Tag Archives: health care

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/

The CDC….Another Trump Disgrace

The CDC has been neutered, shamed, and blamed amid the novel coronavirus pandemic and global crisis. From internal missteps that bungled the country’s rollout of diagnostic testing to blatant political interference and strong-arming on critical public health guidance, the CDC has gone from the world’s premier public health agency to a silenced, overridden, distrusted afterthought in the US response—an agency stripped of its ability to collect even basic health data from hospitals during a raging pandemic.”

Medicynical note: A beloved institution trashed by Trump and his misfits. Once the authoritative epidemiology in the world now the tool of an incompetent Presidency. It will take years to fix……if a competent government follows Trump.

The Bad Joke of American Healthcare

American healthcare in a nutshell.

“Mr. Aita, who lost his job at a record store at the start of the pandemic and is uninsured, received a document at the end of his visit estimating he would owe $1,157. If the hospital had tested him for coronavirus, the federal fund could have covered the visit entirely.”

“Last week, he received a medical bill for the visit that was only $350. He initially thought this was good news — that the hospital had dropped his charge. But when he looked into the issue, he learned this was an additional charge from the doctor who saw him.”

“I understood that if it was related to Covid, it would be taken care of,” Mr. Aita said. “It’s a pandemic, I’m unemployed, and now I’m dealing with the stress of this situation.”

Medicynical note: the design of the American non-healthcare system is elegant. From its lack of disclosure of prices to the multi tier pricing (whatever the market will bear), to the oh so clever linking of coverage to employment and finally to the cynical price gouging patients with the most serious illnesses.

To clarify, by linking health insurance to work insurers have a sure fire mechanism of cleansing their beneficiaries. Those that cost the insurer the most are automatically eased out of insurer’s liability by them having to stop working when they become ill.

In reality what our system does best is collect revenue. Healthcare? Patient outcomes? Not really the primary concerns.

Obamacare (the affordable Care Act) tried to correct some of these distortions but the REPUBLICANS AND TRUMP have diligently worked to undermine its’ benefits and maintain our grotesque triad of ineffectiveness — 1. millions uninsured, 2. the most expensive health care in the world–by far, and 3. mediocre quality care.

That’s America in the 21st century, a fading, mediocre world power with a government that really really really doesn’t want to be responsible……….for anything. VOTE.

The $153,000 Snake Bite and America’s Decline

The paradox of American capitalism is that we say it works best when there is a “free market” with competition.  But as we have seen time and again the goal of business, even in healthcare, is obtain monopoly status (i.e. eliminate competition) for your “product” and then gouge your customers–a great business plan, no?

This was brought home by the Washington Post article reporting a snake bite for which medical costs were $153,000.

The bulk of his hospital bill—$83,000 of it— is due to pharmacy charges. Specifically, charges for the antivenin used to treat the bite. KGTV reports that Fassler depleted the antivenin supplies at two local hospitals during his five-day visit. Nobody expects antivenin to be cheap. But $83,000?

There’s currently only one commercially-available antivenin for treating venomous snakebites in the U.S. — CroFab, manufactured by U.K.-based BTG plc. And with a stable market of 7,000 to 8,000 snakebite victims per year and no competitors, business is pretty good.

and

BTG has fought aggressively to keep competitors off the market. A competing product, Anavip, just received FDA approval this year and likely won’t be on the market until late 2018. This lack of competition is one reason why snakebite treatments rack up such huge hospital bills — $55,000. $89,000. $143,000. In May of this year, a snakebit Missouri man died after refusing to seek medical care, saying he couldn’t afford the bill.

Excessive costs  are nothing new to anyone with a serious illness.     New cancer drugs for example start at $100,000/year for the drug alone, whether they work or not.  As a matter of fact most don’t work at all for the majority of patients treated with them.

This article was almost immediately followed in my browser by the brief statistical review of the 12 economic signs that the U.S. is on the decline published in Fortune magazine  based on the academic article Is the U.S. Still the best Country in the World? Think Again by Hershey Friedman and Sarah Hertz.  Interestingly the thesis of the article is not that the U.S. has too many regulations but rather that unfettered capitalism really really does not work.

“Capitalism has been amazingly successful,” write Friedman and co-author Sarah Hertz of Empire State College. But it has grown so unfettered, predatory, so exclusionary, it’s become, in effect, crony capitalism. Now places like Qatar and Romania, “countries you wouldn’t expect to be, are doing better than us,” said Friedman.

Read the article for the 12 signs but consider that whether it’s incomes, poverty levels, internet speeds, education, health, or prison population the U.S. lags other countries in the world.  Hardly the position for a world leader.

Medicynical Note:  I would posit that the snakebite anecdote is the concrete example of the second article’s thesis.  Our costs lead the world (yes that is one area we are world leader) and that in turn affects access, quality and yes the economic well being of citizens.  The U.S. continues to lead the world in bankruptcy from health care costs–a category of bankruptcy unknown in other countries.

Even more damning is that patients almost never know the cost of a  health care service AND providers (hospitals and practitioners) have little certainty  as to what they will actually be paid for the service rendered.  And yes adding to the insanity,  people billed directly, those without insurance and least able to pay, are billed more, much more, for the same services.  That’s true predatory capitalism!