Tuesday, November 21, 2017

The United States' messed up health and health-insurance system

Our health industry in this country is messed up. I was prescribed a med back in the spring, and for ease of everything, I had it filled by the pharmacy at the Mayo clinic where my doctors are. All I had to do was walk downstairs. It cost me $15. I didn't think much of it, figuring I must have a $15 co-pay (my insurance has changed co-pays a number of times the past ten years, and since this is my first long-term prescription, I hadn't really paid attention to the current values of the co-pay).

The second month I refilled the prescription and it was $15. Woo hoo - consistency! At least the price wasn't randomly changing.

Out of curiosity, I asked the clerk if that was my co-pay amount, or if the co-pay was larger and this medicine was just $15. She said, 'You have no insurance on this.' 'Oh pfffft,' I said to her, 'I assumed that since Mayo has my information that the pharmacy would have it as well. 'No,' she said. I banished her to serve at the Ice Wall for her frostiness, and I trotted off to get my insurance info and brought it back to the pharmacy later. So to recap: the full price of the medicine was $15, for me, an apparently insurance-less person at the time. $15 is the price without any insurance interference.

After they got my info, the cost of the medicine went down to $5.60, of which I paid $1.80. So the medicine that cost $15 for uninsured people now cost just a bit more than 1/3 of that (and my cost was now less than a third of that new negotiated price). I went from $15 a month to $1.80, and the insurance was charged $3.80. The pharmacy gets $9.40 less from the insured than from the uninsured. And now that I have to mail order, the pharmacy gets nothing.

Then, after using my insurance that one time, I got a letter from my insurance saying that this medicine needs to be fulfilled by their own mail-order prescription system, and not the pharmacy, or else I would be charged more than that one-time co-pay. 'Fine,' I thought, 'Mail service for me it shall be. How wonderfully old school, but also convenient, that they'll automatically send me my medicine every three months.' I filled out on-line the information they needed, and the prescription for three months was $4.60.

So, to recap, I went from $15 a month to $1.80 a month to $1.53 a month. The mail-order price also includes shipping.

That was three months ago. Today, my second shipment of medicine for three months arrived. This time it cost me $3.16, which is a third of a cent more than $1.05 per month.

I am blessed to have health insurance! But the system is so rigged. A person without health insurance, and let's assume they work a full-time job but it's a minimum wage one which is why don't have insurance from their employer. would be paying more than two hours of his/her labor per month for this medicine. A total of $180 for a year. That is three days of full-time work plus one more hour. Or let's assume our person in need is homeless - and so many of the homeless that our street ministry work with need prescription medicines and most don't have insurance (some have medicare [or Medicaid, I can never remember what the difference is between the two, and that's not important now anyway] or here in Wisconsin, they might have BadgerCare). For an unemployed homeless person, even a $15 a month prescription can be an impossibility. Hell, let's be honest - it's damn near impossible for them to even get to a doctor to have a check-up and have a prescription written out, so whether they can afford is itself a moot question. They can't even get to a doctor to get a prescription. That's outrageous, and a shameful state for the supposed greatest country in the world, or for the factually country with the largest GDP in the world that exceeds #2 by about 70%. And we can't afford to help our homeless brothers and sisters? Can't afford to offer healthcare to all our citizens? Pshaw. It's not a matter of money, it's a matter of too many people not having the moral will to make it happen.

And yet my insurance company, because of their power and ability to negotiate, would pay the clinic just over a third of that, $67.20. [But of course, now the clinic gets nothing because of the mail-order requirement.] I don't know what the insurance company gets charged now from whomever they are buying the pills, because that information isn't on the paperwork I receive, but I'm sure they're paying less than the $5.60, because a) otherwise they wouldn't require the mail order service since they'd be paying more, and it must be less than $5.60 b) because the cost of shipping the meds is included in the amount they charge me.

And that's one example of what's wrong with our for-profit health-care system that is also so employer-dependent for people to have coverage - yes, the ACA has really helped get a lot more people covered, but it's still a system in which employer's are paying for most of us. Basic universal healthcare for everyone - a moral society would say "We have the money!" and make it happen. Let the insurance companies and employers offer bells and whistles plans and coverages if they'd like, but We The People ought to be taking care of one another to ensure that no one goes without preventive care, no one goes without the medicine and medical care they need, and no one should ever have to declare bankruptcy or steal money or sell all they own simply because they got sick.

This Thanksgiving, I am very grateful for the insurance I have - I've had a lot of medical this year, and if I'd had to pay it all by myself I'd be in a lot of hurt. But there are far too many people who cannot be thankful because we who are rich and well off refuse to give them anything to be thankful for. To continually ship people's jobs oversees, to reduce their healthcare or to deny it altogether, to consistently refuse to make it a law that employed people should be paid a living wage, to continually increase the pay and benefits to CEOs and other executives while reducing pay to the folks low on the ladder, or just firing them because it will make this quarter's earnings look awesome, to continue to imprison the poor at ludicrous rates instead of helping them, to introduce a "tax plan" that will benefit the rich and harm everyone else even as the "Christians" who wrote it constantly bear false witness about it... --- and then to constantly harp on how folks ought to be thankful? That's immoral.

We're better than this, America.