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I write about America’s health care system, and I got caught up in it

nakedcapitalism.com

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Re: I write about America’s health care system, and I got caught up in it

#41

Post by AuthorizedCust »

kemiller2002 wrote: post #38
refurb wrote: post #31

Earlier quoted context omitted.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.

That’s exaggerated. Generics are well known to be effective, and exceptions are unusual. Here’s some commentary to that effect, talking about research to the contrary: https://www.health.harvard.edu/staying-healthy/do-generic-dr...

It’s reasonable to expect people to exhaust lower cost alternatives, that are reasonably expected to work, before stepping up costs.

Re: I write about America’s health care system, and I got caught up in it

#42

Post by civilized »

kemiller2002 wrote: post #38
refurb wrote: post #31

Earlier quoted context omitted.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.

Which doctors know? Insurers have doctors too, that's why they have these rules. What do the doctors treating the patient know that the insurers don't know or are refusing to acknowledge?

Re: I write about America’s health care system, and I got caught up in it

#43

Post by makomk »

kemiller2002 wrote: post #38
refurb wrote: post #31

Earlier quoted context omitted.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.

Thousands of dollars per patient times many different patients and drugs quickly adds up to a substantial proportion of all healthcare spending. Countries with universal healthcare have specific programs in place to move people over to generic drugs for exactly this reason, or at least the UK does - along with policies that intentionally give people less effective treatments if the better ones are a lot more expensive. It's one of the ways they stop costs from ballooning as much as they have in the USA.

Re: I write about America’s health care system, and I got caught up in it

#44

Post by civilized »

lotsofpulp wrote: post #40
civilized wrote: post #33

Earlier quoted context omitted.

If the problem is around different insurers paying for different brands, then yes, I think the solution is for the consumer to have the choice of MCO rather than it being tied to the employer. But I'm sure this would create other problems and snarl the system with even more complexity. That's ignoring the fundamental cosmic absurdity of this entire system, with its pretense to be some kind of competitive private mark…

The hogs at the trough have net profit margins of 5% or less, and pay out 85%+ of premiums they collect to healthcare providers. You can remove MCOs from the equation, and their function will still have to be done by whoever is paying. For example, the approving/denying is still done in the UK even though they have taxpayer funded healthcare. Or even within the Kaiser health system in the US. It does make life easier…

> More importantly, it gives employees an additional hurdle and fear of changing employers, because what if they have to go through what the person who wrote this article did? Maybe they should not shop around to see if they can sell their labor at a higher price, and just stick to their current employer. Another unnecessary chip for employers to have over employees in the US.

This is horrifying to contemplate... do employers just love that chip so much that they see it as worth all the terrible customer experience and inefficiency it causes? Do they lobby to keep it this way?

Re: I write about America’s health care system, and I got caught up in it

#45

Post by hadrien01 »

nceqs3 wrote: post #24
throw8932894 wrote: post #3

> The price of my prescription without insurance was $339 per vial of insulin In most countries insulin price is around $30. I remember it was cheap in US too. Seems like another problem created by US kleptocracy. Make something prohibitively expensive, and "solve" problem by providing handouts to cover costs.

You are comparing an insured price to a cash list price (most of which does not go to the pharma co and a price which effectively nobody pays). As an insured American, I would pay 0$ for insulin.

False. 5 doses of Novorapid insulin (first one I found on Google) is 22.07 EUR in France. After the public insurance scheme, that's 7.72 EUR (or 2.20 EUR in my region). And then you can get further reimbursement from the employer's (or your own) private insurance.

Edit: I just remembered that diabetes is recognised as a long term condition, so you would be 100% reimbursed by the public insurance scheme.

Re: I write about America’s health care system, and I got caught up in it

#46

Post by epmatsw »

tragictrash wrote: post #39
throwaway6734 wrote: post #36

Earlier quoted context omitted.

>those at the top are morally bankrupt. These seniors should vote for and advocate for a more expansive social safety net then.

What twisted fucked up naive world view does this come from. These people are poor, vulnerable and sick. You should be ashamed of yourself. Why don't I throw you in a cage, and then you can try voting for someone to advocate for your release. The point is the seniors need help now, not being told to go organize. The healthcare system is broken, and until you get sucked into it, you don't understand the extent of it.…

I think the point was that seniors as a demographic generally vote for politicians that don’t support those policies, against the wishes of the majority of the rest of the population.

Re: I write about America’s health care system, and I got caught up in it

#47

Post by lotsofpulp »

civilized wrote: post #44
lotsofpulp wrote: post #40

Earlier quoted context omitted.

The hogs at the trough have net profit margins of 5% or less, and pay out 85%+ of premiums they collect to healthcare providers. You can remove MCOs from the equation, and their function will still have to be done by whoever is paying. For example, the approving/denying is still done in the UK even though they have taxpayer funded healthcare. Or even within the Kaiser health system in the US. It does make life easier…

> More importantly, it gives employees an additional hurdle and fear of changing employers, because what if they have to go through what the person who wrote this article did? Maybe they should not shop around to see if they can sell their labor at a higher price, and just stick to their current employer. Another unnecessary chip for employers to have over employees in the US. This is horrifying to contemplate... do…

Someone must be lobbying for it. I would like to be in the room when the Senate panel discusses things like this.

Let us let businesses pay for MCOs with pre tax dollars. But not individuals, that would be undesirable….why?

Let us let businesses select retirement fund options for employees, and then let employees save $21k to $50k per year of pre tax money if they invest in their employer’s retirement savings options (401k).

Let us only let individuals save $6k pre tax in their own retirement account, without the meddling of employers. Let us go one step further and phase this benefit out if one employee works for an employer with 401k and the other does not.

As of 2020, let us let employees pay for student loans with pre tax money if they pay through their employer. But not students who pay themselves.

Let us pay for public transit with pre tax money, but only if via employer.

And so on and so forth. You see TONS of laws that explicitly give an upper hand to employees of well funded employers, effectively giving a competitive disadvantage to employees of poorer employers (small businesses, immigrants) and simultaneously incentivizing those who do work for well funded employers to not seek other options, such as starting their own small business.

Re: I write about America’s health care system, and I got caught up in it

#48

Post by koenigdavidmj »

refurb wrote: post #31
cmmeur01 wrote: post #18

Used to do these “pre-authorizations” for Humana and wanted to kill myself after a week. Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”. Made me realize this whole country is broken and those at the top are morally bankrupt.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

My insurance did this for my kid’s eczema. Except the $5 one was an immune suppressant. For my toddler. For eczema. During a pandemic.

The only sane response to that is “okay, I won’t give my kid either of those; we’ll just stick with OTC lotions”. Which is exactly what they intended.

Re: I write about America’s health care system, and I got caught up in it

#50

Post by civilized »

lotsofpulp wrote: post #47
civilized wrote: post #44

Earlier quoted context omitted.

> More importantly, it gives employees an additional hurdle and fear of changing employers, because what if they have to go through what the person who wrote this article did? Maybe they should not shop around to see if they can sell their labor at a higher price, and just stick to their current employer. Another unnecessary chip for employers to have over employees in the US. This is horrifying to contemplate... do…

Someone must be lobbying for it. I would like to be in the room when the Senate panel discusses things like this. Let us let businesses pay for MCOs with pre tax dollars. But not individuals, that would be undesirable….why? Let us let businesses select retirement fund options for employees, and then let employees save $21k to $50k per year of pre tax money if they invest in their employer’s retirement savings options…

Yeah, the retirement one is very telling, isn't it. Probably a strategic advantage for large companies that already have the bureaucratic infrastructure to administer complex benefits.

And if they want to grift their employees by giving them bad fund options because of some kickback the fund provider gives them, they can.

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