Part of the problem is healthcare provided through work that skews pricing for large companies over individuals/small/medium businesses and entrepreneurs.
If we can't get healthcare removed from employers and have both a private and public option based on Medicare for all. We AT LEAST need legislation to bring in CLEAR pricing for insurance cost and non-insurance rates, similar to the CFPB mortgage Loan Estimate and Closing Disclosure that show all pricing clearly in one sheet of paper both the estimate and the final mortgage.
What other product do we buy that the price is not known until after the product/service is rendered? At least some idea of an estimate is even hard to get as each part of the medical pricing matrix scam (insurance companies, medical services/suppliers, doctors, pharmaceuticals) try to keep pricing shrouded to stick it to people wherever they can.
The consumer healthcare experience is horrible in the US healthcare system and employers being the insurance companies main customers is a major part of this problem but pricing can be helped with clear regulations and needs to be now.
It’s a lot like college tuition - there is a sticker price - but very few student’s actually “pay” the sticker amount, or the same price for that matter
At the end of the day the core problem is that price transparency and price discrimination are at odds with each other...people don’t like being told they have to pay more for something because of “who they are”
But all of this price discrimination is bad -- it's hurting everybody. Medicaid and Medicare patients paying less causes more doctors to not accept them. Privately insured and uninsured patients paying more imposes costs on working people and small businesses who have to subsidize a government program, not through taxes in proportion to their revenue or wealth, but through higher insurance premiums in proportion to their number of employees regardless of how much the employees make.
Eliminating that sort of price discrimination would solve a significant portion of the problem by itself, by eliminating that cross-subsidy and requiring government benefits to be funded overly and by the people who can afford to pay rather than covertly through higher private insurance premiums on people who can't.
Leaving aside from the fact that very few countries have wholly-government owned health care - this formulation doesn't make sense.
Or is it the line about gouging you are referring to?
Can you explain a bit more clearly what your point is? I haven't woken up enough yet to decipher your comment.
> This may be the primary reason why health care in most civilized countries costs half of what it does here.
There is a common conception that simply adopting one of the many different systems used in these other countries would immediately solve the cost problems in US healthcare by way of single payer price negotiating, but the problem that addresses doesn't tell the whole story of high healthcare cost in the US.
It's not just US healthcare costs that are abnormally high but healthcare consumption - due in part somewhat to the defensive posture of medicine towards a tort heavy society, but also because healthcare consumers in the US simply demand more healthcare than consumers in other countries; (call it the Super Size Me effect?)
So it's not necessarily the case that any kind of single payer system is going to change that culture of consumption. The systems used in other countries are largely possible due to different levels and modes of consumption.
Mind you, I generally support some kind of single payer system for the US (preferably modeled after some combination of elements from Canada, France and Australia). But I'm bothered by these panacea arguments when it doesn't seem at all clear that such statements of causality can be convincingly made.
The thing is that single payer healthcare systems in Canada and Europe aren't necessarily owned by the government. In Canada, each province's healthcare is run as a government owned insurance company, with the requirement that everyone have health insurance. Some provinces bill this out to each insured person on a sliding scale of income, with a cut off for the low income.
It's not, because other countries with mixed public/private systems don't have notably higher costs than the full- or primarily-public ones.
Healthcare hasnt been so expensive forever, it was actually very cheap decades ago, when it was still private. The efficiency issues are not public vs private. Its mostly regulatory burdens.
You can manage the problem of pre-existing conditions in an insurance system with a subsidy, instead of a mandate that forces a 20 year old minimum wage person to work part time, because the employer cannot afford to pay healthcare for him.
There has never been a law in the US limiting the number of doctors available.
tying healthcare to the employer, etc.
There was never a law tying healthcare to the employer. Before the ACA, if you had a preexisting condition, that was the only way that you could get insurance - by being part of a covered group. The insurance company wouldn’t cover you.
So we need universal coverage like the rest of the civilized world....
My understanding is that the supply of doctors is limited by the amount of residency slots and that is limited somehow by whatever professional association licenses doctors.
There is at least one such limits to about 1/4 of 65.000. And even within that limit they have an irrational amount of extra requirements.
> There was never a law tying healthcare to the employer.
Sorry but in the US, health insurance is provided by the employer because it is a tax-exempt expenditure. Tax it and see wages diminish considerably once employers pass the cost to the employees.
> So we need universal coverage like the rest of the civilized world....
The uncivilized world also has universal coverage. That should be a red flag, shouldn't it?
Employers already pass the cost to employees through lower wages.
The uncivilized world also has universal coverage. That should be a red flag, shouldn't it?
Yes, that in this regard the US is worst than a third world country...
And you would be very wrong to believe healthcare in the us is worse than in third world socialized medicine countries. You will find horror stories galore as well as all other kinds of trade offs you wouldn’t accept.
Also, while most countries have healthcare that is payed for by the government having the government run healthcare is also fairly uncommon. I know Canada, the UK, and Singapore have public provision but most countries have public payment and private provision.
How could that possibly be a free market system/.
The government itself barred Medicare from negotiating drug prices. If it is incapable of overturning such a policy, why should it be entrusted with 10x more patients?
> So how would you have the government setting prices and reimbursement rates and not have a higher "regulatory burden"?
You could have the government give a health-stipend for insurance for all americans, so its government funded, kind of like school vouchers. Today medicare instituted fee-for-service, which means you have to document every procedure you do and you get reimbursed based on that, which I believe is the core reason why there is so much red-tape in Healthcare.
This would allow all patients to choose which insurance fits best, and unleash major competitive forces on price.
The political faction which opposed and supports the policy you point to does so for precisely the same reason it is opposed to the faction proposing single payer; people voting for the faction that supports single payer would also vote out the faction supporting that policy. So, you are literally conflating two opposing things as the same thing.
> You could have the government give a health-stipend for insurance for all americans, so its government funded, kind of like school vouchers
Yes, and if you also have the government provide a default fully-public-funded option just like with school vouchers, you will have almost exactly recreated what Medicare already does for it's covered population (Medicare Parts A & B are the public option, Medicare Advantage plans are the private options to which public “voucher” subsidies can be applied in place of the default public option.)
I disagree, but regardless of that appreciation the problem exists today when its smaller, if you had single-payer it will be a harder problem to fix.
> Yes, and if you also have the government provide a default fully-public-funded option just like with school vouchers, you will have almost exactly recreated what Medicare already does for it's covered population
It was an example to show how high government participation can lead to low regulatory burden, not an actual intended recipe for the US and its current or proposed system.
The phrase 'doubling down' comes to mind here.
To judge the correctness of your statement, just look at what has happened to other industries that the US Federal Government controls: costs rise, service times increase, quality suffers, accountability disappears, etc.
I asked a friend in the healthcare industry about this - they said that since insurance companies negotiate all the services at once - the insurance company is trying to lower the total cost for the whole insured pool, this often means that they will marginally overpay for high margin services in order to get big discounts for the really costly things. The hospital makes more gross margin, and the insurance company lowers it’s total spend. The offshoot is that individual people may bear the brunt of this grand bargain...
No idea if it’s true, but had a ring of truth to it...
1. ultrasound cost around $300 with insurance...$150 without
2. ER visit cost $4K with insurance....$900 without
3. specialist visit with insurance cost around $200...$150 without
And don't get me started on labs.
It's really a rip off to use insurance for anything other than:
1. general doctor visit (cheap co-pay, pretty expensive cash option)
2. really expensive shit (c-section w/o insurance runs $25-$30K -- cost me around $5K with insurance)
Anything in between seems to be cheaper when you pay individually.
As a disclaimer this is "gold-level" insurance coverage which costs around $1200-$1300/month for a family of 4.
If you're nowhere near hitting your deductible for the year, and don't anticipate hitting it, then looking for cash-only discounts make sense. But if you anticipate hitting your deductible anyway, sometimes it makes sense to pay the inflated price on that individual item, since you'll make up for it later when you hit your deductible and switch to only paying your coinsurance amount (or hitting your max OOP).
I suspect that the chicanery in the U.S. is more severe in the non-dental sectors of healthcare as there's more volume/value there (from a provider/stakeholder POV).
$30K without insurance is insane! I live in another developed country, where childbirth isn't covered by insurance (since it's elective, right?), but the whole C-section procedure + 12 days in a private room in hospital cost a bit over $5K. Almost $4K of that were then paid by the city government (nationwide program to help cover birth costs).
And while I support universal healthcare, this is an easy solution that falls well into capitalism (no 'socialism' here for the far right) as governments role is to create open and level playing fields for both consumer and business to promote a free market.
The fact no legislator has brought forward, let alone voted through, such a simple and effective improvement shows how deep the healthcare industry is in the corridors of power.
So your comment implies that medicare/medicaid prices would go up? Is that true? Could the 'listed rate' drop 40%? I always hear listed rates are grossly inflated for those that dont have insurance and land in emergency etc
When you see some of the inflated prices a >40% drop seems distinctly possible if a truly competitive market is created. Would that be fair?
I’m far from an expert as well, but my point is that a transparent everyone pays the same system is in direct conflict with the current system where certain patients pay multiples of the other patients for the exact same care/service etc.
Depending on where you went it could have been much more than 10%. Non-emergency imaging is definitely one of those things you ask about other locations and if they have cash pricing. When I needed an MRI if I was to use my insurance it was going to be ~$1000 because of high deductible plan. A different place took payment at the time and it was $350. According to the doctor who wanted me to get the MRI, hospitals are far and away the most expensive places to get one.
In vs out of network, deductibles, and co-insurance can also complicate the calculus
If you untied healthcare from employers, then you would unleash a massive competitive force, where if one insurance outperforms another one, patients will react as you say. But today, changing insurance companies would mean changing jobs.
And this is because healthcare is not an insurance! It should be instead thought of as a societal contribution (via a tax) for the benefit of universal healthcare.
Framing healthcare under the microscope of insurance causes the boxed-in solutions currently in existence.
The point of insurance is to manage risk, not to reward it.
Car insurance is mostly based on things you can control -- at fault car accidents, tickets, etc.
A more complicated pre-existing condition would be maybe for kids, young adults whose parents didnt give coverage for , etc. But you could use subsidies to manage those cases and it would be a blip in the budget. If someone deliberately avoided insurance and the catches an expensive disease, he should be toast, because thats the gamble he made and the result of it.
Please also keep in mind that in a state run system, if a treatment is very expensive the state will not give it and thats it. Thats one of the reasons why public healthcare is often cheaper, because it says no to many treatments, which is not something easy to accept for americans.
That’s not how things worked pre ACA. The insurance company could drop you after a certain point even if you had paid for coverage.
Also, before the ACA, if your cancer was in remission and then five years later, even if you had continuing coverage, and you tried to get insurance on your own, you couldn’t get it.
A more complicated pre-existing condition would be maybe for kids, young adults whose parents didnt give coverage for , etc.
That’s also not how things worked pre ACA. If you had insurance that you bought yourself and not through your employer and you had a kid who was born with a birth defect, the insurance company wouldn’t cover you.
That guys a quack and everything he's done has been debunked.
The definitive work on this was Kenneth Arrows work in the early 60's.
See Uncertainty and the Welfare Economics of Medical Care.
tl;dr: Markets don't work for healthcare. Full stop.
One would consider why it is the law for a mechanic to give you a written estimate for work to your vehicle, and be required to call you before exceeding by a notional amount- yet, a hospital can legally withhold all cost information from you and yet you’re responsible for the bill in full after the service.
What happens in the software world when you see twentyseven useless levels of abstraction? Exactly the same. You smell a rat.
In my ideal world:
* Healthcare research funding to come from the public sector and donations only.
* Healthcare products can only be sold once the production process is verifiably fully publicly documented. This means independent reproduction by multiple reputable non-profits.
* Market based generics manufacturers handle production. Competitors (for profit or non-profit) jump in if pricing gets out of hand.
* Healthcare education free to students.
* Only non-profit healthcare services allowed.
* Compensation for people providing healthcare services is linked to median income.
 This is not such a big difference as one would think, as more than half of the basic research in the field is actually publicly funded already.
And I suppose the public will indirectly vote on where research goes and where it does not? I don't trust any party in power to have a monopoly on healthcare research without a private sector counterbalance. But I'm open to reconsidering the current allocation.
EDIT: I found it. They use something called a "decadal survey"
Imagine a researcher invents cheap medication that obviates the need for some kind of eye surgery.
What would happen now? Surgeons don't like it, insurance companies don't like it. It might never catch on. The silly researcher certainly wouldn't get rewarded for his idiotic idea.
What would happen in an ideal scenario? Better health with less side effects for the patients. Cheaper for the community.
Same with sunlight to prevent the onset of myopia, etc. These are things we already know about and can have huge impact, but it's politically infeasible to solve these problems correctly.
Honestly, this isn't necessary, as long as you have single payer (or close to it). When the government is the one paying for 99% of healthcare, they have huge clout enforcing razor-thin margins and high efficiency on the provider side. Just look at how the massive supermarket chains are able to keep the margins of the upstream supply chain at a minimum.
The problem is that governments don't work that way. When a purchasing officer at a business negotiates a lower price he gets a large bonus. What does a Congressman get when he negotiates a lower price, compared to what he gets (from the people he's negotiating with) if he "negotiates" a higher price? What about the government bureaucrat who will be working in that industry soon? That is the problem.
Meanwhile who is more knowledgeable about produce if you have a question, the staff at Walmart or the farmers at the local farmer's market? It's easy to order cost cutting from the top of the tower, but if you don't know what's happening on the ground, you don't know what you're actually cutting.
What you need is for people -- the people who are actually consuming services and can choose to go somewhere else if the price is wrong -- to be able to choose based on published price information. The argument people sometimes make about this is that you don't get to choose which hospital an ambulance takes you to when you're unconscious, but the majority of healthcare spending isn't that, and that doesn't explain why we have no price transparency for non-emergency surgical procedures or diabetes or cancer treatment.
Well, they can... Just look at France. Amazing healthcare, a lot of it private, relatively cheap
> What does a Congressman get
Nothing, they don't negotiate
> What about the government bureaucrat
A performance bonus, a raise, a promotion? Just like any other organisation?
> What you need is for people to be able to choose based on published price information
OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple?
What they're saying is that a large amount of healthcare spending is driven by patients and providers, but paid for by insurance companies. Neither patients nor doctors have an immediate, short-term incentive to make sure they utilize insurance company resources judiciously. On the contrary, the both have an incentive to consume as many insurance company resources as possible (the patient wants to make sure they get every possible treatment, even if that means consuming 10x resources to prevent a 1/10th as likely outcome, and the provider wants to bill as much as possible to increase revenue).
I can tell you, as somebody whose family has catastrophic coverage only, that we think long and hard before we blow $200 so that a doctor can tell us to take some ibuprofen and drink plenty of fluids. And we also ask lots of questions about how much various recommended treatments will cost vs. what they will do for us.
In a place with a different political system, population, demographics, culture, economy, etc... and France has a price transparency law.
> Nothing, they don't negotiate
They pass laws dictating how others can negotiate (or not).
> A performance bonus, a raise, a promotion? Just like any other organisation?
But not like any other organization, because if you gave a government employee a million dollar bonus for doing their job there would be a riot. Meanwhile they can get million dollar private sector employment for not doing their job.
> OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple?
I'm telling you I can get a better deal than the Department of Defense.
Ideally there would be some sort of accountability for elected officials, where they would have to answer to their electorate, and where conflicts of interest would be against the law (and prosecuted), but who am I kidding?
Right, exactly. It's like the claim that Communism would work great once automation eliminates the need for all human labor. It's a nice theory, might even be true, but until we can satisfy the precondition what practical relevance does it have? Go work on the precondition and come back after you accomplish that. In the meantime we need something else.
Not sure if this is required - the UK manages to have a socialist health care system (the NHS) for the vast majority and a relatively small private healthcare system for those who want treatments not covered by the NHS, or a nicer room etc.
I'm not sure I'd be happy with completely banning access to private healthcare - although I'd prefer it if the NHS was resourced to a level where there really wasn't much need to to go private (which certainly used to be the case).
The clinics near my hotel only accepted same day bookings. I tried calling just after opening hours and the phone was engaged. I managed to get through 15 minutes after the clinic opened and the clinic was booked out for the day and I would have to call back the next day. I tried a number of clinics and they were all booked out. I was lucky that I wasn't that sick and got better. Otherwise, I was looking at an exorbitant fee to see a private doctor.
I was shocked, as I always assumed that the NHS was better than the system we have in Australia. I think that there are lots of perverse incentives involved in Medicine and Healthcare. Government intervention is required to balance out these incentives from profit takers and consumers (i.e. smokers, obesity, etc). I'm not sure that any model in the world right now gets the balance right.
The issue with not getting GP appointments quickly seems to have been a relatively recent thing - due to lack of resources and mismanagement rather than fundamental problems with the approach.
You know what a great system for allocating resources in an incredibly complex system is?
From what I've heard about the Charlie Gard  and Alfie Evans  cases, that isn't always allowed, and even being an Italian citizen or an offer from the Pope can't sway the decision .
> Alder Hey Children's NHS Foundation Trust sought a declaration that continued ventilatory support was "unkind and inhumane", and not in Evans' best interests
The treatments not covered were not even approved for use in the UK privately afaik - it was entirely unrelated to the NHS budgets.
All GP practices in the UK are privately run.
This should be 31415926535897932384626434.
What I found most bizarre is that Americans who are "temporarily" in the US (e.g. expats, visiting) can get health insurance with better terms and at about 1/10th the price of what residents are offered.
Someone is being had, I'd say.
It does include the acute onset of pre-existing conditions, $250 total yearly deductible, 100% percent in-network coverage. But it is not available to US residents, only for short term (up to two years) stays.
> Pre-existing conditions are not covered by Patriot America Plus Plan
It requires you to already have insurance somewhere else, and they expect you to go home for anything chronic (expensive). It sounds exactly the same as any travel insurance you can get in your home country (and is included in many fancy credit cards)
You said "expats" before, but ex-pat implies residency in the US. Tourists/business travelers are a whole other ballgame. They're just protecting against not getting hit by a car when they're at their week-long conference. They're all limited in scope of their costs by their visitor's visa duration (typically 90 days)
My colleague spent weeks on the phone arguing with the insurance company while debt collectors from the hospital hounded him after a simple ER visit. In the end someone at the insurance company paid his bill with their corporate credit card because they couldn't figure out a way to get it paid through the system. This despite the fact that the insurance company claimed to have a 'network'-type relationship with the hospital (which the hospital denied any knowledge of). They stopped offering coverage for the US altogether after that because it was too expensive.
My parents are still trying to get their travel insurance to reimburse them after an ER visit while on holiday.
Basically everyone is being had.
My guess is that expats and visitors from other countries are a healthy and lower risk group (because they’re also wealthier) than the general population.
The charge is more than some cheap OTC medicine you might get prescribed, e.g. hay fever tablets are pennies per box and the charge is almost £10. But pharmacists are required to tell you if you could just buy it yourself for less - they collect the charge so they have the opportunity to point this out whereas your doctor needn't know if you pay or not.
Logically the charge must also be bigger than the price for some of the cheapest prescription-only medicine and there's no way to avoid paying extra in the UK as far as I know in this case.
I have seen the system here and some of the effects that come out of it are interesting. Because if the cost of a drug falls below the "recipe fee" it bypasses the insurance and is directly charged there is a mysterious amount of drugs close or below the recipe fee.
I've had both similar, and opposite, experience in the U.S.
My wife has a prescription for an OTS drug. Getting the prescription filled with insurance costs $35. But buying it OTC costs $22-25, depending on the store.
I have a prescription for an OTC drug. Getting the prescription filled with insurance costs $3.55. But buying it OTC costs $10-$12.
It's like they always say in health care — ask questions, keep records.
We have too many politicians with too many fingers in too many pies telling too many lies about the "dream" that is American healthcare.
You say that the US is objectively worse, but I can bring you to 10 people who will argue convincingly that it's objectively better, and then turn you around to 10 people who will convince you of the opposite again. All with real numbers and facts that don't contradict each other.
Do you care more that your healthcare is 10% more effective at its peak, or that 30% of the population is uninsured, without access to good preventative care? From there you have to extrapolate because nobody can predict the cost of these societal schisms, or that of the cost to heal them.
There is no objectivity to be had here; just morality, hope and fear.
Insisting that "10 people will argue convincingly that four is prime" isn't a convincing argument that four is or even might be prime.
Run for office. Failing that, support candidates that support your views. Democracy exists as a function of effort.
Doing that in a climate of contracting economical growth and leaving the EU (where 40% of our nurses come from) makes this impossible without politically suicidal borrowing.
We can’t argue the money doesn’t exist. It exists. You just need a majority of people to decide that efficient healthcare is worth paying for.
Case in point, current opposition leadership would do all this in a heartbeat but between center-leaning members and a very Conservative press, they'll always be portrayed as Nazi-sympathising Communists.
Brexit hasn't helped this either.
(efficient in terms of medical benefit delivered per unit of spending)
If nothing else more complex transactions have higher costs due to the complexity. So, the benifit would need to be rather large and easy to measure to offset this. Until that data shows up it’s rather pointless to argue about.
PS: Also, the effort/tine investment to collect prescriptions is already a modest fee.
This crackdown is at least partially due to the perennial social media posts doing the rounds telling people how to get "free" Calpol for their kids.
You provided no evidence that you have performed chemical and microbial testing on each batch you manufactured before making a batch disposition decision.
It's sad that it requires a 3rd party app to help people not get screwed over by the current US medical system.
Another suggestion, at least for California: always ask for paper prescriptions! Fuck digital prescriptions. With a paper prescription you can go to any pharmacy you want and have it filled (i.e. shop around and find the cheapest)! But with a digital prescription you can't have it transferred to another pharmacy without calling up the doctor, which is completely fucked up. It's especially frustrating when your regular pharmacy is out of your prescription and your refill day happens to land on the weekend. Now you have to wait 2 days for your refill. One situation I've had happen occasionally is that I'll miss my regular pharmacy's closing hours because I was busy, so I'll just drive to my nearest 24-hour pharmacy to have my prescription filled; you can't do that with digital prescriptions!
I've literally saved hundreds of dollars, just by shopping around a bit. And heck, it's not as if driving an extra half a mile is such a big deal, especially when it can end up saving you a few hundred dollars. I'll also note that sometimes even within the same franchise prices can vary greatly, so it's often worth going a little bit further.
I think pharmacists are allowed to point out services like GoodRx, but it might be frowned upon, I'm not sure. At least in my case, I found out about their services thanks to a pharmacist: I was refilling a prescription, and the pharmacist walked out of their sealed off area, pulled me to the side and told me to look up this "GoodRx" thing.
For example, the pharmacist at a CVS decided not to refill my Vyvanse (amphetamine) paper script because I was paying in cash (+ using paper script). Treated me like a criminal. Digital scripts avoid this unpleasant scenario.
The pharmacy system itself needs reform. It’s idiotic that your doctor can write you a prescription that gets denied by someone who puts pills into a bottle. An anti-abuse system that treats everyone like criminals needs a better solution.
A pharmacist is required to fill any prescription, paper or digital, except if the pharmacist has a religious objection (birth control, morning after pill, etc...). This came out in a recent court case.
It's the state that decides if prescriptions for controlled substances (like your Vyvanse) get rejected through a centralized database that works off of your driver's license/state ID scan* to prevent abuse.
There was much chaos a few months ago when the state imposed tighter restrictions on the number of opioid pain pills that could be dispensed at one time. You might have a prescription from your doctor for a 90-day supply, but you could only pick up five at a time. (Not an exact number, as I'm not on opioids.) For months, the lines at the pharmacy were backed up for hours as thousands of people ran into the new rules and took them out on the pharmacists.
* Amusingly, one of America's largest supermarket chains, Albertson's, isn't using the computerized driver's license scan. It keeps records in paper binders where the pharmacist writes down your DL# and you sign next to it. They don't even record what it is that you filled, or how much. Good job, Albertson's!
I always use smaller, non chain pharmacists too. Msny will compound, they know me and mine, and that relationship is worth a lot.
The cheapest is not too important most of the time. Things being right, and an active pharmacist helping with cost, special programs, and accuracy matters more.
Obviously if certain behaviors correlate strongly with people who abuse, then it’s their job to use their discretion to demand more proof, or deny.
Even in Alaska, not generally a very technically advanced state, I never met a doctors that didn't have the ability to send eScripts. I never visited a doc in a remote village however, might be a different story out there.
When you use insurance and pay the co-pay, that counts against your out of pocket maximum on the plan. Prescriptions bought with GoodRx don't.
The insurance isn't doing a great job when they charge a co-pay that is larger than the price GoodRx has negotiated, but it isn't evidence of a scam.
Pharmacists can intervene a lot more than your doctor friend lets on. A good pharmacist will tell the patient there is a generic version of the drug when the doctor wrote a script for a brand name.
A good pharmacist will also tell you not to use your copay when its more than the out of pocket cost.
A bad pharmacist will do neither of those, but they are 2 simple questions anyone can ask when they go to get their prescriptions filled.
Is there a generic? Is it cheaper than my copay?
I learned the hard way after coming home with an Rx that was more expensive than I remembered. Wife found out they gave my brand name "well thats what the doctor wrote!" and chewed her out.
That said, if you are OK with privacy concerns or don't have the time to call yourself, GoodRx is nice to find the lowest cost as they definitely aren't standard and some places even have certain drugs for free.
Source: wife & mother pharmacists :)
Source: awesome family pharmacist.
I was with a friend picking up his meds and I bleeped my rewards card to collect the points, since he didn't have one. Now I get offers in the mail to treat his condition.
So with that in mind, I went and looked at Walgreen's notice of privacy practices  and they say that they will get a written disclosure before using PHI (and that is restated in their Balance Reward ToS.
Bottom line is, if they are selling information then hopefully you're friend has signed a form authorizing use of the PHI otherwise Walgreens is violating HIPAA.
"GoodRx does not sell information regarding your drug prescriptions and medical conditions that are linked to your name, contact information and other personal data you provide us."
Both sell prescriptions, both use USPS or whomever to ship. Besides I bet it would be easier to track illicit use if it was regulated. Not to mention cheaper, faster and digital. Less prejudice.
Too bad the general consensus is that these jobs are necessary when they aren't.
So try not to be in the middle - the ones with enough assets to take, but not enough to defend against having them taken (e.g. not being part of a group that can negotiate out of it).
God forbid we actually come out and say we, as a country, want to support each other. A large portion of our fellow citizens would rather play this game of hot potato, but don’t have the balls to turn poor people away from the emergency room and tell them to die.
That by definition is insurance....
Also, chronic and old age health issues don’t even seem like insurable risks, like getting 20 year term life insurance for a 90 year old. You would basically just be paying for someone else to manage your premium money and take a cut before giving it back to you since the insured risk is inevitable and has to be priced accordingly.
Health costs between what you pay as an individual and what you pay as part of a group is just like anything else. You couldn’t buy the same parts for a computer at the same price as Dell. Dell can get bulk discounts you can’t.
A health care provider is willing to charge less for care per person for a group of people through an insurance carrier than you individually.
If you have ever signed up for term life insurance, you usually get a fixed premium up to a certain age, and then premiums skyrocket as you get older. You theoretically can price life insurance for a 90 year old based on actuarial data. The cost will be prohibitively expensive.
Edit: I understand the analogy of a bigger buyer means better prices, but it's a little different too because the merchant of the computer parts can't bill the losses to the government who then pays via increased taxes. The pricing differences are astronomical too between what prices are given to people who want to pay cash versus via insurance or Medicare or Medicaid, it makes no sense.
I see the US healthcare market as the middle and lower middle class spending a larger portion of their wealth subsidizing the poor class while the upper middle and upper class spend a smaller portion of their wealth subsidizing the poor class because they can negotiate out of it, and they probably get better care too.
And this is all exacerbated because employers get to deduct health insurance premiums from taxes, while independent contractors buying insurance independently don't.
But still, it's all needlessly complicated and unreasonable to expect people to be able to optimize in our current system.
I would say that any company, no matter how small has no excuse not to offer health insurance to thier employees. The cost in administration is minimal and can be outsourced. I have a relative who runs a law firm with just herself and one or two assistants and even she offers unsubsiduzed health insurance. I’m not saying they should subsidize the cost. Just by offering it through the company, it’s cheaper for the employee because the company can offer it pretax.
As an employee, I would never be an employee of a company that didn’t offer insurance if I needed it. If they won’t offer (unsubsidized) insurance, and I want to work for the company, I would insist on working as an independent contractor at a rate that would make up for not getting paid time off, self employment taxes, and future unemployment benefits.
If we can't actually commit to taking care of our own, just who are we as a nation?
Having thought about it for all of thirty seconds, I can't see any downsides. Can anyone convince me otherwise?
Like B2B, often the sales people feel out and negotiate a customer to see how high they can sell a product/service for. And that can actually be nice for small companies. They are probably getting subsidized by larger companies to some extent. I know the company I work for has negotiated very aggressively on some of our infrastructure pieces (metrics, config-management, db etc), where there was no way we could afford the sticker price.
EDIT: OTOH making opaque prices illegal, wouldn't bar negotiation.
Why Your Pharmacist Can’t Tell You That $20 Prescription Could Cost Only $8: https://www.nytimes.com/2018/02/24/us/politics/pharmacy-bene...
After finding that they were doing it in a way that was advantageous to them and disadvantageous to me, I asked a friend who works in medical ethics and billing whether doctors have a duty to serve the client's best financial interest. I was surprised the answer was no because lawyers (my former career) certainly are required to do so.
One wonders what value health system administrators are providing when such a high percentage of negotiated drug plans result in higher prices than cash prices.
Good question. This was also discussed last week on HN.
Since 1970, the number of doctors is up 150%, in line with pop. growth, while healthcare administrators up by 3200%.
On the insurance side, it's a nightmare. The doctor probably charges your insurance $200 for the office visit. Your insurance has a negotiated rate with the doctor's office for $150. You have a coinsurance of 50% if you've met your deductible, so assuming you haven't hit your max out of pocket for the year you pay $75. If you haven't met your deductible (some arbitrary amount you have to pay on top of paying for insurance) you pay $150. If you have hit this max out of pocket number, you'd pay 0. The $50 goes into the void. My employers insurance is something like a $1000 deductible / $5000 max out of pocket / 75% coinsurance.
When you get the prescription filled, well, I have no idea how this insane process works. Last time I needed antibiotics the receipt had a "before insurance" amount of $50 with an actual cost to me of $4. I have no idea where the $46 went or what my insurance actually paid.
I see US folks talk about getting half their prescription filled, or seemingly using the same prescription multiple times. We can submit repeat prescriptions (such as I do for BP etc). but the actual prescription 'document' is a one time deal.
It's very, very odd to me the way it's set up over there. Especially so that some people fight so hard against change.
Mail order pharmacies often fill 90 days at a time, possibly with multiple refills. 90 days dispensed at once is uncommon at retail pharmacies, but is possible in at least some cases. (Not sure if it is laws or contracts that normally prevent this).
It is also possible that a pharmacy may not have enough to fill the script all at once, so they dispense only part, and you come back for the rest later. (I've never experienced this so I'm unclear on the details.)
But how could it be possible that you pay more?
That used to be the way it worked. You'd go to the doctor and he'd charge you, say, $35 for a basic exam, and you'd pay in cash.
Since health insurance became widespread, now doctors charge crazy amounts. My doctor charges something like $210 for a basic exam, or $185 for the "negotiated rate" to the insurance company.
I saw on television once that the reason we're in this mess has to do with WWII. With so many working-age people fighting overseas, finding workers was hard for companies, so they started raising wages. The government was afraid of war + inflation, so it put limits on pay raises. So, instead, big companies started offering health care benefits. And thus, an industry was born.
At least that's what I remember from the TV. I can't cite the show or channel, but I do watch a lot of PBS and virtually zero YouTube.
The price a doctor charges per hour doesn’t go directly in his pocket. That hourly cost has to cover support staff, the facilities, liability insurance, his accountant, etc.
The US health care system doesn't make sense.
Health insurance began as a perk to attract more qualified people and became the expected norm at some point and typically covered the entire family. When that no longer made sense for employers, benefits began eroding and it became more common for benefits to only cover the employee. Employees had to pay extra to cover family. Then the ACA decided the way we fix this mess is we require everyone to purchase insurance.
It's crazy enough that I would seriously consider leaving the country if I thought there was any way for me to pull that off. But I don't see that as at all feasible currently.
Which, by the way, is absurd to me as an American. I think at this point most Americans agree there are major flaws in our system, it’s just a disagreement about how to fix it.
It isn't designed to make sense, it's designed to obfuscate.
I’m on that drug, and have a good health plan that charges the lesser of copay or actual cost for drugs.
That drug was going generic two years ago, and it took the generic manufactures awhile to ramp up. The generic drug cost more than the name brand version for a few months and was constrained — the pharmacies my my area had difficulty doing a 90 day fill.
It ultimately didn’t drop to super cheap status until they were approved to sell it in a normal pill bottle — previously it was sold in blister pack form.
Sometime after that insurance was introduced. Now, as an adult I pay AED 100 - AED 200 (USD 27 - USD 54) [basically the same amount] as 20% co-insurance when getting glasses.
Note 1: USD and AED are pegged.
Note 2: There has been inflation, but not that much. Tea increased from AED 1 to AED 1.5. Taxi increased from AED 10 to AED 20. Clothes increased 50% perhaps.
Ive ordered my last 3 pairs there, and will never pay $200 for glasses again
I'm sure there's some shady big pharma economics behind why these exist in the first place, but at the very least I'm getting a very expensive drug for free.
The drug company sets a super high price, gives you a rebate to cover your share, and then charges your insurance company an arm and a leg. By doing this, they can net more money than if they had a lower price and got money from both you and your insurance company.
This practice also happens in auto repairs, where shops will "waive your deductible" and then charge your insurance company an inflated price. See discussion toward the end of this article: https://www.4autoinsurancequote.com/blog/when-is-deductible-...
The co-pay is designed to make you share in the pain of the sky-high costs the drug manufacturer charges the insurance company. This has two benefits—1) you are only going to get it if you really need it 2) maybe you’ll lobby your congressperson to rein in monopolist pricing.
By giving you a coupon there’s no pain sharing and those benefits are lost. Sure you’ll pay higher premiums, either directly or in reduced wage gains, but that’s defuse and indirect, so far less likely to drive behavior.
Fwiw, the insurance would have covered older alternatives, but the potential side effects on those are worse than the cure.
I see drug commercials all the time that say something like "Visit our web site, or call this number to find out how you can get ___ for little or no money." Perhaps this is the same thing.