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.
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.
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.
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.
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
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.
GoodRX is my favorite shitty bandaid for this feature of a capitalist health care plan.
We got a shitty version of Republican healthcare reform, and Republicans and moderates refuse to admit we need anything more.
Republicans want to tear it down
And "moderates" say asking for more is somehow worse than being a Republican.
Shits not getting better till will finally get neoliberal.politicians out of the Dem party and back where they came from: the Republican party.
I don't know why people act like they don't understand opening the "left party" up to "fiscally conservative moderates" just concentrates all the crazy in the Republican party and depresses turnout from the right.
If you're trying to stop facism, we're taking the wrong path.
If you're trying to make sure the wealthy always win tho, yeah, this makes sense. But the fascists are going to keep winning half the time.
When they could be winning 0% of the time if we just gave Dem voters candidates they want. Because any "moderate" voters that go R, are statistically insignificant.
They're just loud and insist they're always right. Theyre Karen's.
And we need to go back to just ignoring them.
She probably used GoodRx, which has been known to sell patient data.
That's the goal. The insurance company wants your premiums while keeping the out of pocket so high you find another way to pay, so they don't have to cough up a dime.
High drug prices are the result of monopoly capital. There are actually very few pharmaceutical companies. They have dominant control over the industry and careers for relevant STEM majors and applying university research. They charge exorbitant prices through market domination and the US government gladly support this, as it is largely just a proxy for business interests. The temporary monopoly of IP is protected at all costs (it was even used to weaponize COVID vaccine access!).
However, this is not something that will be solved by simply asking politicians to regulate the market. Monopolization is a core outcome of capitalism, it increases the overall volume of profit that a company can make and therefore destroy the competition. And capture of the political system the default, it's an expression of the dominant economic forces. Both parties are capitalist and do the bidding of their business factions, often the same factions at the same time. Expecting a capitalist politician to act against the interests of their donors, their party, and the complicit media apparatus that keeps them in their position is absurd.
Instead, you will only see some PR attempts at the margins, like specifically capping the price of insulin. Access to insulin without impoverishing yourself is of course a dramatically good thing, but it is also a drop in the bucket compared to the overall grift that will remain firmly in place.
A question to ask yourself is: if I cannot reasonably expect capitalist politicians to address this and it's a core feature of the economic system, what should I do instead?
Can’t.
I’ve had literally insane run-ins with the US healthcare system, and have a bad enough health issue that I’ve been absolutely ruined by it: physically, mentally, financially, and socially. I do mean utterly – that was not hyperbole.
I have nothing else to add right now, because I have medically-induced PTSD and can’t even think about anything medical without having a panic attack now.
Just wanted to chime in with how bad it can get, and I know my situation isn’t as bad as it can be. It ruined everything for me and destroyed my family, but I never had to care for a dying child. There are no forbidden depths.
South Park, very relevant and funny to a scary point...
Always ask your pharmacist is what the out-of-pocket price is. Sometimes it's cheaper than your insurance copay.
I 100% get my prescriptions without insurance and just use the local pharmacy discount rate they offer. My insurance is employer provided aimed at people who make a lot more money than the employer actually pays. Such is US healthcare
It's called "extortion."
The reason all this bullshit exists is because the insurance companies CEOs seem to be heavily invested in PBMs. Companies aren't actually paying their full copay in many places - they have PBMs that basically get a coupon back from the pharma companies effectively meaning PBM's and Pharma corps are teaming up to rob you while the insurance company looks the other way.
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pharmacy companies shouldn't be able to charge insurance different rates nor should coupons be allowed. Pharmaceuticals should have 1 listed price all payers pay similar to french laws.
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copays for pharmaceuticals need to be capped at like 50% of pill manufacturing cost not the final sale price. Insurance companies need to be incentivized to bring prices down by paying more for marked up items.
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Fuck insurance companies. They need to die.
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I take a med that's $40/month after insurance which isn't that bad for such a specific medication, but the discount card from the manufacturer cuts it down to $5/month.
S.C.A.M.
Frame Canada
Wendell Potter spent decades scaring Americans. About Canada. He worked for the health insurance industry, and he knew that if Americans understood Canadian-style health care, they might.... like it. So he helped deploy an industry playbook for protecting the health insurance agency.
There's a good chance that they were not actually eligible for that discount card. I recall using one once while I didn't have insurance and I believe they were specifically for people who had no insurance. But you know... The pharmacist probably doesn't care.
It's designed to not make sense.
I had a similar experience when paying out of pocket when a former employer offered really shitty healthcare. Turned an outrageous price into something minuscule just by them entering in some info on my behalf.
If you have private health insurance (not medicaid/Medicare), and the drug is a brand name or a generic with one manufacturer, then you likely qualify for a rebate card from the manufacturer. This is often in addition to any patient support programs from the manufacturer that involve you sharing your personal financial situation with them.
The pharmacy nor providers usually have time, and certainly not the incentive, to share this information with their patients. If they were concerned with patient care they would, but that's part of the problem with privatized Healthcare.
Wait until you see how much the monthly cost is for a family these days if you're going through the exchange.
The other fun game is tech doesn't offer it anymore. I'm in the job hunt and 7 of 10 jobs make you go out of pocket, the next two give you and obscene monthly responsibility so they can say they offer it, and the 10th job has 5000 applicants.
It's not sustainable.
Man I wish that was my experience. Every time I've tried to use discount cards it's a fight.
The blame falls on the insurance companies. It's not the hospitals or the staff at fault. The insurance companies have created this monster.
Sounds like you had a new guy checking you out who didn't know about the discounts or didn't care. The experienced pharmacist stepped in and applied the correct discount codes.
It's just like with your taxes, you're more than welcome to overpay on your taxes if you don't know the discounts available to you.
In a just world the system would just apply all the applicable discounts without your input, but I guess that's the free market in action. One pharmacy will lose your business for not applying the available discounts while another will gain your business for doing so. It's truly fucked up.
The basic problem is when the government gets involved in markets, the logic of the market breaks down.
Because we view medicine as “too important to trust to free markets” we have a thick tangle of laws forcing business to happen in specific ways.
You can’t assume the natural set of incentives are shaping the deals, so you can’t assume the natural set of patterns to appear in the deals being struck.
So, that doesn’t make it make sense. But I hope it makes sense of why it doesn’t make sense.
