply chain. Or there's some sort of collusion at play.
To me this represents further evidence why public goods should be left out of the hands of private for profit organizations for whom disease is simply an externality to capitalize on.
For those comparing vs the us health system, include (a) working f/t with good employer benefits, (b) f/t with less benefits and (c) working part time. And remember to include cobra. And include the state/province/country where the comparison is being done. No absolutes here, either.
Active ingredients Indometacin 25 mg
Drug tariff price £1.36
Active ingredients Indometacin 50 mg
Drug tariff price £1.64
Annual sales for oral and suppository are around 2 mil/year. Barely worth the liability and ongoing regulatory cost.
I would say this system needs to change but considering the democrats can't even escape from a wet paper bag, i don't see that happening.
https://www.medpagetoday.com/rheumatology/generalrheumatolog...
Colchicine, the old gout drug often cited as a cheap anti-inflammatory, hasn't been such a good deal since FDA approval, a study showed.
The inflation- and rebate-adjusted Medicaid price per pill jumped from $0.24 in 2008 to $4.20 after the FDA officially approved a branded form, Colcrys, through the agency's Unapproved Drug Initiative pathway in 2009.
and
Accordingly, Medicaid spending on single-ingredient colchicine rose 2833%," they wrote, and "58% of this increase was attributable to price increases alone."
and
"Only a fraction of an investment was required for Colcrys, a product that has provided no increased value and an unnecessary, long-term cost burden to the health care system," argued B. Joseph Guglielmo, PharmD, of the University of California San Francisco, in an accompanying editorial. "The current study findings illustrate that we can never allow such an egregious case to take place again."
say what you will but this is just stupid american bullshit.
As a part of that process, they offered market exclusivity as an incentive for a company to spend the time and money to do so. As I said in another response, the filing fee alone is $1.6M. It's not as expensive as a full NDA approval, but it's not free.
And your article lays it all out.
"Their study used Medicaid and Medicare data files through 2017, when combined Medicaid and Medicare claims exceeded $340 million for colchicine.
"Colcrys's manufacturer, which conducted a 1-week trial (n=185), received 3 years' market exclusivity for treatment of acute gout, and the unapproved formulations were soon ordered off the market, resulting in a virtual monopoly," McCormick's group noted."
So the price goes up for 3 years and as a result you get a fully FDA approved drug? Not worth that trade off?
https://www.the-rheumatologist.org/article/the-unapproved-dr...
On Friday, Nov. 20, 2020, the U.S. Department of Health and Human Services (HHS) published a Notice through the Federal Register announcing the withdrawal of guidance documents that established the Unapproved Drugs Initiative. This Notice brings to an end a 14-year-old program that has been blamed for significantly contributing to the rising cost.
So... again, yes... greed.