Let face a few harsh facts about American healthcare. We spend about 70% more per capita on average healthcare costs than the next most expensive country and double what is spent by the average developed country. The Affordable Care Act took a lot of people off the uninsured list, but that statute’s optional expansion of Medicaid (for our lowest economic tier) has been spotty at best in red states. Too many Americans are either not covered or are under-insured. How bad is it? Tens of millions of Americans fall into healthcare gaps. These hard numbers (from the September 13th COVID supplement to the LA Times) are just one clear example of our failed system: “The United States accounts for a little more than 4% of the world’s population, but it’s responsible for about 16% of the world’s COVID-19 deaths.”
Our record on the cost of prescription drugs, however, is worse. In order to get the ACA passed in 2010, the resulting healthcare exchanges were not permitted to negotiate what the pharmaceutical companies charged, so we have by far the highest prescription drug prices in the developed world.
We are also the only developed country without universal healthcare. Contrary to reports to the contrary, universal healthcare does not necessarily get rid of private insurance carriers. It is NOT “socialism” in any true meaning of the word. In Germany, for example, private carriers administer that nation’s uniform healthcare policy for a capped fee… and as for prescription drugs, no one pays more than €10/month. Healthcare there is first rate, also covering dental, hearing and vision. See also my January 9th Americans - The Biggest Healthcare Suckers on Earth blog.
What many Americans do not realize is that many US companies, particularly those manufacturers which provide union-mandated health insurance for employees, have to factor in those costs into the products and services they provide. And those companies have to compete against companies based overseas where companies do not need to factor in those costs in their pricing structure. Not to mention that international healthcare costs as vastly cheaper anyway. This is a strong negative for American businesses and workers.
Recent legislation addressing some of these issues passed Congress without any Republican support. Berkeley Lovelace Jr. writing for NBCNews.com, August 16th described one major issue and how that Inflation Reduction Act impacts drug costs, mostly for seniors facing the donut hole in their Medicare coverage: “Exorbitant drug prices in the United States are a key reason many people in the U.S. are forced to skip or delay filling their needed prescriptions. A Kaiser Family Foundation poll published last month [July] found that nearly 1 in 2 adults report difficulty affording their health care expenses, including their prescribed medications…
“Under the new law, the U.S. government is now able to negotiate prices on the costliest prescription drugs, cap costs at $2,000 per year for people on Medicare, limit the monthly cost of insulin to $35 for seniors, and extend subsidies for people buying their own health coverage through the Affordable Care Act, also known as Obamacare. The law also provides free vaccines for seniors…
“Starting in 2026, Medicare will begin negotiating the price of 10 drugs [to be named in 2023], followed by an additional 15 drugs in 2027, and eventually an additional 20 drugs in 2029 and beyond. The negotiation process applies to drugs covered under Medicare Part D that lack a generic or comparable alternative, though drugs under Medicare Part B will eventually be included.” But there is still a huge “mega-fly” in our prescription drug ointment: greed.
Yet, there is no legislation on most of the rest of our nation’s drug pricing. When it comes to highly specialized life-saving drugs, pharmas are increasingly pricing those prescriptions based on the cost of the process that the drug is replacing. No reference to actual costs even with a substantial mark-up. Because they can. Michael Hiltzik, writing for the September 11th Los Angeles Times, tells us about one niche product – with a 90% cure rate for rare a blood disorder (beta thalassemia that impacts only about 1500 Americans) that otherwise requires transfusions as often as every two weeks – where the price for the treatment drug (Zynteglo) is outrageous!
“[The above 90% Zynteglo cure rate is] a life-changing development for those with the inherited condition, many of whom are otherwise condemned to receiving blood transfusions as often as every two weeks. The median age of death of those with beta thalassemia, which is typically diagnosed within a few weeks of birth, is 37… Zynteglo is remarkable for another reason, not so happy. At the price of $2.8 million set by its developer, Cambridge, Mass.-based Bluebird Bio, it’s the most expensive single-treatment drug ever approved in the U.S.
“That makes it ‘one hell of a policy challenge,’ in the words of health insurance expert David Anderson of Duke University… The reason, Anderson explains, is that although Zynteglo might be cost-effective over the long term and from a social perspective, even at $2.8 million, the one-year charge for it can bring ruin to an insurer’s profit-and-loss statement… The previous standard cure involved finding a matched donor of healthy red blood cells — typically a sibling. The donor’s healthy cells could be transplanted into patients to supplant the inherited cells, which can’t efficiently carry oxygen, leading to severe anemia.
“Fewer than 1 in 4 patients have access to a matched donor, according to a report on Zynteglo issued in July by the Institute for Clinical and Economic Review, or ICER, an independent nonprofit that evaluates data to help healthcare stakeholders decide on prices and access to treatments… Others require transfusions every two to five weeks as well as regular chelation treatment, which removes iron from the blood… Their average life expectancy is far below that of healthy people…
“Bluebird has rationalized the high price of Zynteglo by referring to the lifetime cost of transfusions and chelation therapy, which the company says can run as high as $6.4 million… ‘Prices just keep getting higher and higher,’ says Rita F. Redberg, a UC San Francisco cardiologist and an expert in assessing new medical technologies for effectiveness. ‘It used to be that $5,000 sounded high, and now we’re at $2.8 million. It’s wild.’… In our system, insurers saddled with the one-time cost of a treatment aimed at creating economic benefits in the future can’t be assured of reaping those benefits themselves, because of the possibility that the patient will be covered by a different insurer in the future… Perversely, that’s less of an issue for drugs aimed at large populations of disease patients.” It also an argument for why affording treatments that cost so much is easily amortized within a national healthcare system, noting that so much underlying research is funded in whole or in part by the government anyway.
I’m Peter Dekom, and it is time for Americans to wake up to a government that has no issue with deregulation and tax cuts for the super-rich but finds consistent GOP resistance to programs like universal healthcare – available in every other developed nation on earth – for the rest of us.
Posts
No comments:
Post a Comment