We Owe, We Owe, We Owe, We Owe

This was originally posted to my blog, Diabetes Odyssey.

It’s no secret that I hate politics with a passion. Talking politics is up there with math in my opinion, it just sucks. But the fact is that politics (and math) are an important and inescapable part of life.

Wait, what am I talking about here? What was I going to write this post about? Oh, yeah, money, healthcare, greed, chronic illness.

Who’s responsibility is it to pay for medical treatment? Really? Should the ill pay for their own care? Should their families? Should the government? Who makes that decision and why is it that ‘persons’ responsibility?

Every man for himself, or a village to care for one?

The fact is that if we chronically ill didn’t have insurance and ‘others’ to help us pay for the right to stay alive and functioning…we’d die.

I have spoken to so many people who so callously say things like, “why should I have to pay for strangers medical care?” (taxes). And “The government has no responsibility to pay for your medical care.” and “people should only have to pay for their own medical care!”

It’s easy for these people to say these things because they have never been ill, especially chronically ill. They can not fathom the expense that goes into ongoing medical care. They have no idea how frightening it is to wonder if you are going to be able to stay alive because you can’t afford your insulin.

With their ignorant and uncaring words they might as well be saying all of us chronically ill - who never asked to be this way - deserve to die.

We do not expect or even want to have our medical expenses paid by others. We wish we could afford it all ourselves. But pharmaceutical companies, insurance companies, big business, and greedy officials along with others have all made sure medicine of all kinds is outrageously expensive. It is impossible for any individual with a chronic illness to pay in full for their own medical care. We need help. We don’t want it all paid for by others, just help to reduce the cost to an affordable amount for us to reasonably be able to pay.

I have spoken with so many other diabetics of all types who either do not have full insurance coverage for all the medical supplies they need, or have no coverage at all, or have good coverage but still can’t afford all the costs! So they must pay out of pocket for their uncovered supplies. Hundreds and thousands of dollars every time they resupply. For me it can get in the hundreds every few months.

When I had no insurance I had to live on the least effective type of insulin because it was the only kind I could get, and it was the least expensive (but still very expensive). I had to make my syringes last as long as I could. They would get so dull I had to push hard to pierce my skin. Ouch. I never checked my blood sugar because I couldn’t afford the supplies. I never went to the doctor or did blood-work because I couldn’t afford out-of-pocket costs.

I could have died. I did almost die, twice.

I only survived because I had diabetic family and friends who shared supplies with me and loaned me money on occasion. And I developed serious complications I now have to live with for the rest of my life and are costing me more money for ongoing medical care.

Having to make supplies last longer than they are intended or required to is a very dangerous thing to do. Infection is costly and potentially dangerous. Not to mention poor control leading to DKA and death can easily result from using obsolete insulin, old insulin, and not enough insulin.

All because healthcare, medicine, medical supplies, are all unnecessarily outrageously expensive.

Even though I now have very good insurance I still pay a lot of money for my medications and some of my supplies.

Why?! How do we solve the problem of greed?

I always hear this song and think of debt. LOL “We owe, we owe, we owe, we owe”

Will.i.am - Scream & Shout

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I hear you, loud and clear!

And you have my eternal gratitude for not specifically listing physicians as part of the problem. Because we are patients, too, and we cannot somehow magically force health insurers to more adequately and fairly cover the costs of medications, diagnostic procedures, and other medical care.

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It’s the system. Doctor’s are just part of the broken system that is our Healthcare system. Doctors are caught in the middle just like the patients it seems, from what I understand.

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There is a strong strain of rugged individualism running through the American character. This is/was certainly true of me.

In my youth I pursued the goal of self sufficiency. I learned to grow my own food, rebuild my trucks engine build my own house etc.

Then my wife was diagnosed with cancer at a relatively young age. We had lost our insurance a year before, so the financial burden was overwhelming. Treatment seemed to work for a while but 6 years after diagnosis we received the news that the cancer had come back and she was going to die soon. Caring for her in her last days eventually overwhelmed me and I had to lean on friends and neighbors for help. I was left in a financial hole that took me 7 years to dig out of.

This whole experience taught me a lesson. We are all in this together. No one can do it all alone, nor should they have to. Sooner or later we all will need help.

Those who say “why should I have to pay for strangers medical care?” are fools. At some point most of us will face a health crisis or simply grow old. And when that happens they will need help from others or society in general in order to continue to live.

Given the the cost of modern health care the opposition to universal health care baffles me. Yes the stronger and wealthier have to help the weaker and poorer, it’s simple math. But we all need to remember that life may throw us a curve ball and then we will be grateful for the help of others.

It’s an inescapable fact that “We’re all in this together” so we might as well start acting like it.

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This issue comes up regularly, and I’m usually the dissenter, so why break with tradition?

First, the things I completely agree with: Health care is expensive. Especially for those with chronic illnesses. VERY expensive.

Where I bristle is when the judgement comes rolling in. “Unnecessarily”. What does that mean? “Greed”. Really? Where the proof?

I don’t think rgcainmd is greedy. Sure, she could lower her rates, perhaps work for a modest $60-70k a year. That’s a nice income to most. So is she, and other doctors greedy?

As far as “unnecessary”, show me the outsized profit margins, as compared to the economy in general. You won’t be able to. Pharma, insurance, hospitals, device makers, and on and on – profit margins are modest, in line with most industries. 7-10%.

On the other hand, a case for “greed” can be made for high tech – margins there are out of this world! Anyone work at Facebook? What’d you all pay for that Apple Watch, iPhone? Any idea how much profit you handed over with that one?

The private, free-market model may not be the best means to develop and deliver health care services, treatments, etc. in harmony with our social values. If so, we need to change it, but do so with open eyes.

Health care is not expensive because of greed. It’s expensive because it takes and hundreds and hundreds of billions of $$ to research and develop things like CGMs, pumps, insulin analogs, oral meds, and on and on.

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So, ridiculous tort awards are not greedy? Charging 7 or 8 times as much for the same insulin here as it costs elsewhere isn’t greedy? Using regulatory agencies to erect unlegislated import barriers to protect your campaign contributors isn’t greedy? Cooking the books to conceal profits isn’t greedy?

Sure R&D is expensive and needs to be recovered somehow. But to jump from that to the conclusion that everyone’s hands are clean is a post hoc fallacy and a leap of faith. I applaud your faith, but I can’t share it. Too much scar tissue.

And before we award too many halos to the altruistic health care industry for their titanic R&D spending—

The US healthcare industry spends around 11% or 12% of revenue, give or take, on R&D. For European companies it’s around 17% or 18%. And yet, prices are drastically lower in Europe for the same item than they are here, sometimes by 80% or more. Somehow I doubt that they would be selling the products in Europe if they were losing money on each sale.

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I’m 62 this year so I’m old enough to remember healthcare prior to insurance. How it worked was if you got sick you were treated by a doctor who might visit your house and then he sent you a reasonable bill which you could afford to pay even if you did not have a lot of money. Hospitals, pharmacys, and Dr.s offices would work out repayment plans if you could not pay all at once. My mother often reminded me it took a whole year to pay off my delivery room charges. Then came insurance and crappy ideas like HMOs when folks who were’nt Dr.s saw there was a pile of money to be made off illness. Not that Dr.s did not make a good living at the time - but outright greed was very unusual. Not exactly sure when capitalism got to be the overriding concern in healthcare but it happened in my lifetime.

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Sure - they make it up in volume :smirk:

Of course. I forgot that basic business principle. Duh. :confounded:

When other developed countries designed their healthcare systems the first principal was that coverage would be universal, they then worked back from there. Our healthcare debate, which resulted in Obama Care, was an exercise in protecting vested interests and their outsize profits.

Universal healthcare is available in Switzerland using a regulated capitalist system. There is no free government care. Cost is 11.4% of GDP ours is 17.6% . We also know that our outcomes are not as good.

To me this indicates a fair amount of fat in the system. We can argue about where the fat is but not that it exists. If you doubt the existence of excessive profits research the cost of glucose test strips vs the cost of manufacturing. I doubt this is the only case of price gouging in the system.

The only catch is that in Switzerland private insurance is compulsory. As anyone who has studied it knows this is the only way to get universal coverage and preserve the private insurance companies. Most of the other universal care countries use systems that are quasi socialist, like our Medicare, or fully socialist like the British system.

In the U.S. we are presently having an argument about whether we should scrap Obama Care, which would inevitably result in a sharp jump in the uninsured or preserve it, and all its flaws. It seems we should be able to trim fat in the system so we get the most bang for our buck and institute universal coverage.

In the context of this discussion: our system, whatever form it takes, should prevent folks like @Tamra11 from having to damage their health because they can’t access the system.

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[quote=“David_dns, post:6, topic:56261, full:true”]
So, ridiculous tort awards are not greedy? Charging 7 or 8 times as much for the same insulin here as it costs elsewhere isn’t greedy? Using regulatory agencies to erect unlegislated import barriers to protect your campaign contributors isn’t greedy? Cooking the books to conceal profits isn’t greedy? [/quote]No, charging 7-8x as much here as elsewhere isn’t greedy. Here’s why:

You own a grocery store. The government come in and tells you you must sell milk, and you must sell it at 70% if the amortized cost (yes, amortizing that R&D is necessary) to everyone under six feet tall. You can charge the tall people anything you want.

What do you do? You certainly can’t sell product at a loss, overall. People need milk, and will buy it no matter what you charge. So, you charge the tall people enough to stay in business.

How is that greed? While it’s certainly UNFAIR, it’s not greed.

This describes how drug pricing works globally. Governments forcing below-market, below-cost prices in their countries, the US allowing a free market, we get screwed.

I’m far more bitter toward my fellow PWD in their respective socialized-medicine countries expecting me to carry the freight for developing these miracle drugs than I am the drug companies, simply trying to navigate a byzantine and unfair regulatory environment worldwide to, in the end, make a very reasonable 10% net profit.

The thing that scares me is most people have this so wrong (thinking greed and malfeasance on the part of the private industries) while seeing the actual source of the problem – politicians and regulation – as the solution.

If that camp gets their way, kills a “cure” goodbye. And other advances. Anyone here that things the public sector is going to pony up the billions Dexcom has been losing over the years to develop CGMs is smoking some really good stuff.

The bottom line is, the financials of the industry do not support “greed” as the reason everything’s so expensive. If it was, it would be easy to show, and more important, there are plenty of people quite willing to COMPETE at lower prices (if this phantom greed-based overpricing was real) to take the business.

Again, I’m not arguing against the premise that all of this is more expensive than it needs to be. Indeed, if the rest of the world would pay the fair carrying costs of developing these technologies, for instance, prices would be substantially lower in the US. That’s but one aspect of it. There are other significant factors, like torts, excessive regulatory requirements to bring things to market (consider, for example, what Dexcom is having to spend to get the Android version of their app approved), and on and on.

“Greed” was addressed in Obamacare. Caps were put on health insurance companies profits. Did you see a big reduction in costs? No, of course not. Nothing changed, because the profits were never, ever, excessive to begin with. They’ve historically been within the caps already anyway.

The reasons behind the recent brouhaha over Epipens is a poster-child for what I’m talking about.

Anyone here know the full story as to why Epipens went from under $100/pair to over $600/pair in just a few years? If you think the answer, truly, is greed you’re not tuned in.

Well let’s hear your version

I only heard what Heather Bresch (Mylan’s CEO) said in front of the Congressional hearing and it seemed like she said only $50 goes into their pockets today…as she put it…

“As in the past, Ms. Bresch sought to shift the blame for the EpiPen’s price. She said that after distributors and pharmacy benefit managers took their fees, and after other costs were accounted for, the company made a profit of about $50 for each pen.”

They have a generic version that will be sold for $300 for a pair in the near future.

Of course, Congress scoffed at this suggestion from her that they took only $50 from each sale.

The entire congressional hearing was fascinating to listen too: It can be accessed on C-SPAN or here’s a link of some of it.

Epipen hearing

If you really believe that the world works that way, then we simply inhabit different realities. C’est la vie and vive le difference, I guess.

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This woman also moved the entire corporation to Norway on paper to avoid paying US taxes. Her salary went from from 9 million a year to 18 million in the span of a few years. Meanwhile, the Epi Pen prices have been raised 16 times over the last 2 years. Keep telling yourself greed has nothing to with why healthcare in this country is screwed up.

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Interesting. So as R&D is amortized over time, prices go up many times. I’d love to hear the rationalization behind that one.

On second thought, maybe it’d just depress me more.

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Well that part actually is pretty easy to explain, David. How much was the sale price of your home when you bought it? Now what is the sum of all of your mortgage payments combined over 30 years?

That is not to imply for a second that I don’t think we are being gouged to death by the pharmaceutical and insurance industries.

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This argument is assuming that the US is responsible for all medical R&D for the rest of the world. That’s just not true.