Our health care system has been compromised by corporate greed. The mega hospital systems and pharmaceutical companies and the insurance industry. No one has really tried to protect the public. I started working in a university based hospital in the 1970s. The needs of the people most tragically the poor have been ignored. Compared to other countries our healthcare quality statistics are embarrassing. And now the checks and balances we had developed are gone. You know who benefits from this right?
These schemes have been obvious to health care professionals for years, if they bothered to look at the numbers. Formularies have meds with zero copays to patients but what is not apparent is these meds like BP meds, anti cholesterol meds are not free. There are ever increasing charges that insurers and pharmacists are paying for staying in the game. Some meds are almost given away on the formulary as a quid pro quo for carrying certain high priced brand names. Now the generics (which major pharmaceuticals now control) come in two payment tiers! And the formularies are not standard and keep changing coverage as backroom deals are concocted. This makes it very difficult for the average person to make reasonable decisions on which coverage plan to choose.
I personally have an inhaler that costs $300 each and I pay $40 copay. The generic of that inhaler costs me $120 each. I have to insist that my prescriber writes “Brand name only” on my prescription. This makes absolutely no sense. The whole system is corrupted and it is making obscene profits off the illness of the people, who often go bankrupt from medical costs in general. This is not a free market economy, it is a manipulated process by for-profit companies and individuals that are extremely greedy. This is the result of our Congress taking a hands off approach many years ago, for massive payoffs.
And don’t get me started on Advantage Part C supposedly Medicare. The premiums may be free and attractive, but the co-insurance costs are high and the denial rates for treatment are outrageous and deadly.
our health care system is beyond absurd, allowed to evolve into it's present form essentially without oversight or a plan. No excuse for the wealthiest country in the world to be the only developed one without universal basic healthcare other than greed. In the current climate have no idea when that will come close to being addressed sad to say....
Love your mission and articles. Super interesting.
Would love if you include tidbits of historical context. Everyone I explain healthcare to always asks "how did it get that way?" and there is always a reason that made sense at the time. E.g., Corporate sponsored health insurance emerged as a benefit / talent attraction technique when there was a wage freeze to prevent rampant inflation post WWII.
In this article, it would really help. E.g., Health insurers originally didnt want to manage small pharmacies of which thousands exited across the country, thus PBM emerged. Or E.g., Fundamentally the differential pricing mechanism exists because of price/volume trade offs and negotiations and rebates emerged because of XYZ.
The system in part is facilitated by a philosophy of "yes, we can prescribe a medication for that", but on the other it is too often ignored that America is a deeply unhealthy country; our baseline health levels are in decline, and as medication is increasingly seen as the answer [ trying to have our cake and eat it too - this philosophy of management/treatment allows in large part the perpetuation of the current system rather than addressing the myriad [and yes, challenging & complicated] cultural/lifestyle factors that result in people "needing" medication in such large volumes in the first place. A vast oversimplification, and probably preaching to the choir, but always seems worth repeating. Good explainer though, and hopefully more people will begin waking up to these issues.
PBMs negotiate "rebates" from drug manufacturers, supposedly to lower costs. In practice, they keep a percentage of the rebate and pass a fraction to the insurer. The patient sees none of it. A $500 drug might generate a $200 rebate, of which the PBM keeps $80, the insurer keeps $100, and the patient still pays a $50 copay based on the original $500 price.
Since our healthcare and medicines are in the hands of only a few monopolistic corporations, then it should be fairly easy for the federal government to socialize our medical system like Canada did years ago. The government of Canada purchased all the hospitals, hired all the physicians, and negotiated the price of medicines. I don't know what we are waiting for. Let's get all of our Americans the healthcare that they deserve!
Our health care system has been compromised by corporate greed. The mega hospital systems and pharmaceutical companies and the insurance industry. No one has really tried to protect the public. I started working in a university based hospital in the 1970s. The needs of the people most tragically the poor have been ignored. Compared to other countries our healthcare quality statistics are embarrassing. And now the checks and balances we had developed are gone. You know who benefits from this right?
These schemes have been obvious to health care professionals for years, if they bothered to look at the numbers. Formularies have meds with zero copays to patients but what is not apparent is these meds like BP meds, anti cholesterol meds are not free. There are ever increasing charges that insurers and pharmacists are paying for staying in the game. Some meds are almost given away on the formulary as a quid pro quo for carrying certain high priced brand names. Now the generics (which major pharmaceuticals now control) come in two payment tiers! And the formularies are not standard and keep changing coverage as backroom deals are concocted. This makes it very difficult for the average person to make reasonable decisions on which coverage plan to choose.
I personally have an inhaler that costs $300 each and I pay $40 copay. The generic of that inhaler costs me $120 each. I have to insist that my prescriber writes “Brand name only” on my prescription. This makes absolutely no sense. The whole system is corrupted and it is making obscene profits off the illness of the people, who often go bankrupt from medical costs in general. This is not a free market economy, it is a manipulated process by for-profit companies and individuals that are extremely greedy. This is the result of our Congress taking a hands off approach many years ago, for massive payoffs.
And don’t get me started on Advantage Part C supposedly Medicare. The premiums may be free and attractive, but the co-insurance costs are high and the denial rates for treatment are outrageous and deadly.
For profit medicine 💊 is deadly when privatized.
our health care system is beyond absurd, allowed to evolve into it's present form essentially without oversight or a plan. No excuse for the wealthiest country in the world to be the only developed one without universal basic healthcare other than greed. In the current climate have no idea when that will come close to being addressed sad to say....
Love your mission and articles. Super interesting.
Would love if you include tidbits of historical context. Everyone I explain healthcare to always asks "how did it get that way?" and there is always a reason that made sense at the time. E.g., Corporate sponsored health insurance emerged as a benefit / talent attraction technique when there was a wage freeze to prevent rampant inflation post WWII.
In this article, it would really help. E.g., Health insurers originally didnt want to manage small pharmacies of which thousands exited across the country, thus PBM emerged. Or E.g., Fundamentally the differential pricing mechanism exists because of price/volume trade offs and negotiations and rebates emerged because of XYZ.
And yet they get hauled to the hill every few years for performative exercises with nothing being done as a result.
The system in part is facilitated by a philosophy of "yes, we can prescribe a medication for that", but on the other it is too often ignored that America is a deeply unhealthy country; our baseline health levels are in decline, and as medication is increasingly seen as the answer [ trying to have our cake and eat it too - this philosophy of management/treatment allows in large part the perpetuation of the current system rather than addressing the myriad [and yes, challenging & complicated] cultural/lifestyle factors that result in people "needing" medication in such large volumes in the first place. A vast oversimplification, and probably preaching to the choir, but always seems worth repeating. Good explainer though, and hopefully more people will begin waking up to these issues.
PBMs negotiate "rebates" from drug manufacturers, supposedly to lower costs. In practice, they keep a percentage of the rebate and pass a fraction to the insurer. The patient sees none of it. A $500 drug might generate a $200 rebate, of which the PBM keeps $80, the insurer keeps $100, and the patient still pays a $50 copay based on the original $500 price.
Since our healthcare and medicines are in the hands of only a few monopolistic corporations, then it should be fairly easy for the federal government to socialize our medical system like Canada did years ago. The government of Canada purchased all the hospitals, hired all the physicians, and negotiated the price of medicines. I don't know what we are waiting for. Let's get all of our Americans the healthcare that they deserve!