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.
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!