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If you read a lot of news about health care – or probably, if you interact regularly with our health care system – you will probably feel that the way we deliver health care in this country has no meaning.
The insurance is tied to your job and if you lose your job, you lose all the money you paid for your deductible (your what?) While you were holding this job. Hospitals can charge what they want, for example $ 25 for a single aspirin. Sometimes you risk being driven to the emergency while you are unconscious and waking up to discover that the doctor who treated you was out of the network. You have to pay tens of thousands of dollars that your insurance will not cover. (Also, off the network is one thing.) And pharmaceutical companies can also bill what they want for prescriptions, and sometimes old drugs cost more for no reason.
The thing that binds all this apparent madness is profit. In order to take advantage of these different points of the system, such as insurance, medical care and medication, the actors involved must do things that seem illogical, otherwise nothing concerns the care of patients.
Take this NPR story yesterday about hospital prices in Colorado, which expanded Medicaid in 2014. The theory was that hospital prices would drop as they would treat fewer uninsured patients, for which they could never recover the high cost of care, and so do not have to overload others to make up for that.
According to a state report, hospitals have "begun to transfer even more costs to commercial health plans," according to NPR. Indeed, the report revealed that the average patient benefit doubled and the profit per patient with commercial insurance rose from $ 6,800 to $ 11,000. The association of state hospitals blamed insurers for not passing on these benefits to consumers – sorry, patients.
Many complex factors come into play in hospital pricing: Medicaid and Medicare pay much less than commercial insurers, and the chief financial officer of one of the hospital's not-for-profit hospital chains. State asserted that the accounting of their profits did not take into account the expense of expansion of other doctors' offices. But here's a simple fact, from a senior advisor at the Colorado Nonprofit Health Institute:
The state report shows that hospitals in highly consolidated markets should not reduce their prices as their results improve, Toy says. "They can charge anything the market will support."
They can charge anything that the market will support. This is more true in the health sector than in most other industries. Not only is it difficult to shop for care when you have a headache or have a stroke, but it is also difficult, if not impossible, to look for insurers. If you have employer sponsored insurance, you probably only have one choice of insurer. If you purchase insurance from ACA scholarships, 42% of registrants have only one or two choices of insurer. Most patients have no idea how much their hospital will charge, and they will not know until they know how much their insurance will cover, which is different for each patient. In addition, hospital rates are confusing and complicated. And even if your insurance ends up paying for it, we all pay higher hospitalization costs in the form of increased insurance premiums and deductibles. They do not eat that cost, they pass it on.
But surely you think things should make more sense for people with government insurance? Not so. This morning, NPR announced that the cost of specialty drugs is skyrocketing for Medicare patients, who "may owe thousands of dollars in drug costs each year for a single drug." Medicare requires that patients pay 25% of the actual cost. their brand name drugs – many of which can cost thousands of dollars per dose – until they reach $ 5,100 in expenses. After that, they only have to pay 5% of the cost.
But 5% of the thousands of dollars can still be deeply unaffordable for many, especially since Medicare patients already spend a lot on health care: about 40% of them spend more than 20% of their health care income and premiums, according to a 2018 report published in 2018 The Commonwealth Fund. NPR has told the story of Tod Gervich, who "himself injects Copaxone, a prescription drug that can reduce the frequency of relapses in people with certain forms of multiple sclerosis." " three times per week:
His dose of 40 milligrams of Copaxone costs about $ 75,000 a year, according to the National Multiple Sclerosis Society. In January, Gervich paid $ 1,800 for the drug and $ 900 in February. Rebates that drug manufacturers are required to provide to Part D registrants have also been included in the reimbursable expenses. (More information about this later.) In March, he had reached the threshold of $ 5,100 which had pushed him to catastrophic coverage. For the rest of the year, he will need $ 295 a month for this drug, until the cycle starts again in January.
In March, Gervich had already spent $ 5,100 on drugs and will have to spend $ 2,655 more by the end of the year, for a total of $ 7,775. And everything will start again in January. Bad luck if you lose your job or your roof collapses in December.
The reason is that manufacturers of Copaxone and Teva can continue to take advantage of patients like Gervich, who needs this drug. (Copaxone accounted for "half of Teva's profit" in 2015.) God forbid, who made a gross profit of $ 8.3 billion in 2018, allowed Gervich to pay less than seven thousand dollars to avoid a relapse of his multiple sclerosis. God forbid that the government really protects people from the fact that their destructive and destructive appetite for health care is inflicting disease on them.
Whatever strategic goals such as the extension of Medicaid or the existence of Medicare, these goals will never be achieved if you let the profit logic distort them. The pursuit of profit should be completely removed from health care; only then will it be important to keep as many people alive, healthy and able to enjoy life as much as possible.
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