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Only in America

Heartwarming story or grotesque parable? Only in America!

“Farnan met Blaze’s mother at OSF Children’s Hospital and quickly became like family. Blaze’s mom didn’t live near the hospital and couldn’t pay for all the care he needed at home. So, she put her son in the care of a trustworthy person – his nurse.

“The good Lord put us where we are for a reason,” Farnan said. She and her husband took Blaze into their home and gave him the intensive care he needed.

The day of his second surgery in March 2018, Blaze’s mother asked Farnan if she and her husband would consider officially adopting her son.”

Medicynical note: The U.S. stands alone in the industrialized world. Only here would a woman have to give up a child because she could not afford the necessary healthcare. But then again we are the only country that separates asylum seeking parents from their children and then professes no responsibility to reunite them.

Cat Bite, hospital bill $46,512

In American health care money comes first.

“The rabies immune globulin is a complex product, made from blood plasma donated by volunteers who have been immunized against rabies. Three manufacturers make the product, and there are no shortages right now, the Food and Drug Administration says. Currently, the average wholesale acquisition price — the amount paid by wholesalers that then mark it up when they sell it to distributors or hospitals — is $361.26 per milliliter, according to Richard Evans, a drug industry analyst at SSR Health, part of the boutique investment firm SSR LLC. “

“Using that average, the cost for the 12-milliliter dose Parker received would have been $4,335.”

Medicynical note:  Learning the cost of a service in a hospital is like an adventure in unexplored territory. The best you can do is fumble around and keep asking. More often then not, you will get an estimate which is wildly inaccurate and excessive.

Hospitals seem to have an infinite number of prices for the same service. The most expensive of which is that charged those least able to pay, i.e. the uninsured individual.  In this case the pricing for the medication (rabies immune globulin) was several multiples of the actual cost.  This was added on to ER fees which I presume included the physicians fee and the facility fee.  The insurer, in this case did not have a contract with the facility and was charged significantly more than other insurers but much less than the price quoted originally.

But that of course is the nature of health care in the U.S.  The system is not designed to provide value or even excellent healthcare, but rather to maximize revenue.  In private for-profit companies (as well as most “non-profits” ) the fiduciary responsibility of the company’s management is to maximize revenue and provide profit for stockholders or sponsoring organizations.  As a result we have the most expensive health care in the world with the highest cost/capita, the most bankruptcies from health care costs, and the most uninsured citizens (in an industrialized country).

 

Social Mobility…..not here, we’re an oligarchy

Krugman

“the U.S. is truly exceptional — that is, it performs exceptionally badly. Americans whose parents have low incomes are more likely to have low incomes themselves, and less likely to make it into the middle or upper class, than their counterparts in other advanced countries. And those who are born affluent are, correspondingly, more likely to keep their status.”

“If Tea Party types got their way, we’d see drastic cuts in Medicaid, food stamps and other programs that aid Americans with low income — which would in many cases leave low-income children with inadequate medical care and nutrition. We’d also see cuts in funding for public education. And on the other end of the scale, we’d see tax cuts that raise the incomes of the wealthy, and the elimination of the estate tax, allowing them to pass all of that money on to their heirs.”

Medicynical note: in case you weren’t sure: “Oligarchy is one of numerous English words for a type of rule or government. Some of these words, such as plutocracy, have an exceedingly similar meaning (both may be used to refer to rule by an economic elite, but oligarchy often has the additional connotation of corruption). “

Sadly this description of a government of, by, and for……money……is accurate.

Who is electable? (Part 1)

In the past the 10 oldest presidents were:

Ronald Reagan: 69 years old.

William Henry Harrison:68 years old.

James Buchanan: 65 years old.

George H.W. Bush: 64 years old.

Zachary Taylor: 64 years old.

Dwight D. Eisenhower: 62 years old.

Andrew Jackson: 61 years old.

John Adams: 61 years old.

Reagan as you know suffered early Alzheimer’s disease at the end of his presidency. Harrison died from pneumonia contracted it is thought at his inauguration. And Buchanan was probably the worst president before the current one.

What’s the point of this? The lead republican for 2020 was elected at age 70 and be 74 years at the time of the next election.. Biden will be 78, Sanders will be 79, Clinton will be 73, Warren will be 71.

Our experience with the elderly presidents has been at best mediocre and at worst a disaster. We can and must do better.

Only in America

Heartwarming story or grotesque parable? Only in America.

“Farnan met Blaze’s mother at OSF Children’s Hospital and quickly became like family. Blaze’s mom didn’t live near the hospital and couldn’t pay for all the care he needed at home. So, she put her son in the care of a trustworthy person – his nurse.

“The good Lord put us where we are for a reason,” Farnan said. She and her husband took Blaze into their home and gave him the intensive care he needed.

The day of his second surgery in March 2018, Blaze’s mother asked Farnan if she and her husband would consider officially adopting her son.”

Medicynical note: The U.S. stands alone in the industrialized world. Only here would a woman have to give up her child because she could not afford the necessary healthcare. But then again we are the only country that separates asylum seeking parents from their children and then professes no responsibility to reunite them

Horrors of socialized Medicine

Healthcare in the US is an elaborate revenue generating enterprise. Care is a secondary objective.

This from an expat in Taiwan.

“According an American expatriate who shared the story of his ER visit in a Taiwanese hospital, Americans are being taken to the cleaners when we go to the doctor. We live in a country that claims to be the greatest in the world, but where an emergency trip to the hospital can easily bankrupt someone.

Kevin Bozeat had that fact in mind when he fell ill while living in Taiwan and needed to go to the hospital. He didn’t have insurance and he had no idea how much it was going to cost him. He shared the experience in a now-viral Facebook post he called “The Horrors of Socialized Medicine: A first hand experience.”“

I’m back

After A two year break, not that there is a groundswell of demand, I’m going to restart this site.  My emphasis will be on medical issueS and the US political scene.

While somewhat of a downer this article outlines  the challenges we will be facing as we continue to  denying climate change n theLilliputian trump era.

“Once upon a time in America, we could all argue about whether or not U.S. global power was declining. Now, most observers have little doubt that the end is just a matter of timing and circumstance. Ten years ago, I predicted that, by 2025, it would be all over for American power, a then-controversial comment that’s commonplace today. Under President Donald Trump, the once “indispensable nation” that won World War II and built a new world order has become dispensable indeed.”

“As Washington’s global power fades and its world order weakens, Beijing is working to build a successor system in its own image that would be strikingly different from the present one.”

 

Your Money or Your Life: America’s Health Care Disaster

It used to be financial planning was a field which provided assistance for the golden years (retirement),  In the U.S. financial planning is necessary for patients to get their health care.  Our amazingly inefficiency expensive (most in the world) health care non-system is now providing such planning to patients to “help” finance their care.  Something is terribly wrong here.

His doctor had prescribed the cancer drug Gleevec, but Steiner’s insurance refused to cover its $3,500 monthly cost. Steiner, a warehouse manager for a publisher of Bible-themed literature, and his wife, Brenda, a part-time nurse, made just $30,000 a year. No way could they afford the drug on their own.

“We still had six kids at home — how were we going to come up with that kind of money?” Steiner said. “We couldn’t re-mortgage the house, because it had already been re-mortgaged. I wouldn’t have been able to take the medication. We would have had to just trust in the Lord.”

It was a scary brush with “financial toxicity,” as researchers call the mix of economic stress, anxiety and depression cancer patients often endure. But then Steiner was assigned to Dan Sherman, an oncology social worker at Mercy Health Lacks Cancer Center who within days got a free supply of Gleevec from the manufacturer. He also made sure it was delivered promptly. The package arrived at Steiner’s home on Christmas Eve, his 46th birthday.

In the eight years since, Steiner has faced a series of medical and financial reversals, and each time Sherman has done as much as any doctor to keep Steiner going — scrambling to get the treatment he needed without sending his family into bankruptcy. “He keeps throwing me life rafts before I sink,” Steiner said.

Read the entire article.

Medicynical Note:  Health care in the U.S. is a special type of hell if you are not independently wealthy.  Something like 60% of bankruptcies in our country are related to medical expenses and it appears from the above article that the first goal of our non-system is to spend all the patient’s savings and then offer assistance.

Our insurance companies’ main goal is to assure profits to share holders, hospitals have a multilevel billing system which ironically bills most those without insurance coverage and least able to pay;  our drug companies think nothing of gouging patients to pad their bottom line, because they can (pretty sadistic); and our medical practitioners often are on their receiving end of payments from technology providers to get them to use the company’s product.  Care of patient is not the primary concern of many in our health care industry.

There are bright spots.  People working to help patient’s figure out the non-system; primary care types working very hard for relatively (compared to some medical specialties) low salaries; our nursing and medical support colleagues who work face to face with patients helping with their care and problems, medical and otherwise.  

The Affordable Care Act is a good first step but more needs to be done.  

Limits– Drug Pricing in the U.S.

Drug prices are a prime example of the monetization of medical care.  The price of drugs is currently based on the ability of the manufacturer to increase it (exclusivity and lack of competition) and the seriousness of the person’s illness (the more dreadful the illness the higher the price).  The cost of research of course is an issue, but when Pharma raises the price of generics hundreds percent you know that it’s all about profit and that the costs of drug development has nothing to do with it.

It is a fact that the fiduciary responsibility of the drug manufacturer is to the stock holder not to the patient.  So costs skyrocket and we in the U.S. pay more for everything medical than anyone else in the world.  Are we dumb or simply naive.  We seem to buy into drug company and politicians propaganda that we have the best of all worlds, when we don’t.

This in the JAMA gives some perspective

The rate of increase in drug prices has outpaced that of overall medical care every year since 2008. A recent survey found that retail prices of selected brand-name dermatological medications increased an average of 401% between 2009 and 2015 (363% in real terms, accounting for inflation), while prices of the generic medications increased an average of 279% between 2011 and 2014 (265% in real terms). These price increases for dermatological drugs are well above the national average for all drugs and payers—up 23% in real terms between 2009 and 2015. They do not reflect the possibilities that patients might switch to cheaper alternatives, or there may be slower growth in prices paid by insurers and public programs.

Retail prices have increased dramatically for other types of drugs, as well. The aggregate retail price of a basket of 477 widely used drugs doubled between 2006 and 2013, even though retail prices for generics decreased. Per life-year gained, new anticancer drugs prices have quadrupled in 2 decades and now exceed conventional levels of cost-effectiveness.

And

Constraining prices so more drugs are cost-effective—for example, below $100,000 per quality-adjusted life year—is one approach to managing drug price inflation. Although the political prospects for such a policy are poor, recent value-based contracts between manufacturers and insurers or pharmacy benefits management companies are similar in spirit. For example, Cigna’s payments to Novartis for the heart failure drug Entresto are linked to how effectively it reduces hospitalization.

Medicynical Note:  The article follows with a discussion of how much we as a society can pay for drugs.  Frakt seems to accept that $100,000/QALY is doable and posits that perhaps we can pay even more–though not much.  On the other hand one can reasonably argue that we’ve already exceeded our ability to pay and that for a QALY drugs for a year’s treatment should at a maximum cost no more than a our culture’s median or average income for a year –that is $50,000-60,000.  And that may be too expensive.  Read the article!

Health Care as A Market Play: (Daraprim, Shkerli) Nothing new here

People are outraged that a former hedge fund hack raised the price of a 62 year old drug that costs about a dollar to manufacture, from $13,50 to $750/pill.   He has now relented and will “decrease” the price–to an undisclosed cost.  Imagine that, arbitrarily pricing a drug to maximize profit?  Actually that is nothing new in the era of $100,000-$200,000/year for new drugs.

It’s difficult to conceive of a drug costing more than a luxury auto (a BMW or Mercedes for example)  or perhaps over a few years more than the cost of an average person’s home or even a multiple of the average yearly incomes of families.  But that’s what has happened in the U.S.  We have created a pricing monster that’s arbitrary and that’s  bankrupting individuals and the system.

Medicynical Note: This hedge fund refugee is not unique.  Drug company pricing is simply what they sense the market will bear.  Some of that is market economics but other aspects are the seriousness of the illness and the desperation of the patient. It’s your money or you life.

But at it’s heart we’re simple getting grifted by good ole capitalism.  Remember the goal of every capitalist no matter what they say about competition, is to eliminate it and have a monopoly.  That’s nirvana.   In pharmaceuticals this goal is facilitated by our patent law, aggressive often deceptive marketing practices and the need for safe drugs.  

Big Pharma has been pricing arbitrarily without regard for cost or value for years.  This clown simply said look here! the emperor has no clothes.  Gouge when you can. 

Our drug costs have predictably spiraled.  As to what would be a fair price for a drug costing $1 to manufacture and which has long established indications?  I’d say under $5.   But don’t bet on that!