The theme of my day yesterday was health care. First, I read this blood pressure spiking article from Pro Publica. Remember when I mentioned payday lending? Well, it’s the same idea—leeching off of the very people who can least afford it—except with medical debt.
In 2013, 79,000 debt collection lawsuits were filed in Nebraska, a state with fewer than 2 million residents. One collection agency in the state files an average of 120 lawsuits a day. The charges are often less than $100, but the judgements tack on court costs, attorney fees and interest, so for example one bill for $66 became $275. The collection agency then proceeds to relentlessly seize meager bank accounts and garnish the wages of low income people. Nice racket, right?
Nebraska may be the most egregious outlier among the 50 states, but it is hardly alone. The number one cause of personal bankruptcy in the US is medical debt; it results in more collection actions than credit cards. And the majority of bankruptcy filers have some type of health insurance.
This is your health care on capitalism.
Next up, a headline from The Washington Post caught my attention: The contradictory reasons cancer-drug prices are going up. After reading the piece, I cannot for the life of me discern what is “contradictory” about the reason(s) cancer drug prices are going up. SPOILER ALERT! It’s because they can get it. I know this will come as a shock to everyone, but it turns out that people with deadly illnesses desperately want these treatments, and will bankrupt themselves to survive.
And it’s not just cancer drugs (or “cancer-drugs”) either. In October, the same Post reporter wrote this:
For example, tetracycline, an antibiotic discovered in 1948, cost 5 cents for a 500 milligram capsule back in November of 2013…Nearly two years later, it’s coming in at $11 a pill — a nearly 2,200 percent increase. Clomipramine, an antidepressant developed in the 1960s used to treat obsessive-compulsive disorder, cost 22 cents per pill in November 2012. Now, it’s $8.17 — a 3,600 percent increase.
…
In 2010, Amedra Pharmaceuticals bought the rights to abendazole, an off-patent drug used to treat intestinal parasites. At the time, the average wholesale price of the drug was $6 a day. By 2013, it was $120 — a nearly 2,000 percent increase.
Back then, the Post offered this explanation, if you can believe it: “The trouble is this: right now, we can’t tell why prices are high, or even if they are high.” Are the writers and editors at the Post high? Because it doesn’t take a PhD in economics to understand what lies at the root of this phenomenon.
This is your health care on capitalism.
The most baffling thing about the article (besides its author remaining strangely mystified by the blindingly obvious) is that virtually every sentence in the article requires this clause appended: “in the US, but not in other advanced Western countries.” Like this:
The $10,000-a-month cancer drug has become the new normal, to the dismay of physicians and patients who increasingly face the burden of financial toxicity, in the US, but not in other advanced Western countries. A pair of new studies illustrate just how recently that pricing model has come into vogue and pull back the curtain on the strange market forces that push prices steadily higher in the years after the treatments are launched, in the US, but not in other advanced Western countries.
The first study, published in JAMA Oncology, examined 32 cancer medications given in pill form and found that their initial launch list prices have steadily increased over the years — even after adjusting for inflation, in the US, but not in other advanced Western countries. The average monthly amount insurers and patients paid for a new cancer drug was less than $2,000 in the year 2000 but soared to $11,325 in 2014, in the US, but not in other advanced Western countries.
A study published Monday in Health Affairs examined what happened to the prices of two dozen cancer drugs after launch and found that pharmaceutical companies on average increased prices 5 percent above inflation each year, in the US, but not in other advanced Western countries. That inflation dwarfed ameliorating effects from competing drugs being introduced, which resulted in an average discount of about 2 percent, in the US, but not in other advanced Western countries. And the biggest hikes — of about 10 percent — coincided with the drugs receiving approval for other conditions, in the US, but not in other advanced Western countries. In other words, when a drug became useful to a larger number of patients, the price shot up, in the US, but not in other advanced Western countries.
The findings highlight the often mind-boggling ways that drug prices behave, in the US, but not in other advanced Western countries.
YES IT’S TRULY MIND-BOGGLING. Jeezus.
But the Post wasn’t finished boggling my mind just yet. Next up came an article with this darkly comical headline:
Researchers: Medical errors now third leading cause of death in United States.
It’s by a different writer, yet she too inexplicably forgot to append “in the US, but not in other advanced Western countries” to her sentences. ???
Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care, in the US, but not in other advanced Western countries. Lest you assume those cases are the exceptions, a new study by patient safety researchers provides some context, in the US, but not in other advanced Western countries.
Their analysis, published in the BMJ on Tuesday, shows that “medical errors” in hospitals and other health care facilities are incredibly common and may now be the third leading cause of death in the United States — claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimer’s, in the US, but not in other advanced Western countries.
She almost hints at it here:
[Kenneth Sands, director of health care quality at Beth Israel Deaconess Medical Center] said that one of the main barriers is the tremendous diversity and complexity in the way health care is delivered. [in the US, but not in other advanced Western countries.]
Ooh! So close.
[Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research], said “When a plane crashes, we don’t say this is confidential proprietary information the airline company owns. We consider this part of public safety. Hospitals should be held to the same standards like they are in other advanced Western countries but not in the US.”
Gosh, ya think?
I’m just spitballing here, but could it have anything to do with the fact that the US health care system is primarily concerned with profits, not health? Nah. That would be evil.
THIS IS YOUR FUCKING HEALTH CARE ON CAPITALISM.
Sadly, this is all to be expected. The US is an exceptionally special snowflake, the Very Bestest Ever Country Ever In The World Ever™, so obviously we would never need to look elsewhere for obvious solutions to our exceptionally special problems. But it’s not like you’re going to hear about any of that from the Washington Post, the self-referential go-to news source for the Squirrel People (and Dick Cheney’s Lizard People) infesting the capital and defending the utterly indefensible status quo. For some reason Post staffers prefer to remain confused and mystified, sitting around scratching their heads, forbidden from using Google.
#Medicare4All
Who needs medicare!? We’re gonna get $1t worth of new nuclear weapons, the moribund F-35, the topheavy littoral fighting ship, and the airforce’s newest boondoggle long-range bomber. USA! USA! USA!
I cannot understand why some people are so frightened of having government bureaucrats set healthcare policy but are totally unconcerned about having for-profit insurance companies set healthcare policy.
Cancer drug prices keep going up because there is no mechanism for price control in the USA. We are the only developed nation that has no government oversight of drug prices. The big pharmaceutical companies raise prices every quarter on every branded cancer drug. There is no “free market” to check this. And Medicare isn’t what it should be. What percentage of the cost of chemotherapy and other inject-able supportive care drugs do you think Medicare pays? It’s not 100%. It used to be, but the Medicare Modernization Act dropped that to 80%. So you need a second commercial insurance or your copays will bankrupt you. When you say “Medicare for All,” I know you mean Universal Health Coverage for All. But you need to know that you can have Medicare and still not afford modern cancer care. Or have it and still go bankrupt. Or both.
Raucus Indignation: I’m aware of Medicare’s limitations: “Medicare for All” has been the shorthand slogan for “comprehensive universal single payer” at least since Occupy. And it’s actually worse than you suggest: Medicare, one of the largest payers in the world, is barred by law from even negotiating drug pricing for its beneficiaries, unlike for-profit insurance companies and even other government agencies like the VA, which pays significantly less for the same medications. I know Kafkaesque is an overused cliché, but…
Satanists can’t see what they sold their souls to ignore.
My cancer drugs cost just a hair under one thousand dollars a month, every month, and will do so into the indefinite future. Since I’m in Canada my out of pocket on that is zip, nil, nada each month. I’m a couple of years down the road from my stage four stomach cancer diagnosis and my family is out of pocket about four hundred dollars in total.
America is a very benighted place in so many ways, I honestly feel quite sorry for anyone stranded there.
Iris, I am well aware. Unfortunately, the private payers all follow Medicare guidelines more or less. They usually pay what Medicare pays for cancer drugs or a bit more. And they have no real incentive to do otherwise. Not when they can just increase their premiums to ensure they turn a profit. And since the ACA caps the maximum amount of profit – as a percentage of their premiums – they can make, it’s actually in their interest to have higher premiums. The whole system is rigged and grotesquely unfair to the patients, and the healthcare providers as well.
There are currently something like 2 or 3 major health insurance companies in the US. They are complaining about how hard it is for them to turn a profit and asking for help from the government. Have you ever heard of an industry so ripe for nationalization?
You must have a different definition of “capitalism” than I do. In the US, the government – at one level or another – controls either directly or indirectly almost every aspect of health care. A “market” for health care and drugs really doesn’t exist, there are so many distortions and disincentives baked into that cake.
If you want to change that to read “This is your health care after politicians and special interest groups have fucked with it”, then I’m on board. Imagine what it would look like under single-payer – one shudders at the thought.
Don’t need to imagine what it looks like. I live in a country where there is single-payer and I’m glad of it. Sure I can get insurance too to get a bit more choice in providers, or nicer rooms if I have to spend time in hospital, or if I want some elective surgery, but on the whole my medical costs are tiny, and my insurance costs a tiny fraction of what they would be in the USA.
transient 9:
Apparently. I mean “profit-driven.”
Right. That’s why CEOs at “not-for-profit” health systems make millions per year.
Tell it to the people who forego their drugs and health care because they cannot afford market prices.
Fantastic! Then we are in agreement. Your quoted text is an excellent definition of capitalist health care in practice.
YES! If by “shudders” you mean “dances for joy in the streets.” After all, we pay more for health care per capita (by far) than any other Western country, and have worse outcomes by almost every measure.
You sound incredibly naive and uninformed. Here, let me help you.
U.S. Health in International Perspective: Shorter Lives, Poorer Health. National Research Council and the Institute of Medicine, for National Institutes of Health (NIH). (Jan. 2013) (brief) (full report).
U.S. versus European healthcare costs: the data. EpiAnalysis (Jul. 2012).
Why the Private Health Insurance Industry Has to Go. Geyman, J., Physicians for a National Health Program (PNHP) (Apr. 2015).
The Business Case for Single Payer. Lieb, T., and Weisbart, E., Physicians for a National Health Program (PNHP), (Jan. 2015). (SLIDESHOW).
Dying and profits: The evolution of hospice. Whoriskey, P. & Keating, D., The Washington Post (Dec. 2015).
Lack of access to health insurance keeps U.S. premature birth rate near Somalia’s. Ingraham, C., The Washington Post (Nov. 2014).
The price of private health insurance. Metz, S., Oregon Live (May 2010).
Inform yourself. I won’t be continuing this discussion with you until you do.
It might look like…Canada! The horror, the horror! Well, except that Canada’s got a higher life expectancy than the US. As do most industrialized countries. Gee, what’s different about other industrialized countries. I wonder…
Anecdata: I’m in Germany, a country which has had universal health care coverage since the 19th century. It’s notably easier to get a doctor’s appointment, including specialists. (Including language screwups.) Costs are lower, even with having to pay up front and get reimbursed by my insurance. I got an MRI on the same day it was ordered and it was cheap enough to pay cash and risk not being reimbursed. And my doctor there…makes more money than I do. So, I should fear universal coverage, why exactly? Better care, quicker, for less, with health care professionals making more money. Who’s losing?
Like…what? I’m not being snarky, I honestly have no real idea what you mean by this and would rather you explained than that I went off on what I think you might have meant.
dianne 12:
Capitalist profiteers who financially benefit from human misery. WON’T SOMEONE THINK OF THE SHAREHOLDERS.
During the original Obamacare debate, I kept pointing out that, under the definitions the opposition was using, we already HAVE “death panels”, it’s just that they operate on a stock incentive.
*****
As for ‘capitalism’–the core of capitalism is supposed to be competition. I knew the opposition to universal health care was completely intellectually bankrupt when, after decades of insisting that government-run health care would be the most horrific offspring imaginable of the IRS, the DMV and the Post Office, they then turned around and said that the Public Option (allowing people to basically pick Medicare as their insurer) was unacceptable because the private insurers couldn’t possibly compete with the government.
Have you seen this: http://www.rawstory.com/2016/05/how-i-got-the-84000-hepatitis-c-drug-for-1500-by-buying-it-from-india/
U.S. healthcare: if you start dying, we might cover your drugs.
India: reasonable price, no problem.
And then it’ll be expanded to cover the immigrants who are taking our jobs and living off our welfare. Schroedinger’s generic government disaster.