Health Care in America is a Predatory System
Will We Ever Fix It?
I finally tested Medicare.
I’m almost 72 and have never taken long-term medicine. I’ve been told that’s unusual. That people much younger than me are often on a half dozen prescription meds. Not me. Thus far, I’ve only used Medicare for annual checkups and the occasional infection, but recently, things changed.
I went to the ER with a fluttering heart rate.
They hooked me up to all kinds of machines to monitor my heart, BP, and oxygen levels. My heart rate was fluctuating between 140 and 160. Eventually, they administered meds to stabilize the heartbeat through an IV. Roughly six hours later, they sent me home with a diagnosis of Atrial Fibrillation.
My mom had the same diagnosis and dealt with it for many years.
The staff were amazing. Great bedside manners, willing to listen, and full of good information. I wasn’t in pain so I chit chatted all night with everyone who came and went.
There was plenty of laughter, too, as I can crack a good joke while under duress.
That was until they brought my paperwork to me and I saw the estimated price of one of the drugs being prescribed. Let’s call the drug Princess Jezebel. Shall we? A 90-day supply cost over a $1000.
I was shocked.
Fortunately, this all happened during open enrollment. Otherwise, I’d be stuck until the following year with whatever plan I had. I placed a call to my Medicare Part D rep, Carly, and asked her to see if there was a better plan that covered the prescription. She said she’d check on it.
However, this particular drug was problematic, because it would put me into the donut hole part way through the year.
Ugh!
Frankly, I had to read up on the donut hole phenomenon because it was never very clear to me. Now I know. Medicare part D coverage keeps track of everything they spend and when my meds reach $4430, I go into the donut hole. Whenever that happens, my cost for the drug goes up — a lot. When you have an expensive drug like Princess Jezebel, that can happen in a matter of months. Once you’re in the donut hole you stay there until the next year. I need a plan that offers a better deal on my particular drug, but I’ll end up in the donut hole no matter what.
In the meantime, while Carly was looking for a better plan for me I bought one month’s supply of the drug at just under $500.
I wasn’t prepared to buy the 90 days’ worth at over a $1000 until I had done a follow-up appointment with my cardiologist to review my situation. Apparently, if I buy a 90-day supply, I get a discount. Instead of roughly $1500, I would only pay the $1058.
Gee thanks!
While I was waiting on Carly, I started looking for other solutions. Could I buy the drug from Canada? After all, I live less than three hours from the Canadian border. Maybe I could drive up once every 90 days and refill my prescription like people do in Texas with Mexico pharmacies.
Of course, I stumbled across online pharmacies which would save me the trip.
The price was considerably cheaper. So different, as a matter fact, that I decided to research what other countries throughout the world were paying for this drug. What I soon discovered is that every country that I looked up was cheaper than the US. Not by just a little, but by a lot, somewhere around a third of the price or less.
Holy guacamole, eh?
How could that be? How do these other countries get their hands on American made drugs or at the very least American patented drugs at such low prices?
This is where my travels abroad came in handy.
I had known for a long time that other countries negotiate a price with American companies for their patented drugs. In other words, Spain, where I have wintered for many years, has a fixed price that they are willing to pay for medication and an additional fixed price that they are willing to charge their citizens. Consequently, Spaniards pay less for the drugs that American companies have developed than Americans do. As do the Germans, Canadians, Swiss, French, and on and on and on.
Their governments look out for the bottom line in order to keep health care costs as low as possible. Geesh! Must be nice.
So how can pharmaceutical companies sell their drugs to every other country in the world for less than what they charge Americans? The answer is because they still make a profit. Otherwise, they wouldn’t do it. Americans just happen to be the only people that they can hold hostage with such high prices. Shame, shame, shame, shame on America.
Turns out America isn’t the greatest country in the world, but then I’ve known that for a long time.
In my search for options, I decided to check out Mark Cuban’s pharmacy. They still can’t get their hands on my prescription drug, but their prices are very good for the number of drugs they can access. You can put your name on a waiting list so that they can let you know right away if the drug you’re in need of is finally added to their available medications.
The saga continues, however.
Turns out that Princess Jezebel has a generic, but it won’t be released for possibly two more years. Apparently, patent issues prohibit generic drugs going on the market too soon, so often they remain high priced for years. So many people must make a choice between eating and buying medication. Fortunately, I’m not in that situation, but the principle of it is enough to make me fighting mad. I’m like that. I don’t need for something to happen to me personally to understand how it’s affecting other people, but a lot of Americans do. We’re not terribly interested as a culture in the collective good of our society.
That’s unfortunate because I believe in the end it will be our demise.
So here I am sorting through the rubbish trying to find a reasonable answer to this problem. I have the possibility of online Canadian pharmacies. That’s something. Also, Carly found two plans that offered some relief but with both plans I will end up in the donut hole by August. It’s an improvement over the plan I currently have, but if I should be unfortunate enough to need to switch to another drug after I change plans, I have no idea what that will cost, and it could put me in the donut hole even quicker.
It’s the inability to know in advance that drives me crazy. What a crap shoot!
When it comes to American health care, it’s almost impossible not to be caught off guard by a bill that could seriously tax the family budget.
All of this left me with one final question which I feel I must mention. Why on earth is healthcare in America so convoluted and difficult to understand. Whether it’s your employer’s insurance before you retire or Medicare after you retire, there is so much to try to put your head around that most people are bound to be somewhat confused about what the hell it’s going to cost them for many services they receive.
There’s a part of me that believes that it is deliberately designed to be confusing, making it easier to protect a health care system that is predatory by its very nature.
I could write an additional article about the decline of employer health insurance or buying health care insurance if you’re self-employed. It’s an endless array of charges on top of the premiums that make it risky business to go to the hospital or get prescribed a lifesaving medication.
Everyone knows the dilemma we’ve faced in this country with insulin prices.
Parts A, B, D, supplemental, copays, deductibles, donut holes, out of pocket costs, what’s covered and what isn’t, Medicare assigned costs, out of network, in network, and on and on and on. Let’s face it, most of us are at the very least mildly confused when it comes to what we’ll be charged when we’re finally forced to use our health care plans.
You need a PhD to stay on top of it. I only have a master’s degree. I guess that’s my problem.
Teresa is an author, world traveler, and professional myth buster. You can find her books on Amazon.
