Make it make sense.
The price was bullshit to begin with. The cream probably sells over the counter for about $2.50 in most other countries, so OP still ended up paying 10x the price.
Its a tax scheme.
The pharmacy claims this medication is worth $275, insurance covers $40, and then they get as much as they can out of the patient while claiming the rest as a loss they can write off on their taxes.
US healthcare is stupid.
You should really be replacing
stupidwith “evil”That’s fucking evil and the cunts should be held accountable for their evil
But yous won’t cos you’re pussies
I’d say US healthcare is toxic, and behaves despicably toward those in its care. It’s also inefficient and often counterproductive.
All of this is a result of stupidity and evil, coming both from outside the industry, as well as perpetually generated by the already-ill structure of the industry.
It warps the minds of those who join it, as customers, providers, and regulators. We’re all like software devs loyal to the terrible architecture of a bad codebase due to having to adapt to it to get anything done.
Fucked up systems fuck people up.
Nope. It’s consequential. They need to raise their shareholder value in any way that’s legal, even if it’s not morally right. If they won’t do that, they’d get into trouble. For corporations tax loopholes are there to be exploited.
Making those loopholes illegal is what will fix this. Then you can call it good craftsmanship by politicians. Right now you can barley call it shoddy.
Health is an easy thing to jerk people around with because most of the people you’re stepping on are literally too weak to fight back.
It looks like the pharmacies do not get the tax write offs, if any. It’s the drug manufacturers who get to double dip by charging insurers for whatever they’re willing to cover, and then write off the rest causing tax payers to foot the bill.
Regardless, I agree with the article that there needs to be legislation that both bans these type of “shell game” programs, and capping the price of medications. And for what it’s worth, I don’t care if that means companies don’t make as much money. They’ll still make money, and the drugs do not actually cost that much to make.
It’s also a scheme for the pharmacies to get as much as they can from the insurance companies.
It’s not the pharmacies that set the prices. At least, not really. The pharmacy pays near the listed “cash-price” for the drug from the wholesaler, who buys from the manufacturer, so the pharmacy can’t really afford to charge much less than they do for many drugs.
And the price the patient sees after insurance is decided based on the insurance or pharmacy benefit manager who deals with prescription benefits for the insurance.
Pharmacies are also contractually prevented from charging less to a cash-paying patient than what they charge to the insurance companies, so you start getting weirdness with coupon cards to work around that.
The benefits managers are in on it with both the insurance and pharmacies. When you choose insurance in the US, there’s only one pharmacy brand that you get good benefits at. The drug prices at the others are either insane or not covered at all.
You misspelled tax ‘scam’…
That’s not how tax write off losses work.
That just sounds like fraud with extra steps.
Yeah, it makes sense if you think of it like Skyrim Horse Armour except with life saving drugs. They’ll take as much money from you as they think they can get away with.
Yup. This price is at least partially distorted by the fact that she can’t just go buy the cream without getting a prescription first. That means tight control over distribution, meaning huge barriers to entry and being forced to play ball with this insurance system when someone does enter.
There’s no way for the market to create that simple channel from this medicine to those who need it at the natural market price which is quite low.
All these elements that aren’t naturally required, but are required by law to be part of the deal, cause the price to get weird.
Sort of like hospital bills now. My wife went to the E.R. 2 months ago. They billed the insurance $4K. The insurance said nope and paid $220. We paid $40.
Recently had to buy Paxlovid. Pharmacy: “it is expensive and your insurance doesn’t cover it. Will be $1500.” Me: “I don’t know.” Pharmacy: “Wait. If you go to the Pfizer website you can get a coupon.” Me: “ok” (Looks up website and gets coupon on my phone. Paxcess Patient Support Program.) Pharmacy: “let me check now. Oh, free!”
Please make it all make sense.
Your lucky your pharmacy tech recommended the manufacturer coupon. My wife was the only one at her pharmacy that did that
Are the other people she works with actually evil or what? I can’t imagine not begging everyone who came in with a Paxlovid prescription to do that.
Likely one of those things where if you use it too much you lose it.
Meanwhile over in Europe - went to the doctor in spring as a cough didn’t go away for ages. As suspected nothing he could do much - irritated throat, and just at the time when cold season was giving way for allergy season. So he prescribed some nose spray - and asked if he should also add some antihistamine to the prescription to save me a few eur (didn’t check, but it probably is single digits. That stuff is cheap)
Shit when I have coughs that go too long I just keep coughing.
As a hospice worker, please don’t let stuff like that go unaddressed if at all possible.
Oh trust me the doctors don’t care. Went to the doctor twice already and got sent off after marking me down for general anxiety and possible sleep apnea.
Yeah I have terrible allergies and went to a new doctor, he couldn’t do much but I mentioned I use an over the counter nasal spray for $40. He’s like oh, let me write you a prescription and now I get a prescription one for free in Canada. Too bad my allergy pills aren’t covered though but those are still an affordable price at least.
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The only thing crazier to me than American healthcare is how many of my fellow Canadians keep pushing for us to have this bullshit, too.
It’s not just Canada - there are people in countries with far better Healthcare Systems that the US, including with National Health Services, who want a US style one.
However this isn’t “man on the street” kind of people, these are the kind who think that if Healthcare costs went from 7% of GDP to 14%, they themselves would be able to capture a significant proportion of those extra 7% - so “investors”, financiers and the kind of politicians bought with money from ultra-rich Americans (like the money that Steve Bannon came to Europe with a couple of years ago very overtly to strengthen the far right).
My own country now has an ultra-neoliberal part that popped-up from nowhere some year ago after Steve Gannon brought that money to Europe, with the most glitzy marketing and the most expensive political pamphlets of all parties, and who, in a country with an actual National Health System, were the only party that wanted it fully privatised, though they stopped being open about it when they found out people were overwhelmingly against it. This party’s ideology has zero local ideas or basis and is wholesale imported from the America’s hardest neolibs (think Financiers and Tech Bros) and yet it got itself up to 7% of the vote in about 5 years.
What’s their argument?
That US system is better cause the privileged don’t have to wait…
Most countries have a private option in some capacity.
But they want the poor to help pay for their privilege…
Even if a semi-private healthcare system means the rich get better care, the money generated will improve the free system vs what we have now. So overall everyone gets better care although some people get BETTER better care
- this is the argument *
This is exactly NOT what will happen.
I’m assuming that was your intention OP, but just in case:
What will happen is private sector clinics/practices/ect will be able to pay more than public, because they can charge whatever they want, so all the talented nurses/doctors ect will vacate the public sector for private, leaving public understaffed and underfunded even more than it is now. Then some shit government will point at the anemic public system they let suffer and say “it doesn’t make sense to keep this thing alive” and take it out back and shoot it. Then we turn into the states.
The rich get better care (which they can already get with a quick plane ticket if they can’t wait) everyone else gets $300 cream.
It’s f-ing ridiculous that anyone believes for profit healthcare would (note I believe they COULD, they just are designed not to) provide better care than a unified public service that wasn’t being slowly chipped away to make room for profiteering.
Exactly, it could work in theory, but that theory relies on our government executing a proper plan, which they repeatedly seem incapable of doing. Anyone who believes it could work at this point is hooked up on hopium (in my opinion)
It doesn’t even work in theory. The core concept of a two tiered system is unstable. One way or another, one of those two systems will collapse the other.
I don’t see how it could work in theory. Let’s assume you have a public and a private system and somehow the private system magically performs better than the public system. Then people cut support and funding for the public system and all you have is a private system. But now everyone is stuck with it, so at best you have to have a large body of regulators watching over private companies that are trying to flout the rules as much as possible because that’s their profit margin. And this must all unavoidably drive up the price, because of the profit margin and the extra people involved.
And that’s all assuming that you can properly regulate the system, which you clearly can’t, because the more money it has then the more power it has, and healthcare is a massive industry.
Yeah! I’m sure if we give insurance CEOs enough money, the excess will “trickle down” to the rest of us! There are 0 examples of this backfiring spectacularly.
Our Healthcare system isn’t properly funded and managed for our growing population. Covid burst the bulkheads and is used as an excuse to push for private government funded clinics as “more access to healthcare is better”. Why don’t we save some money and just open more public clinics is never on our politicians agenda.
This is the grifters spreading misinformation so that they can privatize healthcare and make money off of it.
And people fall for it.
I have a medicine that is $1650 with insurance, copay is $60. Or, rung without insurance and the discount card, it’s $0.
Medicine pricing is utterly a scam.
Yeah dude I have dry eyes. A 3-month supply of my eye drops is $2700 out of pocket, but there’s this magical card that makes it zero. WTF.
It’s actually a pretty clever scheme by drug companies to foist the cost of medicine development AND supplying uninsured people onto insurance companies (and from there, the cost is passed on to people with insurance). I just don’t understand how it’s legal, or why the insurance companies - who are supposed to have such great collective bargaining power - accept this status quo.
I have noticed that it only seems to happen with very expensive, very recently developed drugs which are not yet part of the insurance companies recommended therapies, and they typically require a prior authorization (special approval based on the doctor stating there is a medical necessity for this, and only this, drug).
It’s actually a pretty clever scheme by drug companies to foist the cost of medicine development AND supplying uninsured people onto insurance companies (and from there, the cost is passed on to people with insurance).
Hey now. You forgot that research for 99% of novel drugs discovered this century was funded in at least equal portions by public grants (paid for via taxes). So, the drug companies are really triple-dipping there.
My infusions are 10k. It gets cut by half for insurance. The drug company has like 20k in credits set aside per patient. They pay $10 of my $15 copay with that.
It’s ridiculous.
If you just need to hydrate your eyes, chances are your drops are just salted water
They’re repurposed Borg nanobots in saline solution.
TBH that would absolutely be worth $2700 to me.
Exactly this. The only annoying part is that it then doesn’t count toward your deductable and out of pocket maximum. It’s crazy how nominally $1k+ medicines become like $30 when you pay without insurance.
American health insurance is gambling
All insurance is. So are warranties.
:::The house always wins.:::
The involvement of actuaries is a dead giveaway.
you did not save any money for the insurance because that discount is negotiated. they don’t actually pay the $40. They contract with the drug supplier to raise their “full” price and then discount it for the insurance customers so they look like the insurance is providing value.
This. Insurance is incentivised to make everything as expensive as possible.
So it’s more like a tax for not having insurance then.
I would call it more a racket than a tax but thats just semantics.
https://pluralistic.net/2024/06/13/a-punch-in-the-guts/
TLDR deregulating medicine has been a disaster. Monopolistic hospitals, ridiculous drug IP laws, and medical price middlemen with bad incentives make the US medical system the most expensive in the imperial core countries with the worst outcomes.
My insurer bought my pharmacy, and my FSA provider bought my clinic. My wife’s wellbeing is one acquisition or merger away from being fully at the whim of a single corporation in which every single component continues to fail to talk to another, and is fully disincentivized to do so.
It’s not a “healthcare system”. It’s a “health insurance system”. And like all insurance systems, it’s designed to make money for the insurance companies. It functions quite well in that respect.
Many countries in the world actually have health care systems, but the US does not.
It’s insane to me that healthcare looks like this in the US, I mean I live in an objectively weaker economy and my healthcare is vastly better in terms of cost, availability and has no hard ties to employment.
That is crazy messed up. My gut feel is that it’s again down to the corporate shareholder problem, where infinite growth is demanded. It’s defies belief that this hasn’t been fixed, and really makes me think that overall we may be losing the war of greed vs humanity.
My gut feel is that it’s again down to the corporate shareholder problem, where infinite growth is demanded. It’s defies belief that this hasn’t been fixed, and really makes me think that overall we’re losing the war of greed vs humanity overall.
It’s also maintained as a tool to punish labor for stepping out of line. Look at recent labor disputes in the States. The first thing that is done by the company is to shut off healthcare access.
You’re absolutely right. Tie health insurance to a job and you get people to never leave.
I had a guy argue with me once that US is better than other countries because we have choice in health insurance and I said most people have healthcare tied to their employer who chooses what options they have and this dude argued we ultimately have the choice because we choose where to work.
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America is not a country that cares for the well-being of its citizens; it is a collection of businesses
I don’t even bother with health care because of shit like this. I’m not gonna participate in a fucking guessing game of how much shit should cost. I go to the eye doctor because I have bad vision but that’s it. Even then half the time my insurance refuses to cover my contacts until I called them to argue about it. It’s so infuriating. I’m fortunate to be healthy otherwise. I don’t know how people that need more help deal with it.
A brief history verifies your gut feeling.
I work in health insurance administration. I can confirm health insurance companies are bullshit.
GoodRx or something like it was used. Welcome to the man in the middle scam that makes people think they’re getting a good deal when in reality, they pay for insurance but insurance makes it so costly to use their insurance that people have to pay for it out of pocket or with an HSA but can’t apply the cost to their annual deductible. This is a win win for insurance companies and patients get screwed. I hate the US healthcare system so much from spending time interacting with it from the perspective of work and personally.
The fact that the US is the only major industrialized nation without some from of a universal healthcare system is supremely fucked up…
I legit think it’s way too late to implement universal healthcare because the entire food industry would have to change also.
Interesting take. I’ve never heard anyone connect the two. How do you mean?
A lot of the food in the US has chemicals that are banned in other countries that have universal healthcare. The food companies spend millions on research and development to make the food literally addicting. Also our portion sizes are insanely huge. When the other countries have to pay for the healthcare of their citizens, they’re going to make damn sure the food is healthier.
Excellent point. I like it.
And hate it because it’s true. Bastards.Honestly, everyone always pretends like America is the best, but were so painfully behind with so many things…
Who pretends america is the best? It leads in some metrics. Other countries lead on others. Quality of life is high for most but not all, comparitavely. However, there is more inequality and poorer healthcare. Even healthcare for the wealthy is expensive for little benefit compared to poorer countries.
I really don’t feel like the quality of life is high in the US. How is that measured? Affordable healthcare? Well paid jobs? Affordable healthy produce? Access to public transport? Good infrastructure? Little wealth disparity? Access to education? Can someone tell me which of these the US leads in?
Other Americans mainly…
It leads in some metrics.
Oh, the irony.
Who does, Hollywood movies? Life isn’t a movie.
The Republicans exist y’know…
I once heard a european say we eat like we have free healthcare. No we don’t. We eat like we have a government with more accountability to monied interests than to our health, a food industry that profits from us being compelled to overeat cheaply produced foods, and a healthcare system that profits from chronic illness and sudden misfortune. Oh yeah, this onion’s got layers, and it’s rotting from the inside-out.
In fact, I think a genuine effort behind universal healthcare would involve the government suddenly caring a lot more about industry in general growing profits by running things as cheap and dirty as they have been and, in a way, passing their costs onto the general population.
Do those of you in the US understand that this is literally only a thing in the US?
Most of us do but unfortunately only about half of us are under the impression that other systems are better and more sustainable. Entrenched financial interests run our government and a large portion of those entrenched interests made their fortunes from this medical system
Two-thirds but one third has oversized voting power.
Those who don’t mostly seem to assume that every other country is still doing bloodletting and that America is the only place with MRI machines. Those that understand that’s not the case will probably say something about wait times.
Yes. But it’s a little difficult to get healthcare from a different country.
Well, maybe Baltic states. Not sure.
Yes. Unfortunately, we’re stuck with it. No voting people in or out of the system have changed it. No, we’re not content with it, and we’re envious that other places don’t have to deal with this. This isn’t an endorsement of voter apathy, it’s just that any politician using big pharma reform as a part of their campaign are lying or unsuccessful in their efforts.
I definitely share your frustration… That said, there is some progress - see e.g. The price caps on insulin put in place this year, or the ACA reaching a bit further back – and I think it’s worth recognizing (and recognizing how we got it). Still a very long way to go and it’s an uphill battle unfortunately.
True. Thank you for that.
Eczema medication costs a few cents to produce, you can get it for a few bucks in almost every country, but the patents in the US and the weakened regulatory system due to corporate pharmaceutical lobbying means that the patent holders can charge whatever they want and until healthcare reform occurs or unless a specific law is passed, like with insulin, US shoppers will keep paying literally any price the patent holders and their subsidiaries pull from the top of their heads and write down on your bill.
Because half the country votes for a party that explicitly says this is a good way to run things, and the other half votes for a party that says it isn’t great, but we shouldn’t really do anything meaningful about it.
Until there is mass “you are all assholes and we demand a more representative electoral system” demonstrations, nothing will change.
Readers may note that this applies to basically every problem in the US right now
This is a bipartisan issue, thanks to corporations.
Corruption. The word you’re looking for is corruption.
Exactly correct!
Neither party wants to fix it. Corporations be damned.
Maybe!
The US healthcare system isn’t broken. It’s functioning exactly as it’s intended to function: as a way to extract the maximum amount of money from the US public.
