Insurance and the price of drugs

Many ways…where healthcare is concerned.

If band aids were covered by insurance, they’d be about $10 each.

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Insurance isn’t just a middleman though when it comes to pharmaceuticals… they’re negotiating secret rebates which just continuously raise the list prices higher and higher with no bearing to what the drugs actually cost or how much is actually (and secretly) being paid for them (which has become a trade secret of the PBMs because the rebates they receive are confidential)… they are a driving force in the upward price escalation not merely an added layer of expense

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Having lived in several other countries, I have seen first hand that other systems are cheaper (sometimes much cheaper), but also less able to deliver best-quality care. We have best-quality care in most ways, but we pay more. So not everything about it is bad, far from it. Let’s not forget that people come from all over the world to get the best care they can get – when they can pay.

I know Western Europe well. Every system in Western Europe is cheaper, but none of them gives the quality of care we have, particularly for “hard” cases.

For instance, I don’t think there is a country in Europe where the Dex is authorized for insurance (I could be wrong). For sure it is not authorized in most European countries for insurance.

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That is true.

A post was merged into an existing topic: Foreign drug import is now legal: new SCOTUS decision

well, but the outcome measures suggest that at least some of our “best care” is unnecessary. As far as I know Dex is paid for by insurance certainly in Norway. But that doesn’t mean every country pays for them.

i do think there are often worse outcomes when you come to the more serious or rare conditions (certainly UK’s NHS has been dinged for forcing breast cancer patients to take outdated, cheaper drugs when newer ones would be more efficacious). And I know that in the realm of premature babies, they certainly work less hard to save the smallest ones, for instance.

But my guess is that by improving standard care for the population, they’re reducing the incidence many serious conditions. And that when you have fewer unhealthy people in the population, that also allows you a little bit more leeway to pay for the sicker patients.

This is written by one of my old teachers. Not sure I agree with all the conclusions, but I think the charts he included are quite interesting. My takeaway is that we have more health inequality than other countries, but that people who are in some groups are getting quite good care. Good health care or bad though, no question it’s way more expensive than in other countries.

I’ve lived in quite a few countries myself, but didn’t experience the healthcare myself directly (as far as the billing/payments go) as I was in the Army; however, my daughter lives in Germany and I’m certain the Dexcom is available there (as it is in 44 other countries - which you can see here.). Although it wasn’t covered by insurance in previous years, it is now (as of one year ago.)

Concerning how cheap HC is in other countries…lots’ of other countries (including Germany) have FREE* healthcare for all…(* - the trade-off is a much higher tax rate…my daughter and x-wife pay nearly 50% in taxes from each of their paychecks.)

As far as Western Europe goes, I can really only speak to Germany…I LOVED their gesundheitsbereich (healthcare system) and had many experiences with various Krankenhäuser (hospitals - including having my daughter in one of them)), and I had nothing but the best, highest care I could have ever asked for. I’m sure you’re correct with regards to the ‘hard’ cases; however, because all of the global “smart” people flock to America because they know this is where they can make the most money.

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When I lived in Kalifornia I paid about 50% of my gross income in taxes, and healthcare wasn’t free. If it included healthcare, I’m sure it would be over 75% in this country.

It doesn’t have to be that way…we just have to have legislators that want to work FOR the public…for their constituents…instead of, to the highest bidder. We need complete reform in our government…only then (imho) can we come to common sense legislation for us, as a nation. Not the top 1%.

well, I live in California and am shocked you paid about 50% of your income in taxes; are you counting things like sales tax in this equation?

We pay about 35 to 40% of our income in taxes (State and local) but we take literally $0 in deductions, as we are not homeowners and have no other factors at play (we paid less when I was freelance and deducted home-office expenses).

Still, live in San Francisco and as such can get access to a universal health care program as long as I’m employed and live in the city, along with 12 weeks fully paid maternity leave. These programs actually have a negligible impact on my total tax contribution; by far the biggest cost is federal taxes, which go to a bunch of services that are much less visible to me, many of which I disagree with.

So I think paying 75% of income in taxes is a bit of hyperbole, personally. But yes, providing health care access for more people will likely result in higher taxes. Personally I’m in favor of increasing those health-care-related expenditures and then decreasing tax expenditures for other things.

Didn’t even think of sales tax. I’m talking about federal income and FICA tax, self employment tax (I was not incorporated), state income tax (not insignificant), property tax.

You would also be shocked at the business taxes, fees and assessments that I paid from my gross practice income. Next time you go to your dentist all him why he charges $1500 for a crown.

BTW, I don’t care about which agency it goes to, it’s still money out of my pocket.

huh, I think this may be the difference between being in private practice versus employed by someone else.

As a total aside, my dentist billed $600 for my first-ever crown a few months ago I paid $300 out of pocket. I had no idea if that was expensive or reasonable. So that’s cheap?

That is less than half of the Delta Dental acceptable fee for a crown in the Bay Area. I was in the East Bay (Contra Costa Co.) as of five and a half years ago, and my accepted Delta fee was $1250.

Maybe there was some other fee that was separate. Maybe that was just the crown and the filing down and the temp crown were billed separately…

Interestingly here, we have a pretty good discussion going about why things cost more here in the healthcare field. If we decide to socialize our healthcare, as with every government decision there will be winners and losers.

Losers would likely include, all specialty physicians whose income will go down precipitously, insurance companies who would have to go out of business, pharma companies who would have to sell to one insurer, highly paid hospital executives who would likely have their salaries capped.

Winners would likely be the government employees who would need to multiply many times over to administer the system.

Interesting things to noodle.

It is very unclear what effect this would have on hospitals.

I use Delta Dental of California. My last crown was billed for $650 (I had to pay $130 out of pocket.)

@ClaudnDaye I assume you don’t live in California. Delta allows maximum fees according to the provider’s zip code. It varies widely across the country.

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Yep, I live in VA (arguably the most beautiful state in the country.) :wink:

Unintended consequences include losers being patients, as a result of lower quality providers coming on board due to lower income possibilities, and existing good providers exiting the system for the same reason.

Believe it or not, bright young people go into medicine in large part because they think that it can provide them with an above average income for the rest of their lives.

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