Americans paying more for drugs
 

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Krugman: Health care horrors
By Paul Krugman

Friday, April 11, 2008
PRINCETON, New Jersey:
Not long ago, a young Ohio woman named Trina Bachtel, who was having health problems while pregnant, tried to get help at a local clinic. Unfortunately, she had previously sought care at the same clinic while uninsured and had a large unpaid balance. The clinic wouldn't see her again unless she paid $100 per visit - which she didn't have.
Eventually, she sought care at a hospital 30 miles away. By then, however, it was too late. Both she and the baby died.
You may think that this was an extreme case, but stories like this are common in America.
Back in 2006, The Wall Street Journal told another such story: that of a young woman named Monique White, who failed to get regular care for lupus because she lacked insurance. Then, one night, "as skin lesions spread over her body and her stomach swelled, she couldn't sleep."
The Journal's report goes on: "Mama, please help me! Please take me to the ER," she howled, according to her mother, Gail Deal. "OK, let's go," Deal recalls saying. "No, I can't," the daughter replied. "I don't have insurance."
She was rushed to the hospital the next day after suffering a seizure - and the hospital spared no expense on her treatment. But it all came too late; she was dead a few months later.
How can such things happen? "I mean, people have access to health care in America," President George W. Bush once declared. "After all, you just go to an emergency room." Not quite.
First of all, visits to the emergency room are no substitute for regular care, which can identify and treat health problems before they get acute. And more than 40 percent of uninsured adults have no regular source of care.
Second, uninsured Americans often postpone medical care, even when they know they need it, because of expense.
Finally, while it's true that hospitals will treat anyone who arrives in an emergency room with an acute problem - and it's wonderful that they will - it's also true that hospitals bill patients for emergency-room treatment. And fear of those bills often causes uninsured Americans to hesitate before seeking medical help, even in emergencies, as the Monique White story illustrates.
The end result is that the uninsured receive a lot less care than the insured. And sometimes this lack of care kills them. According to a recent estimate by the Urban Institute, the lack of health insurance leads to 27,000 preventable deaths in America each year.
But are they really preventable? Yes. Stories like those of Trina Bachtel and Monique White are common in America, but don't happen in any other rich country - because every other advanced nation has some form of universal health insurance. We Americans should, too.

Very timely, Sarah.

At the conference this week an Italian researcher stopped at our table to see what we were all about. Some of the people thought we were there to raise funds.

We explained we were non-profit, run by volunteers. That is a novel concept to many! We are only trying to raise awareness and educate.

The Italian woman told us that when a drug such as Herceptin becomes a standard of care there, it is mandatory that a patient is offered it no matter who they are or where they live. The government pays and for Herceptin the cost is about $1,200 (but she may have meant Euros).

My insurance is billed about $6,000 for my Herceptin alone each treatment. Some of you pay more.

An interesting woman from Argentina talked to us about the HER2 testing also being standard in that country now. Joe and I were recalling that in 2003 in San Antonio the oncologists from other countries (such as Mexico, India) were telling us that there was NO MONEY to pay for tumor testing. No wonder a cancer diagnosis was a death sentence.

Nice to see that turning around.

Hello all,
My herceptin costs 1200 euro every 3 weeks (per shot) including the hospital, nurse, etc. that's $1911!!! how is it you pay so much more in the US? Since I pay into a universal health system, it is covered by that. Frankly it is the health insurance companies in the US that are getting away with murder. Someone should do an investigative reportage on them. I highly recommend universal coverage - like democracy it may not be perfect but it's better than the alternative and personally I don't like to think of people dying because they don't have enough money. As for screening, we get constant and thorough screening. Again I am so grateful that my recurrence happened while I'm living in France.
I hope Americans won't be persuaded by the cynical advertising of the insurance companies to be afraid of universal coverage.
My father was a doctor and worked in Canada, England and the US and we all loved Americans and living in the US but my father liked universal health care because he felt it was fair to everyone. Don't forget that the US gov't pays twice as much per person for health care - I suppose because the desperate get treatment only when they need everything or all the emergency room visits. who pays for that? on top of paying large sums to the insurance industry.
But it's not a question of cost, it's a question of humanity. As a deeply religious country, the US should appreciate that.
I wish good health and happiness to all of you,
sarah

A universal health system won't be 'FREE' as it is often perceived - we will have to pay with a much higher tax rate on our income - as our taxes are much much lower than in the UK or other european countries. And, the costs of the universal health systems in other countries are becoming a financial burden on the governments and some are in danger of imploding in coming years as the cost outweighs what the taxes bring in to support the programs. They are currently grappling with this potential in many countries. Most countries also have individual insurance situations that supplement the universal systems. Also, is the UK one of the countries where it depend on what health district you live in as to whether certain drugs or treatments are approved?

I know our system is complicated and certainly not perfect, but there is not a health system in the world that is perfect, fair and totally free, no matter what the perception of it is. It is a complicated situation for which there are not easy answers.

Hi Pink -
That number of $6000 was for a 3-week dose of Herceptin. The other lab and nursing services are on top of that.

When I had weekly along with Taxol and Navelbine, the Herceptin cost a lot more than the other two drugs combined, but don't recall the exact number at the moment. But it was close to $3,000 each week.

We had a thread started by Sheila about how much everyone paid for their Herceptin. Her clinic was charging by FAR the most, at something like over $10,000. She got it reduced based on all the info the rest of us gave on our much lower charges.

We have visited this subject before, and I will say it once again - I agree with Pink and sarahdalton. You would have to pull me screaming and yelling from my home before I would give up our Canadian universal health care. It's not perfect, and we do pay higher taxes - but Americans pay high insurance premiums, so what's the difference? The difference is that everyone is covered equally.
You get diagnosed, you can see any doctor you want (no HMOs or "sorry, that doctor is not in your network" stuff), you get your treatment and do not have to fill out any forms or worry about how much the treatment is. No one is mortgaging their home to pay for Herceptin, or wondering if they have to choose between putting food on the table or take their child in to the pediatrician...

Yes, we pay for supplemental insurance, for stuff like semi-private hospital rooms, dental services... but most medical expenses are covered. If your child is born and has to go to the NICU, it is covered. If you need Herceptin, it is covered. Yes there are some longer waits for some surgeries, but the majority of the system is working, and working well.

The American insurance companies will continue to use their scare tactics - the American health care system would somehow fall to its knees if universal health care would be brought it ... Uh no, I think their profit margins would be plummeting. As I have said before, our system is not perfect, but it is equitable for all citizens.

Ok, Pink and Caya, stop that bragging right now and shed a tear or two for those of us fighting our insurance companies to keep our Herceptin going! No, really, I haven't got a clue what is best. I just know I'm willing to do battle to keep getting herceptin. My doctor went to bat for me with the director of the insurance co. last month to get me 3 more months. Not sure what will happen after June 28, but I'm praying someone far wiser than I will figure this all out and go to battle for us all! There are too many who don't have the care they deserve. I'm blessed and I'm grateful! Luv to all of you warriors, ma

Hi everybody! I hope you're all doing well. I'm not a very good computer person, so I thought it would be better for me to ask you guys. I wasn't involved with cancer when Herceptin and alot of the chemo. drugs came out. Where did herceptin come from, and who funded the research?

Steph you are right...my Herceptin ran about 12,000 every 3 weeks, I did get them to reduce it, not I am getting it every 2 weeks to coincide with the Taxol and it is 8000.00.....which is really cheap I guess compared to the 20,000 a pop when I was getting Avastin....with the Taxol figured in, the blood counts , the premeds and the infusion and supply charges, my chemo bill was running 65,000 every 2weeks!!! I remember the bill for November included installing the port, and my November hospital bill was 150,000....my hubby always says that port is the most expensive jewelry i will ever be wearing around my neck!

If we didn't have our system, would anyone be interested in doing research? BB

Hi Bill,

Read "HER2, The Story of Herceptin, a Revolutionary Treatment for Breast Cancer", by Robert Bazell. Very interesting book that tells how Herceptin came to be and where the funding came from. I found it at the library but it can be ordered from Amazon.com

All my best,

I agree with Caya, I really like my universal coverage and I've been through the US private insurance method and universal and I'll take universal. I'd like to ask some questions and hope they won't seem rude:
1. what is the cost you pay plus what your employer pays for your insurance?
2. Can you see anyone anywhere in the US or do you have to chose for a list? (with my PPO in the US I had to chose from a list and the surgeon who did my biopsy quit the system before the next surgery!)
3. Does your conscience bother you that others with less money have problems getting medical insurance?
4. What about the fact that the US gov't pays twice per person what gov't with universal health pay person? Isn't that a kind of tax?
Also our taxes go to good roads, hospitals, schools, the police and fire dept. etc and here where I live we have 6 canadair fire plances - in LA that yearly went up smoke, they borrowed one from Canada one year!