What can you say about the high-speed train wreck that is American healthcare that hasn’t already been said? Perhaps nothing, but there are plenty of stories out there to talk about; a number of truly distressing examples that should be pointed out repeatedly as reminders to us all that this system is deeply diseased.
Late last year in Marina, CA my sister and brother-in-law responded to a terrible commotion on their patio and found a raccoon attacking their two small dogs. When they stepped in to break it up the raccoon was undeterred and bit them. A trip to the emergency room followed and then they underwent a series of rabies shots, which was the most painful development of all, and not for the reason you might think – they were presented with a bill for $10,000. They have medical coverage, of course, a solid school district policy through my sister’s teaching job, but it didn’t cover the full cost of the rabies series for two people – an eye-popping $90,000. This is hardly an elective procedure, as you probably know. Rabies is 100 percent fatal.
An article on this very treatment appeared recently in Vox, pointing out that the high cost is due to a drug called immunoglobulin. US emergency rooms charge up-to $10,000 for a single dose. In the UK they charge $1,600. “Rabies treatment is more expensive in the United States, as are many medical treatments, because we don’t have price controls,” according to Charles Rupprecht, a biomedical consultant who previously ran the rabies control program at the Centers for Disease Control and Prevention, as quoted in the Vox piece.
My sister told me another story recently – about a man she knows who needed surgery for prostate cancer, but he was unemployed and his COBRA plan wouldn’t cover it. A local hospital wouldn’t perform the surgery without an $5,000 payment up front, money he didn’t have. So he was forced to establish a GoFundMe page to raise the cash required for an operation to save his life.
It’s a time of staggering irony in modern medicine – never has it been more scientifically advanced, more technologically remarkable; and never has it been so abjectly ridiculous. While much of the rest of the first world cares for its citizens through some form of universal approach (more later), the United States of America, arguably still the greatest country in the world, defers to the whims of insurance companies, pharmaceutical companies, CEOs and shareholders, and we all pay the price.
My mother is 83 years old and, unfortunately, in declining health. The American medical industry has responded with prescriptions – you know, better living through chemistry and all that. It turns out there is quite a lot of chemistry. She takes 23 pills every day. We–her children–have attempted to engage her doctors in some analysis of what is actually effective and what may be potentially harming her through interactions with other medications. But we haven’t had much success.
According to a web site called Statista, The United States alone holds over 45 percent of the global pharmaceutical market. In 2016 this share was valued at about $446 billion, with six out of the top 10 companies from the US. $446 billion buys a lot of lobbyists on Capitol Hill and, as we have all seen, a slew of expensive TV advertising for drugs that may or not be helpful but are likely profitable. An example is the anti-depressant Abilify, which can lead to coma or death.
Abilify may not be for you.
The legendary Steve Martin spoofed the absurdity of drug company disclaimers 20 years ago in an essay he wrote for the New Yorker called “Side Effects.” Here’s an excerpt:
Do not consume alcohol while taking this pill; likewise, avoid red meat, shellfish, and vegetables. O.K. foods: flounder. Under no circumstances eat yak. Men can expect painful urination while sitting, especially if the penis is caught between the toilet seat and the bowl. Projectile vomiting is common in thirty per cent of users-sorry, fifty per cent. If you undergo disorienting nausea accompanied by migraine and raspy breathing, double the dosage. Leg cramps are to be expected; one knee-buckler per day is normal. Bowel movements may become frequent-in fact, every ten minutes. If bowel movements become greater than twelve per hour, consult your doctor, or any doctor, or just anyone who will speak to you.
Insurance companies are seen as the other major villain in this train wreck. The stories of denied coverage and counterintuitive explanations are legendary, and have been for decades. We all seem to have first-hand experience with it or know someone who has. The state of California recently launched a probe of Aetna after after learning that a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care. While that statement isn’t necessarily surprising, the fact that someone would be put in a position to have to admit it is unusual, and it’s quite welcome.
A story developed several weeks ago about a 51-year old self-employed New England carpenter who won a $1 million lottery prize and was looking forward to squirreling some money away for retirement, buying a new truck, and relaxing a little. Turns out he he didn’t have medical insurance–couldn’t afford it–so he used some of the money for a long-overdue trip to a doctor, where he learned he had stage-four cancer. He died less than a month after cashing the ticket.
Yep, health insurance is messed up. I take three medications daily and like just about everyone else refill my prescriptions monthly. My co-pay is $1.62, not each but in total. I could certainly afford a much higher co-pay and would be more than willing if it meant that people like that carpenter could afford health insurance and therefore see a doctor regularly, and my sister and brother-in-law didn’t have to deal with a bill of 10-grand for life-saving treatment, and my chronically-allergic wife, who has been treated several times to prevent attacks of anaphylactic shock, doesn’t have to face the prospect of paying several hundred dollars for shots of epinephrine she carries with her in devices commonly called Epipens, because insurance coverage has slackened as prices have dramatically increased.
In 2007, according to Business Insider, a pharmaceutical company called Mylan acquired the rights to produce Epipens. The story points out that at the time pharmacies were being charged less than $100 for a two-pen set. Then annual price hikes set in – peaking every year in August, when parents of children with severe allergies typically stock up on Epipens for use in schools. In 2016, the price reached $608.61 – an increase of more than 500 percent over a decade. And that eventually landed Mylan CEO Heather Bresch in front of a House oversight committee, facing uncomfortable questions. Before long, though, the problem had taken care of itself, as lower-priced competitors surfaced, including “Adrenaclick,” a $10 Epipen alternative. Mylan has seen its market share plummet. As far as my wife is concerned, we still must navigate the doctor-pharmacist thicket to try to secure one of those alternatives, be it Adrenaclick or something else.
The slow-burn journey through the bureaucracy we will surely face will help us prepare for the next phase of our lives – membership in the Medicare generation. It’s government health insurance when you’re 65, unless you’re still working, and–of course–it’s not complete coverage. You’re gonna need another policy on top of that and probably still pay out of pocket. Here’s the AARP, attempting to explain: “Depending on which (Medicare) plan you choose, you may have to share in the cost of your care by paying premiums, deductibles, copayments and coinsurance. The amount of some of these payments can change from year to year.
“Most people who qualify for Medicare don’t pay a monthly premium for Part A, but they do pay premiums for Part B and Part D or a Medicare Advantage plan.”
Ok, parts A, B and D; WTF? Well, Medicare is helpfully separated into sections, including a part C. Again, the AARP explains:
- Part A (hospital insurance) helps pay for the costs of inpatient stays in hospitals and short-term skilled nursing facilities, home health services and hospice care.
- Part B (medical insurance) helps pay for doctors’ services (including those in the hospital), outpatient care, preventive care, and some medical equipment and supplies.
- Part C (Medicare Advantage) is an alternative coverage option to original Medicare that allows you to receive all of your Medicare benefits through one plan. Medicare Advantage plans (typically HMOs or PPOs) must cover all of Part A and Part B services, and most plans include Part D prescription drug coverage in their benefit packages. Some plans provide extra services that original Medicare doesn’t cover.
- Part D helps cover the cost of outpatient prescription drugs.
The AARP advises that if Medicare patients have questions, they can contact Medicare, or the Social Security Administration–which administers a piece of the program–or something called State Insurance Assistance Programs (SHIPs). Does all this seem confusing? Yes, I would venture to say it does, even more than the convoluted system that holds those of us under 65 captive. As we get older and seek more simplified lives, American healthcare vexes us by funneling us into a system that is anything but simple.
Into this abyss plunged guess who? Yep, the infantile Donald J. Trump. Following his improbable election his first order of business was to attempt to un-do the Affordable Care Act, or Obamacare, for the sole reason that it was an achievement of President Obama’s. After several tries he finally managed to convince Congress to put some provisions in place, to predictable effect. A recent story in the Los Angeles Times stated, “Those fiscal geniuses in the White House and Republican-controlled Congress have managed to do the impossible: Their sabotage of the Affordable Care Act will lead to 6.4 million fewer Americans with health insurance, while the federal bill for coverage rises by some $33 billion per year.”
Most of the other developed nations of the world have some type of universal health care – places like the UK (and much of the rest of Europe), Canada, Australia and Japan. Imagine how this madness looks to them. Well, we actually have some idea, thanks to the Internet. I pulled this example from a friend’s Facebook page:
“Whilst living in the States, my 3yr old daughter was jumping on the bed (despite many warnings not to) Naturally, she fell off and knocked herself out. She was unconscious for a few seconds (which felt like years) and after a frantic 911 call, two ambulances, a firetruck(!) and a police car showed up. They strapped her to a back board and then….something weird happened. The ambulance guy turns to me and says “do you want us to take her to hospital in the ambulance?” “Err…yeah” I replied, thinking, is he cracked? What else would you be doing with her? Off we went with me beside her & my husband following. All checked out well.
Two weeks later a bill drops on the mat for $835 – for the ambulance. I call up to explain that there’s been a mistake, we have insurance, etc,. “No” says the lady on the line, “that’s not covered by your insurance” (we had the gold-standard- armour-plated one).
Apparently, an ambulance ride is viewed as a separate cost that many insurers don’t cover. It defies belief, it really does. We were so glad to move back to the UK – warts and all, it’s a much fairer society. Altho’ the Tories would rather it wasn’t. This is the reality.”
Meanwhile, in the Canadian province of Quebec, more than 700 medical professionals, mostly doctors, are protesting planned pay raises. They’re asking their employers to hold them back for the good of the entire health system. The doctors feel they already make enough money. The average salary for a physician in Canada is $260,000.
If all this isn’t enough, consider the American opioid crisis. According to the Atlantic, in 2012 there were 793 million doses of opioids prescribed in the state of Ohio, enough to supply every man, woman, and child, with 68 pills each. Roughly 20 percent of the state’s population was prescribed an opioid in 2016. Ohio leads the nation in overdose deaths. Reasonable questions are being asked: Are drug companies pushing opioids on people by shipping huge quantities to areas with population sizes that make no sense for the quantity of drugs? Why haven’t crack downs on these companies worked? Have there been been crack downs? Some public officials are trying. Ohio has joined a handful of other states suing pharmaceutical companies for spending millions on marketing campaigns that allegedly trivialize the risks of opioids while overstating the benefits of using them for chronic pain. The companies allegedly lobbied doctors to influence their opinions about the safety of the drugs. Additionally, some of the latest research indicates that opioids are not more effective long-term painkillers than other medications like over-the-counter acetaminophen and and prescription lidocaine. The cause is believed to be a built-up tolerance to opioids, a development that helps feed addiction and keeps the gravy train rolling.
American physicians apparently get a piece, too. A joint study by CNN and Harvard found that in 2014 and 2015, opioid manufacturers paid hundreds of doctors across the country six-figure sums for speaking, consulting and other services. Thousands of other doctors were paid over $25,000 during that time. Physicians who prescribed particularly large amounts of the drugs were the most likely to get paid. Can you say bribery?
It is, of course, no surprise that when Trump recently called for executions as a mitigating measure in the opioid crisis, he wasn’t talking about CEOs of pharamceutical companies.
America is broken. Its healthcare system is a major symptom. So is its president.