Health Care Tidbits

Well considering developments and happenings this past week I decided it was time to post some words on healthcare in America.  Sometimes it’s hard to believe the shit that goes on before our eyes.

First a few words on the cost of insulin in this country.  Now this is something I know well being a type 1 diabetic virtually all of my life next month going on 80.  I take two shots a day and a vial lasts me about 2 weeks and a couple of days.  Without it I would have been dead a long time ago.

I have written about the insulin racket several times here; one can read my previous rants by simply typing the word “insulin” in the search box above.  Once upon a time I took insulin made from pig pancreas.  It was dirt cheap.  Then came the “human” insulins and the move to drive the pork insulins out of the market.  Human insulin was practically given away – until one couldn’t buy pork-based insulin anymore.

The price of insulin has been rising ever since.  There are only 3 manufacturers in the world and only one, Eli Lilly, here in America.  They move their monopoly pricing in lock step.

The retail price of a vial of the insulin I have taken forever is currently $184.64 per vial.  Keeps me alive for 2 weeks and a couple of days.  It took me two minutes to locate the same insulin from a Canadian pharmacy for $77,31 without insurance.  Canadian citizens pay even less.  Same insulin.  Same manufacturer.  Same package box.

Additionally, I have a carton of 5 pens filled with quick acting insulin for emergencies.  Cost $714.87

Now I don’t pay that price.  I am retired and on Medicare and my cost for insulin is capped at $35 per month.  Folks with private insurance however pay a lot more than me.  And folks without insurance who can’t afford the cost simply ration their insulin till they die.

So, this week a bill came before the Senate to cap the cost of insulin for everyone at $35 a month.  It required 60 votes to pass.  Every one of the 50 Dems voted for it; but only 7 Republicans.

The bill failed.  Why?  Because the GOP members who voted against it are in the pockets of big pharma.  They can bullshit spin it anyway they like but that’s the truth.

The discovers of insulin sold the patent for $1.  They wanted to keep the cost low and available to everyone who needs it.  How’s that working out?

The Dems were successful in getting approval for Medicare to negotiate the price of prescription drug with manufacturers.  Currently Medicare is not authorized to do so.  The bill should pass the House and be on the President’s desk within days.  Big Pharma and the GOP fought it like crazy. It is going through on reconciliation which only required 51 votes in the Senate.  Every Republican Senator voted against it.

Why is it needed?  I am currently in the “donut hole” on my Medicare Part D drug plan.  If you don’t know what that is, you will have to Google it.

Not too long ago I got a 90-day refill on Eliquis – a blood thinner.  My drug plan was billed $1,775 by big pharma.  It paid $1,332 leaving me to pay $443 for 3 months Eliquis.  A 30 day supply of Entresto (a heart med) was billed at $698 of which the drug plan paid $523 leaving me to pay $175 for 30 days-worth of drugs.

The new bill will allow Medicare to negotiate the price of these drugs billed to the insurer drug plan.  It will also reduce my total out of pocket cost for drugs to $2,000 per year.  As of today, Medicare has been billed $10,349 for my drugs of which the plan has paid $8,554 leaving me to pay $1,795.  Under the new law I would reach the $2,000 limit and obtain coverage for the remainder of the year by the end of this month.

Now for a really fun one!

Last June I was having some intestinal issues and after discussion with my doctor on the phone I proceeded to the emergency room of my local hospital.  I met with a physician for about fifteen minures, gave blood and urine for testing, had an IV put into me for fluid and eventually had a CAT scan of my abdomen.  I was there in the waiting room for maybe 3 hours.  Doctor came out, told me there were no blockages, it was nothing serious and prescribed two weeks-worth of medication.

Medicare received a billing from the ER for $28,857!!

Now any medical facility or doctor who serves a Medicare patient has agreed in advance to accept the amount that Medicare pays in full settlement.  Medicare can decide the amount for services through the medical code system; it then pays 80% in cash and my supplemental insurance with Blue Cross pays the remaining 20%.

The invoice billing had about $4,500 in blood and urine tests.  The remaining $24,313 was for the CAT scan!  Laughable!

Well all of the services provided were approved, relieving me of any liability to the hospital.

Medicare paid and the ER accepted $443.50 in full settlement.

Why bill $28K+ and settle for less than $500?  Probably because private health insurance companies negotiate EVERYTHING.  Providers therefore ask for outrageous amounts for services knowing full well its a negotiation to get paid.

Medicare however publishes these settlements in advance and providers know what they are going to receive in payment.

With private insurance however the game is different.  Suppose your policy has a $5,000 deductible.  Your insurer would be in a position to pay a more attractive settlement to the provider than Medicare would have paid while sticking the patient with $5,000 of the settlement offer.

Nice.  Who the hell knows what an uninsured patient will owe.  Will he receive a $24,000 bill?  The issue becomes one of transparency.  One never knows what the hell the bill is gonna be and there are very few ways to find out in advance.

Medicare did.

That’s enough on America’s health care system for today.

Best from Florida

 

About toritto

I was born during year four of the reign of Emperor Tiberius Claudius on the outskirts of the empire in Brooklyn. I married my high school sweetheart, the girl I took to the prom and we were together for forty years until her passing in 2004. We had four kids together and buried two together. I had a successful career in Corporate America (never got rich but made a living) and traveled the world. I am currently retired in the Tampa Bay metro area and live alone. One of my daughters is close by and one within a morning’s drive. They call their pops everyday. I try to write poetry (not very well), and about family. Occasionally I will try a historical piece relating to politics. :-)
This entry was posted in Uncategorized. Bookmark the permalink.

8 Responses to Health Care Tidbits

  1. So disappointing and disgusting that the cap on insulin for all didn’t pass.

    Liked by 2 people

  2. beetleypete says:

    Neverending shocks about the US healthcare system come as no surprise, sadly.
    In Britain, Diabetes is classed as a ‘Lifetime Illness’. That means all treatment and drugs for both T1 and T2 are completely free. There is not even the usual charge for the prescription to be written. (£9.35) This makes sense, as the cost of controlling the illness is far cheaper than someone ending up in hospital because of the outcome of an untreated condition.
    However, our current government is envious of your system, as they want to make money for their friends in the big insurance companies and drug companies. So they have plans to ‘review’ the NHS drug protocols next year, with talk of a ‘means test’ for those who can afford to pay.
    Best wishes, Pete.

    Liked by 1 person

  3. Don Ostertag says:

    I am afraid my comment would not be something I should say in a public blog.

    Liked by 2 people

  4. Jennie says:

    This makes me angry!

    Liked by 1 person

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.