Posts Tagged new york times

Waiting for Care — getting worse in the U.S.

longlineElisabeth Rosenthal’s article in the New York Times 7/5/14 “The Health Care Waiting Game” again puts the spotlight on US health care.  This time she points out a problem everybody has been experiencing:  long waits for health care appointments.  The average wait for a family practice appointment is about 20 days with extremes across the country from 5 days in Dallas to 66 days in Boston.  Examination of the private sector begins to make the VA look better.  The question now:  how many people have died waiting for appointments?  (it’s a no brainer — lots)

While wait times in the US have gotten longer they have gotten shorter in other places in the world like the UK.   To some degree the acute problem is an influx of newly insured people into the US market.  But, long before the acute problem there has been a chronic decline.

From an economic point of view it’s all supply and demand (see “Principles of Health Economics) .  Economists point out that the demand for healthcare is almost infinite whereas the supply is always going to be limited.   At some point a line must be drawn.  Is $100,000 per year for a medication acceptable?  Is $500 for a “wellness”exam too much?  Do we really need MDs to treat diaper rash?

Long waiting lines are a sign of poor management.  If a person can’t be evaluated by the healthcare system there is no way to know what is being overlooked.   Perhaps that person in the line only needs a cheap generic medication; not everyone is waiting for hip replacement surgery.  As a country we need to get the best bang for the buck and use limited resources wisely.

We seem to be wasting time coming to grips with healthcare problems.

“I wasted time, and now doth time waste me.”
― William Shakespeare

So, what can a patient do?

  • accept appointments with providers that are farther away
  • accept PAs and Nurse Practitoners for follow-up and simple problems
  • do your part to learn about your health problems so you don’t drag the system down with poor healthcare literacy
  • complain about high prices and long waits and vote for better health care regulation, not less.

 

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Insulin pumps for diabetes — the cost of health

insulinpumpElisabeth Rosenthal of the New York Times published her article “Even Small Medical Advances Can Mean Big Jumps in Bills” on April 6, 2014.  Type 1 diabetes is a rapidly fatal illness without insulin treatment.  The discovery of insulin in the 1920’s changed the disease from fatal to treatable and with improved insulin and improved devices to deliver the drug people with the disease now can look forward to a long life.

The article by Ms. Rosenthal points up the cost of current insulin pump therapy.  She lists the yearly cost of insulin treatment for one woman as $26,470 (a large part paid by the woman’s insurance).

Surely, big pharma would not take advantage patients with life threatening illness like diabetes.  Surely, they would not pad the bill with unnecessary equipment or lock-in patients to their brand of insulin with a device linked to that brand.  Surely, US big pharma would not disadvantage US citizens and favor drug plans in other countries.  WRONG, WRONG AND WRONG AGAIN.  It’s the modus operaindi of such organizations and a lack of regulation that allows it to happen.

  • Ms. Rosenthal comments on the fluff added to the bill:  talking pumps with multiple colors and new models every year.
  • The linking of insulin pumps to only one type of insulin (made by the insulin maker).
  • The withdrawal of less expensive insulin from the market.
  • The 70% profit on insulin.
  • The limited number of companies that now make insulin.
  • The sweet deals for countries that drive hard bargains (acquisition cost for a bottle of insulin in the UK $30 but in the US $200).

It seems there is a line to be drawn.  On one side is the unquestionable benefit of research and development that brings fantastic life saving benefit to many patients.  On another side is a business formula for fantastic profit to a few people.  Fortunately, one need not choose either extreme — it is possible to have adequate research and reasonable profit as demonstrated in other parts of the world.

So, what can and should be done?

  1. Break up drug companies to separate the manufacture of insulin and the manufacture of insulin pumps.  The competition in the pump market should not be limited by the drug maker.
  2. Limit drug patents with a strict end point and encourage smaller companies to make generics that may not be an exact copy but simply be similar (bio-similar).
  3. Set prices for drugs and devices based on realistic economic considerations (like limiting profit to 5%).
  4. Allow government sponsored research to compare various types of similar therapy to allow a reasonable choice by patients and providers.
  5. And, allow the government to negotiate prices since the government now pays a big part of health care costs.

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Prescription Medications — sky high price

pillsnbills

Elisabeth Rosenthal wrote the lead story for The New York Times today (10/13/13) “The Soaring Cost of a Simple Breath“.  This is another blockbuster exposé of drug costs that are crippling US health care.  Sadly, not a story about what is being done to correct the problem.

Here are some of her key points:

  • The average brand name prescription has risen from 1995 at $40 to 2013 at $170
  • The average generic prescription has risen from 1995 at $20 to 2013 at $45.
  • A common asthma medication Pulmicort costs $175 in the US but only $20 in the UK and $25 in France.
  • Drugs account for 10% of the $2.7 trillion annual health bill.
  • Americans take more generic medications than people in other countries (they just can’t afford branded or new medications)
  • Other countries set the wholesale price of drugs to make drugs affordable.
  • US pharmaceutical companies have used the FDA to restrict manufacturing rules to favor large companies and have used the judicial system to bankrupt competitors.
  • US pharmaceutical companies have paid generic companies not to sell their products in the US.
  • Medicaid, paid for by taxes, pays millions of dollars to drug companies for high priced medications.
  • Asthma medications have been the target of profiteering drug companies.  Not a single inhaler is available as a generic.  Despite the fact that inhaled medications have been available for over 30 years.  The effect on people with this condition is a tremendous burden.
  • Drug companies spend about 50% of funds on marketing and only about 20% on drug research.  Other advanced countries prohibit marketing prescription medications directly  to consumers.
  • Medicare is prohibited from negotiating prices.
  • Drug prescribing guidelines published by the government are prohibited from considering cost.

Rather than just be angry about the sorry state of drug costs, what can be done?  Just take a lesson from other countries, this is not rocket science:

  • The US government should set the prices for all drugs
  • The FDA needs to loosen the rules for generic manufacturing — for goodness sake, an inhaler is an inhaler, not the space shuttle.
  • Comparative effectiveness research should be required, and the results published for doctors as in the UK.  Drug cost is important to all US citizens, so restricting the government from considering cost  borders on insanity (perhaps giving psychiatric medications to Congress is currently too expensive).
  • Finally, there is no excuse for the current drug cost problem — other countries have solved the problem, the US needs to do the same.

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