This spring, a patient of mine, Richard Gardner, called me regarding a prescription I wrote for him. The drug was Plaquenil, a medication for rheumatoid arthritis, and he was frustrated and angry. The medication was working fine, that wasn’t the problem. The problem was that the price of generic Plaquenil had increased from $30 per month to $85 per month. The brand name Plaquenil would now cost him $200/month.
And this was after his health insurance picked up a portion of the cost.
Raise your hand if you can relate to Richard Gardner. Maybe you’re on four or five medications with yearly out-of-pocket payments of thousands of dollars. Maybe you’re on Tier 5 “specialty drug” where your insurance picks up 80% of the cost and you are left with, let’s see, 20% of $30,000 per year for a biologic drug in rheumatoid arthritis is…$6,000 per year.
We, the purchasing public, frankly, are being fleeced. Martin Shkreli, a former hedge fund manager and founder of Turing Pharmaceuticals, justified his price increase of the anti-parasitic drug, Daraprim, from $13.50 to $750 per pill at a Congressional hearing in 2015 with the simple statement: “Because I can.”
Of course, it’s not just the price of medications which contributes to our ever-rising insurance premiums and $5,000 deductibles. It’s everything.
Let’s spin the wheel of health care costs and it lands on, “Administrative costs.” In my former private practice in Portland, one of our employee’s jobs was to obtain prior approvals for medications and necessary tests. On the other end of the phone was an employee of the insurance company whose job was to say no. Eventually, our office was usually able to get our patients needs met. It was a lot of work. Is it any wonder that roughly 20% of the cost of your private health insurance goes towards administrative costs?
Let’s not leave out hospital costs. As Sarah Kiff recently wrote in Vox: “Americans pay on average $1,119 for an MRI. An Australian pays $215. It’s the exact. Same. Scan.” Several years ago I underwent successful same-day surgery at Maine Medical Center. The charge was $12,791.46. But as I poured over the three-page bill and realized that I had incurred 39 separate charges, I decided to break down the costs. For instance, I was charged $194 for 2 liters of lactated Ringers solution infused during my surgery. When I returned to work the next week I asked our office manager how much our private practice paid for a liter of lactated Ringers solution for our patients receiving IV infusions in our office. Her answer: “Under four dollars.”
Hospitals see thousands of patients each year without insurance and balanced billing is unavoidable if they are to stay afloat. I get that. But come on, $194 dollars versus $4 dollars?
Thankfully, there is a way out of this morass. And it’s not repealing and replacing the Affordable Care Act or even improving the Affordable Care Act. It’s a single payer system, Medicare for All. We need to join the rest of the industrialized world and provide health care to all of our citizens. Implement new laws and allow Medicare to negotiate the prices of medications as the Veterans Affairs and Medicaid programs do. Let Medicare with its extraordinary low administrative costs (estimated at 1-5% as compared to nearly 18% for private insurance) streamline our system so that we get more for less.
In my vision of a healthy America, private health insurance remains in the mix and competes as a secondary payer for the 20% Medicare traditionally does not cover. Heck, keep private health insurance available as primary insurance for those who want to avoid Medicare entirely, similar to the taxes paid by the wealthy to support our public schools even as they “opt out” and pay for their children to attend private schools.
I don’t underestimate how difficult this transition may be. A large portion of our economy is dependent on the health-care industry. Perhaps the transition can be phased in by dropping the Medicare age by 10 years at regular intervals until we cover all Americans. I don’t pretend to have all the answers, no-one does.
But we’re reaching a point where the Richard Gardners in our country is going to demand major change, and that doesn’t mean squeezing into an old pair of jeans which no longer fit. As a nation, let’s buck up and do the right thing. Republicans and Democrats need to come together and adopt a simpler, less costly system, and that’s Medicare for All.
Medicare for all is the answer. Excellent information!
Thanks for commenting Janis. I’m on the board of Consumers for Affordable Health Care here in Maine and I hope we can make Medicare for All a reality someday. Chuck
I agree completely. This is another reason I find being American embarrassing. Seems like we no longer lead the world as a country to learn from but rather as the country refusing to stay abreast.
—Daughter to mom—“Mom, what’s a Canadian?”
—Mom to Daughter—“An unarmed North American with Health Insurance”.
Unfortunately, the VA and Medicare fail the Americans they serve everyday. Many of the men and women who served our country can’t get the basic care they deserve because that system has failed. They decide that they are ineligible because they didn’t serve in a war, or they don’t have a disease relating to their time in service, or worse they are just neglected because the system is overburdened. Many men and women wait in the que to be seen for months and years. Medicare/medicaid both deny patients over and over until either they give up and don’t seek treatment or they just need additional insurance to cover everything that isn’t covered. The socialized systems work in smaller countries or countries that have significantly less population because their governments are centralized, and on a smaller level. They are also taxed up the wazoo, they pay taxes on top of taxes. Our system of government will not allow a single payer system because as much as people say they want it they won’t pay for it, they won’t give up their rights to get it. We have separate sovereign states, though united they are independent. Each state have their own system already in place with differing laws, it’s not a matter of simply centralizing it’s a matter of states rights. The last time there was a disagreement about states rights it go bloody.
There is an option, regulate the insurance industry and put a cap on fees for services from hospitals just as the justice systems do for legal fees. We can regulate without losing our quality of care.
In England people can wait years for healthcare in lines to see specialists. The people still pay for their medication it’s not free unless you fall under certain strict qualifications. Their doctors begin training at the age of 18, there is no undergraduate degree first. While it may seem expensive for our education, it makes a difference in the maturity and well rounded education of our doctors. They are better for the added education.