Drugs for people - cost

[True Grit Farms]

Carroll County, GA GCA chapter

I guess my whole point on the post was: What about the middle class people who dont have health insurance? Perhaps they have health insurance but it is capped or has lifetime limits? Some dont live within range of a clinical trial or qualify. Compassionate use requires very low income limits.

My brothers response to this question was; "They die, thats what happens to them!"

The rich dont have to worry and the government covers the poor but what about the middle class? You could work your butt off your whole life and do everything right and yet this happen to you. "There but by the grace of God go I." One illness and a lifetime of work and savings wiped out. Got to be a better way but I don't have the answers.

You go to India and take your chances.

 

[Bestoutwest]

A few things. I had a patient once that worked at a pharmaceutical as a chemist. We were talking about what goes into the development of a drug. There is the actual R&D that comes up with the drug, and then trials. Several trials, all closely monitored and the drug is possibly tweaked after each round. He was saying that in the 80's it wasn't uncommon for a drug to cost a company $100,000,000 before it even passed all of its trials. He was telling me of a couple that went over $1,000,000,000 before they made it to the patient. Secondly, the patents don't last as long on pharmaceuticals like they do for other products. Therefore, there is a mad scramble for that company to make its money back ON A DRUG THAT WILL SAVE YOUR LIFE! Thirdly, part of the high cost is to recoup money lost from folks that can't pay for those drugs. With my foot infection, I was getting $8,200/week worth of drugs (or $1,171/day). It cost that much because there are people who don't have insurance or their insurance isn't that good. I'm lucky, we have great insurance, but some aren't and their illness will bankrupt them. However, 30-40 or even 10 years ago these people would have died a lot sooner without medical intervention.

 

[hurleyjd]

What has our healthcare system got us. A lower life expectancy that has been lowered the last two years. Best health care in the world with the worst results we are not in the top countries for good healthcare outcomes.

 

[hurleyjd]

So husband was at endocrinologist this morning and he was prescribed a couple more drugs for glucose, thyroid, etc. Jardiance at $400 per month. Keep in mind he is already on Keytruda at $12,500 per month at Emory - $150,000 per year for that one med. He is taking about 14 meds in all. Not complaining as we are blessed to have good insurance but...what happens to people who dont?

You could hock everything you own and still not afford more than about a year. Never invested much in stocks but I cant help but realize drug companies are making a killing. Also, why do we pay so much more in the USA for drugs?

On the brighter side, I did tell the husband that I had once again managed to screw an insurance company legally as the second dose of his keytruda probably covered every payment to Blue Cross/Blue Shield I ever made.

I am just puzzled at how much longer this can go on...

When you are sitting in the office of your doctor and a well dressed long legged woman comes in with a brief case and can go back and see the Doctor then there is a good chance she is s drug company Representative.

 

[Caustic Burno]

Carroll County, GA GCA chapter

I guess my whole point on the post was: What about the middle class people who dont have health insurance? Perhaps they have health insurance but it is capped or has lifetime limits? Some dont live within range of a clinical trial or qualify. Compassionate use requires very low income limits.

My brothers response to this question was; "They die, thats what happens to them!"

The rich dont have to worry and the government covers the poor but what about the middle class? You could work your butt off your whole life and do everything right and yet this happen to you. "There but by the grace of God go I." One illness and a lifetime of work and savings wiped out. Got to be a better way but I don't have the answers.

The government wants us old people to die for sure.

 

[bball]

Something else to consider: hospitals(ERs) are forced to treat whatever walks through the door, regardless of if they have insurance or means to pay the bill. When a significant portion of your clients can not pay the bill, like every other sector in business, guess who it gets passed on to? That's correct, those who can pay. Just like taxpayers that pay the cost for many that can't, won't or don't pay taxes, but still draw the benefits.
I will give you an example. A middle aged man walks into the ER complaining of abdominal pain. He has no insurance and is a self pay customer. His ER work up includes lab draws, abdominal imaging, some IV fluids, perhaps some Zofran for nausea. Imaging reveals he has a perforated bowel and needs emergent surgery. The surgery crew is called in, his surgery is completed and he is admitted inpatient to Med/Surg unit for 3 days post op recovery antibiotics, IV fluids, etc. The ER bills, coupled with his surgery and inpatient bills is substantial as anyone who has been hospitalized well knows. But this gentleman isnt going to pay because he cant. Even if he had Medicare or Medicaid, the reimbursement would barely be a break even for the hospital. If our pt in the scenario complains about any aspect of his visit, reimbursement becomes even less. So who eats this substantial bill? The hospital, ER physicians group and Surgeons group. The same folks that have to pay staff, maintain equipment, building and all the expenses it takes to maintain a facility, not the least of which is insurance of several varieties (fire, malpractice, etc.)

In the above scenario, if the surgery was determined to be non emergent, then the hospital only has to eat the ER work up(still a good chunk of cash) because as an ambulatory or scheduled inpatient procedure, the hospital can collect some payment before the procedure or decline to provide service if payment arrangements can not be made.

I am here to testify, as someone who manages a mid level hospital after normal business hours, this type of scenario occurs very regularly. Small hospitals are closing or consolidating across the nation, mid levels are consolidating or fighting for their existence, even the large operations aren't churning out a tremendous profit in many cases.

These types of occurrences eventually are written off as losses because of inability to collect. No successful business can function for long taking losses.

Just something to consider.

Thank you for the effort to post that. You may know if this is true - I had a friend in Helena Montana who was a Pediatrician. He claimed doctors do not make as much as public perception. Considering the cost of a practice, malpractice insurance, etc. He like to tell me that I made more than he did.

I can tell you that in some instances this is definitely true. A lot depends on the practice type and the patient load. I do not fault the physicans in the current system. Some of them struggle just like the rest of us.

Completely agree. The specialties tend to do well. Family practice is a tough row to hoe in today's climate. All about volume to make it work....and partnering with a group to share expenses on office space, employees, etc. Many ER physicians and Hospitalists are also partnering with groups and contracting their services. Seem to do better that way, but still carry significant malpractice insurance. On the contracting side,(well acquainted because we contract in our ER) the pay is directly proportionate to the shifts worked. One of our physicians works 25 days out of a 30 day month, 12 hour shifts. She resides out of state in an extremely expensive major city, has a yacht and a 20 room mansion. Our absolute best physician works 12 out of 30 and when conversing with him, he explained he doesn't live above his income and values his free time more than an extravagant lifestyle. Both ends of the spectrum. I have noticed that many physicians are heavily invested in the stock market and follow it closely...

Bright Raven, it is quite possible he was telling you the truth. I suspect you made a good income as a ranking govt employee.

 

[Bright Raven]

Bright Raven, it is quite possible he was telling you the truth. I suspect you made a good income as a ranking govt employee.

His daughter was same age as Clint. They were in school together. His home was very modest and he lived a very modest lifestyle. Clint was considering being a medical doctor. He jokingly told me - Can you talk him out of it! Lol

 

[boondocks]

Pediatricians and family drs are the lowest-paid, to my understanding. Given the amount of education; the cost of same; and the stress/hassles/work hours, anyone wanting to go into medicine should go into a specialty. The electronic health records are killing primary care providers.

 

[greybeard]

Pediatricians and family drs are the lowest-paid, to my understanding. Given the amount of education; the cost of same; and the stress/hassles/work hours, anyone wanting to go into medicine should go into a specialty. The electronic health records are killing primary care providers.

In the 70s, we were told we are entering a paperless society.
I was at a pre-op appointment today, and watched as they printed off what seemed like a full ream of paper. I signed each one, then had to (using my hi-tech fingertip) electronically sign or initial about 8 different forms on her tablet.
So much for a paperless society.

What really gets me, is you have to fill out paperwork in the waiting room, then when you get called to go to he back, have to answer the same questions verbally that you just submitted by form 10 minutes previously.

Months ago, I had to go to the ER for some heart related problems, answered all the questions down in the emergency room, then when they sent me upstairs, someone came in and asked me the exact same crap over again.
"I just answered these exact same questions a few minutes ago on the 1st floor."
"Sorry, I have to ask them again for this floor"
"Are you telling me, I can converse, email, and skype halfway around the globe in seconds, download an entire movie in less than 5 minutes, they can talk to astronauts on ISS 250 miles in space while they're skimming along at 17,000 mph and ya'll can't get information from the 1st floor to the 3rd floor?"
"No, we can't do that."
"It's just 2 flights of stairs or a short elevator ride...Want me to get out of this gown, get dressed & walk down there and get you a copy right quick?"

Blank look........

:bang:

morons abound

 

[sstterry]

Pediatricians and family drs are the lowest-paid, to my understanding. Given the amount of education; the cost of same; and the stress/hassles/work hours, anyone wanting to go into medicine should go into a specialty. The electronic health records are killing primary care providers.

I have friends that are Drs. (every hospital is like a mini-Peyton Place) and a lot of them get jealous when one of the other docs buys a new car, saying "how can they afford that?"

The above as an aside, I never thought about electronic records or HIPPA impacting workers. Other than transcriptionists, can you expound on that impact?

 

[Bestoutwest]

The above as an aside, I never thought about electronic records or HIPPA impacting workers. Other than transcriptionists, can you expound on that impact?

It's a lot of excessive clicking. If want to print out a requisition, it is five or six separate clicks that are useless. The flow is not done well. The providers have it worse than I do. Throw in the fact that not everyone is on the same level as they are, and they are fixing mistakes, redoing what they originally did, etc.

 

[Bestoutwest]

What really gets me, is you have to fill out paperwork in the waiting room, then when you get called to go to he back, have to answer the same questions verbally that you just submitted by form 10 minutes previously.

Months ago, I had to go to the ER for some heart related problems, answered all the questions down in the emergency room, then when they sent me upstairs, someone came in and asked me the exact same crap over again.
"I just answered these exact same questions a few minutes ago on the 1st floor."
"Sorry, I have to ask them again for this floor"
"Are you telling me, I can converse, email, and skype halfway around the globe in seconds, download an entire movie in less than 5 minutes, they can talk to astronauts on ISS 250 miles in space while they're skimming along at 17,000 mph and ya'll can't get information from the 1st floor to the 3rd floor?"
"No, we can't do that."
"It's just 2 flights of stairs or a short elevator ride...Want me to get out of this gown, get dressed & walk down there and get you a copy right quick?"

Blank look........

:bang:

morons abound

They may have different programs or a specific reason for asking you. I have to ask everyone why they're seeing me for an x-ray even though the provider puts down a diagnosis. You'd be surprised at how incorrect those are. I've done exams for constipation when the person is vomiting or 'hand pain' for a wrist. Also, the notes aren't updated quickly enough for me to see what the provider and patient talked about, so that also plays a factor.

 

[greybeard]

They may have.... a specific reason for asking you.

They do.
An extra assessment, even tho my name, dob, allergies, medical history, home address, ph #, next of kin etc did not change one bit during the short elevator ride up..
The reason?
It makes them mo $$$$$$$$$$$.

 

[callmefence]

We both know better so I'm not going to touch that one.

Seriously, I may be more socially liberal than you but when it comes to fiscal and economic concepts, I am fiercely conservative. I believe every publicly owned corporation has an obligation to make all the profit possible. I don't consider the pharmaceutical industry as the "evil empire" many do.

It's not exactly capitalism, if the government forces everyone to have health insurance, and provides subsidies to pay medical bills. Any time the government is involved in subsidizing any sector, it's not capitalism.
If people were having to pay their own medical bills without insurance, the prices would be a lot lower.
I can buy any drug through my vet, or from a russian phar., for a tenth of the cost from an american phar. I wonder why???
Could it be that they know they can get the money from a government subsidized insurance plan???
Take the government, and insurance out of picture, and I bet you anything the price of drugs will drop like a rock.
BR I know you were just poking a stick at everyone, hoping someone would yelp. If you truly believed in capitalism, would be able to spot that this government subsidized insurance is not capitalism.

that's exactly right. ....the whole dam post....exactly right

 

[greybeard]

that's exactly right. ....the whole dam post....exactly right

X2