Category Archives: Health Economics

American Health Care: Your Money or Your Life

Cancer drug pricing started, as I recall, to accelerate in the 90’s with the advent of Taxol (paclitaxel). This drug used mainly for breast cancer was priced at what now seems a “reasonable” $1000 for a dose. Prior to this “advance” the maximum cost for a drug was in the range of a few hundred dollars.

With better understanding of DNA and the genetic basis of cancer “targeted therapies arrived on the scene and prices rapidly spiraled. The first of targeted treatments, i.e. those that block a genetic defect, was Imatinib (Gleevac). A revolutionary advance, it was initially priced at between $26,000-and $40,000 (I recall the latter) for a year of treatment. A very big escalation. Now, FYI, that very same drug is sold at about 5 times the initial high price, $120,000 per year.

What’s amazing is that our so-called healthcare system paid up. Since then costs have spiraled. And todays example is just one of the extreme ultra-high priced medical “advances.”

Approved by the FDA in January 2022 as the “first and only” treatment for metastatic uveal melanoma, Kimmtrak has kept his tumors stable, according to Davis. His oncologist told him he should stay on the drug “until it stops working.” Its manufacturer markets the drug’s power to deliver “6-month improvement in median overall survival.””

Medicynical Note: In cancer therapy the drug prices only partially reflect the actual cost of development. Companies price medication to maximize profits not to assure affordability or access. They consider the frequency of the disease as well as what any other drug for that disease will cost. When there is no other “effective” drug and the disease is severe and rare, the sky’s the limit.

The question remains who can afford it? How much can we afford to pay for 6 months of survival? Can insurers absorb the costs or is this the proverbial bridge too far?

Trump Tax Cuts and our National Debt: A Shell Game for Suckers

As Republican Trumpist radicals posture about our national debt remember their early actions during Trump’s first year in office that is constantly increasing our debt to the tune of over a trillion dollars over 5 years.

Medicynical Note: This is not rocket science nor advanced economics. The game plan is to play up the debt and try to pay for it by cutting Medicare, Medicaid, Social Security and other necessary domestic programs. Defense of course will be exempted from significant cuts.

After marching in lock-step to increase the debt under Trump by cutting taxes on the wealthy our republican faux libertarian radicals want to place the burden of the debt that THEY created on middle and lower income earners. Are we so stupid as a country to fall for this? ………. maybe. Watch the posturing over the next few weeks and find out.

American Health Care…… isn’t

Understanding health care coverage and costs requires a PhD. The folks in today’s health care fiasco bought coverage from a company that for two years doesn’t cover “pre-existing” problems…. and got burned.

‘The plans are often faith-based, whatever that means, and have surged in popularity in recent years because they can be cheaper than traditional insurance — the Kings said their plan cost $534 a month, plus an additional $118 a month to join a direct primary care medical practice.”

“But the sharing plans offer fewer protections than insurance and come with provisos. The Kings said their plan did not fully cover preexisting conditions like Jeff’s heart condition for the first two years of coverage — and he needed the surgery after 16 months.”

In this case the couple found they were liable were for the entire $160,000 billing.

Medicynical Note: Healthcare has become worse than buying a used car, in part because the car purchase is discretionary while in health care one’s very existence may be involved……..and, in part because the amount of money involved in healthcare is so much more.

The article notes: “Hospital charges are generally understood by health economists to bear little resemblance to the actual prices that are typically paid. Instead, they are more of an opening salvo in the high-stakes negotiations between hospitals trying to get as much money as they can for providing care and insurance companies trying to pay as little as possible.”

In this case after billing $160,000 the hospital knocked off $107,000 from their original pricing. This for a non-surgical Cath-lab procedure that probably required only an overnight stay. And FYI the hospital involved had a net revenue of over 800 million dollars and net income (2020) of over 57 million dollars. Not bad for a “non-profit.”

It’s sadly true in America that in America healthcare companies are more interested in income than outcomes.

Over the Counter Meds— Benadryl vs Diphenhydramine

Below are ads for the anti-allergy antihistamine and sleep aid diphenhydramine, perhaps better known as Benadryl, from the internet on Dec. 22, 2022. This allergy medication has been on the market for over 50 years. It’s been available as a generic for almost all that time and yet it’s still marketed under it’s brand name, Benadryl. It’s priced from around a penny (Costco in-store price under $5.00) or two (Walmart) / pill for the generic diphenhydramine versus ten cents to 20 or 30 cents/pill for the branded Benadryl pills. And everyone selling the medication makes a substantial profit. That the magic of capitalism.

Medicynic Note: The actual cost for the diphenhydramine must be a fraction of a penny/pill— Neither Costco nor Walmart sell this drug at a loss.

However the brand name version still outsells the generic, so it’s no wonder that drug and pharmacy companies still sell the brand name version but at 10-20 times their actual cost for the medication.

CVS and Rite-aid also show the brand name with their own CVS/Rite-aid label generic version…..usually at 50-75% of the branded prices above.

Healthcare in America: Income over Outcomes!

America has a system of revenue generation that it calls healthcare. Many of it’s “healthcare” corporations work more diligently to improve revenue and income than on improving patient access, affordability and outcomes. That’s American private healthcare even if the company involved is supposedly “non-profit.” This article documents some of the actions of a large non-profit church run hospital system. In reality it is a cash cow that launders hospital income into huge privately held investments.

As noted in the article “But The Times this year has documented how large chains of nonprofit hospitals have moved away from their charitable missions.”

“Some have skimped on free care for the poor, illegally saddling tens of thousands of patients with debts. Others have plowed resources into affluent suburbs while siphoning money from poorer areas.’

And: “Today, Ascension operates in 19 states, mostly in the South and the Midwest. It serves about six million patients.”

“By many measures, Ascension is rich.”

“In addition to its billions in cash, it runs an investment company that manages more than $41 billion. Last year it paid its chief executive, Joseph Impicciche, $13 million.”

“Because of its nonprofit status, Ascension avoids more than $1 billion a year in federal, state and local taxes, according to the Lown Institute, a health care think tank.”

Medicynical Note: In large areas of the country, because of the tax advantage from their non-profit and church related status, hospitals like Ascensions’ have become the only provider of health care, dominating both inpatient and outpatient services. Besides scrimping on staffing and services to maximize return they also enforce health care religious proscriptions on their non-practicing patients and staff.

In the end America has a revenue generating rather than a health generating system of care. It’s interest is more in income than outcomes. Sad but true.

$35,500 Medication in U.S. …… $250 in the U.K. The U.S. Medical Scam

I’ve previously talked about the manipulation of medical prices through price gouging and medical code game playing. What follows is an example. Not unusual. It happens every day in the U.S. of A.

“Total Bill: $73,812 for the two shots ($35,414 for the first, $38,398 for the second), including lab work and physician charges. United Healthcare’s negotiated rate for the two shots plus associated fees was $27,568, of which the insurer paid $19,567. After Hinds haggled with the hospital and insurer for more than a year, his share of the bills was determined to be nearly $7,000.”

Medicynical Note: Almost everything on this bill is a manipulation of the system. First, the pricing of the lab tests. Each are inflated probably several times the actual cost of doing the test or the price of the test done for outpatients. Next, the cost of the medication leuprolide $35,000 (gasp!). This, for a drug developed in 1973 and priced at a few hundred dollar just a few years ago and costing $250 or less in overseas healthcare systems. Current pricing in various locales here. And lastly the use of codes to increase the billing i.e. separating the office visit fee from an “evaluation and management” fee. Both events, of course, happened simultaneously. Or consider the over $500 fee for a quick, less than a 1 minute, administration of a drug that has almost no immediate side effects. The nurse administering the drug didn’t even have to find a syringe to draw up the medication as it comes ready to go in a syringe.

Healthcare pricing has little to do with actual costs. This patient had insurance and paid a “negotiated” reduced but still excessive amount. But if he had no insurance he would have been billed and held accountable for the full amount, unless maybe he could claim poverty or was a skilled negotiator.

The finances of healthcare in the United States are worse than going to a used car lot and dickering for a car……and more expensive. When you understand that the CEOs’ of so-called health-care companies major concern is income not outcomes than you understand why we pay so much.

$80,000 and 5 ER Visits: In American healthcare it’s the INCOME not OUTCOMES

An encounter with our health care system is worse than going to a used car lot. In the latter case you more or less know before the purchase what your cost will be, albeit the route to the final price is galling.

In the U.S. healthcare non-system the sky is the limit as providers hide prices and arbitrarily raise them without consulting with the consumer. Needless to say the buyer of services is ultimately liable for the full price.

“Laub opted for the methotrexate injection. After getting the shot, patients need certain follow-up blood tests for several weeks to confirm that the pregnancy is ending or has ended. Laub returned to the emergency department for bloodwork and an ultrasound three days after the shot. She returned again three days later and was given a second shot of methotrexate since the pregnancy hadn’t terminated. The following week, she repeated the treatment in two more follow-up visits. On July 20, after 12 days and five emergency department visits, Laub was scheduled for laparoscopic surgery to remove her fallopian tube.”

“The total charges to date for the medical treatment: an eye-popping $80,000. Because her health plan had negotiated discounted rates with the hospital and the other providers, all of whom were in her provider network, Laub’s out-of-pocket cost will be a fraction of that total. It now appears Laub will owe a little more than $4,000.”

Medicynical Note: When I lived in a third world country years ago, little kids would approach me at the open market and ask for baksheesh. Every time, every single time. They’d ask whether or not I gave.

Our healthcare system is a rabbit warren of rules and regs a little like that open market. Providers always ask for the gift and diligently game the system to maximize billings. Hospitals hide prices and years ago learned that they made more by itemizing every little thing and overcharging for each item rather than by providing a comprehensive price for a service. Adding to the confusion, prices charged insurers vary widely are often tiny fractions of that charged to customers without insurance.

And yes, the multimillionaire CEO’s of healthcare companies and health insurers could care less whether you get affordable care or whether you survived your encounter with the healthcare system For them it’s the company’s income not patient outcomes that is important. That’s America.

The Price of Ignorance: American Healthcare Costs

Procuring and paying for healthcare in the U.S. is an exercise more opaque and yes, potentially even more expensive than buying a new car. Ever try and get a firm price for healthcare services? You’ll find that no one can give a total price and guarantee that’s what you’ll be charged.

We have a system of revenue generation not healthcare. Your doctor in modern America is an employee and has little to no control over his office. And doctor’s fees it turns out are only a small part of the total cost.

Adding insult to injury our non-system of healthcare is set up to charge the neediest the most.…..unless they are fortunate enough to have insurance of some type (Obamacare policies, Medicare, Medicaid or private coverage). In the wealthiest (maybe) country on earth we have a system of health care revenue that charges those with the least, the most.

Medicynical Note: I’m an elderly retired M.D. and am well covered by insurance. This year so far my Medicare/Medicare Advantage policy was billed $5,954 for services. Because they have agreements with providers they paid only $2,210.34 for the services with me paying a very modest $10/visit co-pay. Not a bad deal if you have the coverage.

If I were one of the un-insured the providers would charge the entire $5,954……ironically or perhaps by design charging those least able to pay, the most. It’s really an absurd way of paying for health care and is the only such faux health care system/revenue generation system in the industrialized world.

Health care costs in the U.S> are among the leading causes of bankruptcy. Such bankruptcies are unknown in other parts of the world.

Liability and Covid…..who bears the costs

I read three articles this morning that raised concerns about liability and COVID. It’s inevitable in a litigious society that this will become an issue.

The first article concerned a State Trooper who died from COVID. It was disclosed that he had not received a COVID vaccination but was at work until he became ill. Who would be liable if they developed COVID after exposure to this guy?

The second article involved public employees in Washington State resisting the mandate for vaccination. Who would be liable if they were allowed to resist the mandate and infected colleagues or others who they met in the course of their work?

The third article points out that the vaccine mandate is working. The vaccine proved to be safe is assuring vital institutions a protected work force going into the third winter of the epidemic. And perhaps more vitally it limits their risk of facing suits regarding negligence if a person was thought to have acquired COVID in a hospital setting.

Medicynical Note: There are strong arguments for vaccination. It is safe and appears to offer almost complete protection against fatal COVID infections. Breakthroughs cases appear to be in the immunocompromised and the debilitated elderly.

With a safe and effective intervention it could be posited that an employer was negligent and liable in allowing customers (patient or other workplace contacts) to be exposed to a sometimes fatal disease. The mandates protect more than the vulnerable individuals, they protect their employers and their contacts.

In a related thought, the insurance industry denies or charges more for insurance coverage for people at increased risk. Perhaps as an another incentive to vaccinate, private and government insurers should provide only limited medical cost coverage to those refusing to protect themselves. As my conservative friends point out there are consequences to bad behavior.

Why We Pay More (Drugs)? Because We Let Them

Last week, we learned that Merck is planning to charge Americans 40 times its cost for a Covid drug whose development was subsidized by the American government. The situation spotlights two sets of facts that have also gone largely unmentioned in the legislative debate over whether to let Medicare negotiate for lower drug prices.”

“Fact one: Americans are facing not merely expensive drugs, but prices that are examples of outright profiteering.”

“Fact two: in many cases, the medicines we are being gouged on are those that we the public already paid for.”

Medicynical note: It’s safe to say that we, in the U.S., pay more for medications than any other country in the world. We consider newly developed medications akin to new inventions and offer generation long monopoly like patents, having ceded our financial interests to the companies in the 80’s and 90’s.

Drug companies are not part of the health care community. In fact they care more about revenue and the exhorbitant pay of their executives and the price of their stock (stockholders wealth) than the health and well being of their customers.

They benefit from a system fixed in their favor. They do this in part by financially supporting numerous congress people to forestall congressional oversight and then charge U.S. customers whatever they wish–no discounts to offset previous taxpayer support and no negotiation with their largest customer (Medicare) to assure reasonable pricing and profits on U.S. sales.

In fact, we pay more than any other locale in the world because we let them charge us more. Do we have any right to complain?

https://arstechnica.com/science/2021/10/mercks-thor-inspired-covid-treatment-hammered-for-700-price-a-46x-markup/