re: How Do We Fix American Healthcare?

quote:

---

In many (perhaps most) cases, hospital administrations are breathtakingly uninformed as to costs, potential cost savings, and purchasing impacts. A transactionally opaque, anticompetitive pricing environment enables operational incompetence. Often no one, from top to bottom, has a clue as to costs.

---

I have been home for a few years now and I know this stuff changes daily. But when I was in administration, I think we had a good handle on costs, cost to charge ratio, cost reports, large group purchasing, etc. We surely had waste but we stayed ahead of the game. Things have changed and thankfully, I was gone before ObamaCare. But, what you say about the complexity of the whole issue drives home my point that the general consumer can't make two cents out of healthcare pricing. I am all about transparency but the healthcare consumer is the least informed of all industries. You can't kick a tire and pick your hospital based on some arbitrary price list that means nothing to even the back office people that work in the billing office. Someone codes the procedures, someone punches in the codes and out spits a bill. Insurance gets in from there, whoever that might be.

quote:

---

or it's 1/10th of that in Canada and less in Mexico. Same drug. Same manufacturer. In some cases, same packaging. But a ten-fold price difference. US insulin prices have skyrocketed over the past few years.

---

I started this post thinking that tenfold was an exaggeration, so I decided to check out pricing online to see what came up:


Of the most popular basal insulins:

Basaglar: CA: $153/5 pens. In US $250/5 pens

Lantus:
$153 in CA (5 pens) while $286 for the same 5 pens here

Levemir:
$210 vs $462

Tresiba:
$158 vs $608

Toujeo:
$200 vs $308

All above prices are in USD. I've admittedly not looked deep into other particular suppliers but prices seem to be somewhat similar at a few other sites.

It looks like the US is, at face value, more expensive. From somewhere between 40-400%

If you look here, though, you'll see that Sanofi will accept $99/m for a monthly supply of your insulin up to 10 vials/pens per month, which would be cheaper than even the Canadian price advertised for Lantus.


This is all information readily accessible online, but it is far from intuitive. Doctors of write a prescription, and if the patient doesn't complain about the cost, they move on. If patients ask, it is often fairly easy to find a workaround that works for all involved. Being a smart consumer and talking about prices with your physician goes a long way if it interests you or the prices are out of your comfort zone. There are times that nothing can be done, but more often than not there's a workable solution.


And if you want just a good place to start, GoodRx + manufacturer's websites are the best two places to go to look for coupons.

quote:

---

Which countries have the cost of R&D + the years long FDA process worked into the cost?

---

None. We pay; they benefit. I am sure some drugs are developed overseas but I doubt any companies doing the development have the onerous rules and regs of the FDA.

quote:

---

But the current system definitely sucks. But the hospitals aren't totally to blame. They're working within the convoluted rules written for them to operate within

---

I agree somewhat. And I do understand that hospitals are operating on thin margins (but that’s partially because there’s never not a construction crane over the hospital). And I do understand that they have loss leaders. An insurance company I worked for had a major computer company as a client and the hospitals in that company’s headquarters’ area had a flat rate of $350 or something ridiculous for a carpal tunnel procedure. Because the insurance company could.

quote:

---

Even still, I’ve got some good friends practicing in Canada and a handful that came here and never went back. I’d much rather receive treatment here than there. And I’d much rather be a physician here than there, for what its worth

---

The majority of people that have lived under both systems for any extended period of time and have used them come to the same conclusion. I have 22 year in each give or take - as much as I high have frustration here - easy call - here every time.

Not a fan of my 1700 a month premium but that is another story for another time