Hello everyone. Time for one more instalment of my humble reportage from America about our healthcare system as I have come to know it and experience it. As I have said before, I am very lucky to have the insurance that I do, but if there is one area where I am likely to “lose my cool”, (as we baby-boomers used to say) and go off on an endless rant, this is it.!
Let me start with an example from years ago. I had excellent insurance thanks to my school district when I was working, and even after I retired, until I was old enough for Medicare. Even luckier, I paid very little – if anything – for this insurance. But like all insurance plans that I know of, prescription drugs are layered into tiers, based on what they cost. The higher the tier, the more you are going to pay. Generally, plans will pay for a level-one or level-two generic drug. Regardless of the cost, you are charged a set co-pay for each prescription: in my case that was $8 for up to a month’s supply. This method also holds true with Medicare and/or supplemental insurance, but the co-pay may differ greatly; and there is also a list of drugs on any particular plan where the insurance company will not pay anything at all.
Because of my psoriatic arthritis, my rheumatologist at the time did blood work to assess my levels of vitamin D. I barely showed up on the scale at all, let alone have anywhere near enough vitamin D in my system. So I was prescribed a huge amount of vitamin D to correct this problem. Technically, the dosage was well above any over-the-counter pills that I could buy, and should have qualified as a steroid. But as soon as the insurance company saw the word ‘vitamin’, they refused to pay one red cent toward the drug.
Knowing that different places charged different amounts, I started checking around. I called a number of local pharmacies, gave them the dosage and the number of pills that I would require for a month’s treatment, and asked them to look up the price. The lowest price I got was from a national chain of mini-drugstores, who quoted me a price of $86. Every other pharmacy went up from that, to where one pharmacy wanted to charge me over $500 for the same thing. I was dumbstruck. How could this even be possible? And some of the pharmacies that are always advertising how they will save you money, well they’re up there in the $2-$300 range. Absolutely unbelievable. Obviously I made the choice for the cheapest prescription, but I know a lot of people would not even think to look at the prices for their prescriptions, and would just order them from the place where they normally shop.
Then when Obamacare came along, major drug manufacturers were afraid that limits would be placed on them, so they immediately began price-gouging – increasing the normal price of many common drugs by several thousand percent. And do you want to hear the real scandal of all of this? Thanks to the power of the Republican Party in Congress, Medicare is not allowed to negotiate prices with drug companies. So the government-backed healthcare system that we do have, must pay the going retail price for any and every drug. Needless to say, those congressmen receive huge political contributions from major drug manufacturers, while the taxpayer foots the bill.
Another example from my own life under Medicare: I have recently been diagnosed with glaucoma, a disease which robbed my father of his eyesight. I was already using one kind of eyedrops to lower the pressure in my eyes and hopefully prevent the disease. Once diagnosed, I was prescribed a second eyedrop, and the ophthalmologist gave me a free sample of the drug so we could see if it would be effective or not.
Sadly I ran out of the sample a few days before I was to be retested, so I had to scramble around to find a local pharmacy that had the drug in stock, and an eye doctor to prescribe it. This all happened on a Saturday afternoon, when neither of those things is generally available. Through some luck I was able to get to a local pharmacy 10 minutes before it closed, to pick up a bottle of the eyedrops. The pharmacist said to me, “You do realize the bill for these eyedrops is $125, don’t you?” I almost passed out. The price should have been $8 according to my plan. I said I didn’t know, but I needed the eyedrops, so I paid the bill, figuring I would sort it out with the insurance company later.
Well, guess what? My new eyedrops are a tier-three drug. So for the privilege of not going blind, I must pay an annual deductible of $100, plus one-third of the current retail price for each tiny, tiny bottle of these drops. At the time, the retail price was $75, so that’s a total cost of $125.
Next visit to the eye doctor was the following Monday – and I am very pleased to report that the eyedrops are effective in controlling my eye pressure, and thus my glaucoma. A huge relief… until we placed a new prescription with my mail order pharmacy for more bottles. It turns out that the price had more than doubled since the previous Saturday. What a surprise. So having met the deductible for 2020, I am now privileged to pay a mere $50 per bottle! Talk about sticker shock.
Later that week, my wonderful cleaning lady came to the house, and I was telling her my tale of woe about these eyedrops. Now she has relatively good insurance because of her husband’s former employment, and she began to tell me about a cell-phone discount app that might save me some money, and which she uses every time she goes to the drugstore. So she looks up what she would have to pay for the same drug, same size, same potency. Her discount price was $273. What the ….?????????? So I guess if she gets glaucoma, she is going to have to do a lot more cleaning to avoid possible blindness.
This is what people in the military might well describe as a Charlie foxtrot. Out of a sense of decency, I will avoid translating that into English…. Or what we refer to as English on this side of the pond. 😉 Suffice it to say it is not a complimentary term.
Now I don’t know what system you have in place with your national health service for prescriptions, but I am guessing you would rather have that, than the mess we have. I would think long and hard before allowing this kind of highway robbery to replace whatever system you now have.
So there you have it… yet another facet of the wonderful healthcare system we deal with here in America. I am not sure, but this is perhaps the last article that I will be writing for West Country Voices. We shall have to see. At any rate, I am hoping that my meagre submissions have provided you some insights into what you can expect from a semi-privatized healthcare system.
Best wishes for continued good health,
John from across the pond