What follows is a story that is true in every detail, a tale that is, to borrow a phrase from ex-President Bush, "uniquely American." Rather than giving away the ending, I will tell the story chronologically (and for the sake of the reader, as succinctly as possible).
Nov. 30, 2010: Recognizing that I would run out of a prescription medication sometime in early January, I called my doctor to make an appointment. As is the case with most "managed care" insurance plans such as the one offered to employees of my current university, patients are funneled through a ludicrously small number of "primary care providers" who serve as gatekeepers to specialist physicians, lab tests, outpatient care, and prescriptions through the insurer. Since it takes an average of around 6 weeks (yep) to see this overwhelmed small medical practice, calling shortly after Thanksgiving afforded me a slim chance of seeing the doctor before my pill bottle ran dry. I was lucky enough to secure an appointment, though.
Dec. 31, 2010: My Blue Cross health insurance expired effective this date because…
Jan. 1, 2011: Having had the temerity to get married in 2010, I started a new insurance plan with the new calendar year under which my spouse is also covered. The new insurer (I will point no fingers, but it rhymes with "Miser Hermanente") sent me not one piece of information in the four months (August 7 wedding) preceding this transition. Not an email, not a new insurance card, not a form letter. Nothing. I had to re-check with HR several times to ensure that I had filled out the requisite paperwork correctly. I was assured that new coverage would begin on 1/1/11.
Friday, Jan. 7, 2011: I saw my doctor for about 30 seconds. He wrote me another 12 months' worth of prescriptions and refills. See you in 2012, health care provider! I'm glad we had this talk.
Saturday, Jan. 8: Having missed the closing time of the Kroger pharmacy on Friday evening, I went to pick up my medication on Saturday morning.
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They informed me that my old insurance number was invalid.
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Never having received a new one, I called Miser Hermanente. They have no customer service reps of any kind available on weekends. None. I resolved to call them first thing on Monday and return to Kroger.
Sunday, Jan. 9: My prescription ran out. Abruptly quitting anti-seizure medications can cause…seizures. I am worried.
Monday, Jan. 10, 10 AM: I call Miser Hermanente and discover that due to inclement weather, all Georgia offices are closed and only a skeleton crew is available. The weather is no one's fault. I wait on the phone for an hour before a nice, harried lady tells me they have no record of my existence. I have no account number because "They're a little backed up entering new customers for 2011.
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" 30 minutes pass before she manages to push whatever magic buttons are necessary to enroll me in their system and give me my very own ID number for the insurance plan.
12:00: Armed with this information I return to Kroger. They cannot bill my insurer because Kroger pharmacies are not in the Miser "network." Nor is CVS. Nor Walgreen's. Nor Wal-Mart. Nor…anything except Rite-Aid, which I thought had gone out of business in the mid-80s. The nice pharmacist calls all three Rite-Aids in town to transfer the prescription. None are open due to the winter storm (or what passes for one in Georgia).
1:00-3:00: I work the phone attempting to find an open Rite Aid and arrange the necessary bureaucratic mating rituals. Shortly before the Kroger closes at 3, I find that one pharmacist has arrived late in the afternoon at an open Rite Aid 25 miles away. I catch the Kroger pharmacist as she is walking out the door. She angrily agrees to call the Rite Aid for me.
4:29: I arrive at the Rite Aid. Due to the lack of snow/ice removal equipment in the south and the complete inability of anyone in Georgia to drive a car in winter conditions, the 25 mile trip takes almost 75 minutes (I left around 3:15).
4:30: Armed with my Member ID number, I stride with pride into the empty Rite Aid. The kind pharmacist readies my medication, and none too soon. I am feeling shaky (literally and figuratively) at this point.
4:35: Apparently, says the pharmacist, Miser uses some subcontractor to manage its prescription billing and they have no record of my existence.
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My ID number and other information from Miser is useless. I call the company again. Fortunately, wait times are reduced as more employees staggered into work throughout the afternoon.
4:55: With the Rite Aid about to close (and freezing sleet starting to come down atop the snow) the Miser representative gives me a final "I give up. Call back tomorrow or something." I take out my American Express and pay $633.35 for 30 pills – about 55 hours after I went to pick up the prescription the first time.
April, 2011: Ed receives reimbursement from his insurer, although it is much less than the amount he paid because their rules state that prescriptions should be billed directly rather than paid and submitted for reimbursement.
THE MORAL: Aren't you glad we don't have government-run health care? Just imagine the high cost, poor customer service, long wait times to see a physician, and nightmare of bureaucratic hoop-jumping we would have to deal with. Why, we would have to navigate a labyrinthine bureaucracy for days on end just to refill a lousy prescription.
Alvin B. says:
Careful, someone might think you're serious about the moral. Seriously.
Natalie says:
But you see, Ed, you work for a UNIVERSITY which is librul and run by the govnmnt. So you're already part of that bureaucracy. And not deserving of healthcare anyway.
Ursula says:
I have been with this Miser company, but in another state. When I was with them, I could not get my prescriptions from from Target or CVS, but I had to go to a Miser pharmacy. From your description, however, it sounds like this infrastructure in Georgia.
Hobbes says:
And this is why I am thankful that my TA union has negotiated with the university so that our prescription insurance (Navitus, I think) covers prescriptions through the university clinic. Well, that and I live in Wisconsin where snow is a YOU HAVE SKIS FOR A REASON sort of event where things like pharmacies stay open even when we get several feet of the stuff.
rumor says:
Ed, you glorious bastard, my condolences for your wholly undeserved troubles (no one deserves such shit anyway).
Unrelatedly, I'm not that hot on buying stickers… is there a way I can just donate directly to the august foundation that is G&T? I recall a brief donation option a while ago and how you weren't comfortable with it, but I feel like paying for the words I look forward to reading every morning. You know, like I would have paid for a book.
Marinus says:
Here's a story from a single-payer-healthcare system for some contrast. Here in New Zealand, my dad lives on a farm near a rural town called Taumarunui (every bit as lively and exciting as that name sounds). A few months ago he had some digestive troubles that worried him enough to see a doctor, so he drove to town to the local clinic. After the examination, the doctor informs my dad that while it's not too bad now, his intestines will only get worse in time, he'll need to get operated on sooner or later, and they'd prefer to do it sooner. Taumaranui is a has-been town with an unemployment rate many times that of the national average, fast depopulating with almost only poor brown people left, and correspondingly largely abandoned to the fates, so while there is a building there called a hospital, it's not running as such since the local health board can't afford the necessary staff. Instead, the doctor has an ambulance waiting outside for my dad, who thentakes him on the 2-2.5 hour drive to nearest city, Hamilton. He gets put under observation, operated on a couple of days later, spends the rest of the week recuperating, and gets sent home. The district nurse checks up on him on the farm a few times in the next fortnight. Total cost to my dad: the initial doctor's visit, since everything else was done on doctor's orders in the public health system. He is in a low income bracket, so with the government subsidy for his doctor's fees that would have cost in the vicinity of US$20-30.
Not a sugar-coated story — after all, there isn't a serviceable hospital within 2 hours of a once-important-and-sizeable town — but what happens when a state sees the health of its constituents as a basic function of government.
Forgetful_Man says:
A word from the socialist workers' paradise to your North: Not surprisingly, last weekend I looked in my magic pill bottle and realized I was running low on what sounds like a medicine similar to yours. Solution? Call Dr. Office. Not open. Walk to clinic at end of street. Show govt healthcare ID. Wait 20 min. See Dr. Walk out with prescription. Walk across street to pharmacy (which I have never been to before). Show govt. healthcare ID. Get prescription filled. Cost? $100, which people's govt. of British Columbia will reimburse me for, because I had forgotten my pharma card as wasn't in this pharmacy's system already.
Are taxes high? You bet they are. Do feel I got my money's worth when it mattered? You bet I do.
Nunya says:
Jesus, Ed. Sorry to hear about your recent run in with the joys of the HMO.
For some reason that I cannot explain, many of my contemporaries feel certain that a government run health service would be far worse. How, I cannot imagine but it is son ingrained that it seems an impossible task to convince them that the rest of the industrialized world never spends a moment's thought about receiving healthcare for little or no money out of pocket.
America is fucked for a variety of reasons but first and foremost is that we are so bothered that a person that has a shitty job or no job might sit next to us in a doctor's waiting room. I mean, how ghetto is that? It's like rifing a city bus ferchristsake!
Maybe when 51% of Americans have no reliable access to healthcare we night rethink our position.
Cokehead says:
A very close friend of mine got close to dying in this country, actually. Turns out he was misdiagnosed (probably, can't afford to check to make sure) – but had the diagnosis been right, he'd of been dead right now, and it's because there's no way he could pay for his own meds. He'd be functional so long as he was on the meds, but without them, he's basically stuck in his house. But, as soon as a virus pokes in slightly a little bit…
Still irks me really badly that there was literally nothing I could do and my best friend could've died within a few short months, and the country everyone calls great would give exactly zero shits.
Lawry says:
This is nothing but mind-boggling to us Scandinavians. How the American electorate fails to consult easily accessible human development data before rejecting state healthcare is simply incomprehensible. Sorry for your misfortune!
comrade x says:
Americans still labor under the delusion that their employers " pay" for their health care. Not understanding that they actually pay for most of it themselves. Or that certain congress critters are proposing an elimination of the tax breaks that employers get to keep costs down.
Yeah, your typical American blowhard would rather die of curable ass cancer than admit he has anything to learn from " old Europe".
Prudence says:
I read this to my English mother, who kept repeating, "how can they do that?!" An understandable reaction considering she is over 70 and can have her free NHS prescription meds *delivered to her* (also for free). Sure, the NHS has its faults, but neither I, nor anyone I know, has ever had a problem with them. Which, of course, is why I am rabidly supporting the Robin Hood Tax proposal, rather than reduce funding for vital services like schools, universities, hospitals, libraries, etc.
And Cameron, that predictable bag of Tory excrement, is raising the Value Added Tax to 20% while lowering the top end tax for rich fuckers.
anotherbozo says:
I used to think we'd have national health care when the headless monster Capitalism figured out our corporations can't compete on the world stage without it, that not every fucking American job could be outsourced or downsized and our companies can't campete internationally or survive hard times while having to pay health benefits to even the upper eschelon of employees. But then I realized that Capitalism in its current guise is all about short-term greed, not long-term investment, is properly thought headless for a reason, and the Koch Brothers and Richard Mellon Scaife are never going to realize that it's in their best interests to get out of the way for a real national plan.
Your story makes me–an old fart on Medicare who has no similar terrors to relate–more than furious, Ed. As if that does any good for anyone.
Major Kong says:
But! But! We have the best health care system in the world! That's what they keep telling us!
It has to be true – right?
Southern Beale says:
Ya know, NONE of this would have happened if you hadn't gotten married!
[ ducks }
Hazy Davy says:
I, too, switched to Miser Hermanente when I got married (though it was a long, long time ago…)
And I had similar (though not as terrible) experiences. I would say that I'm now MH-proficient.
Is there an MH-run pharmacy (perhaps near your primary care physician's medical office)?
In many states, medicines (such as anti-siezure medicines, I assume) can be dispensed under urgent conditions, without a renewal prescription. In those cases, can't you say to Kroger, etc. "I need my anti-siezure medicine" and they can call over to MH, and work it out? More importantly, the schmoe at the desk usually isn't a pharmacist. So it would be better if you asked to speak directly to the pharmacist, and then used magic words (like "siezure"), and folks will typically help you out.
MH is a non-profit. With that, you get both good and bad things. But once you're settled in to it, it's pretty sweet. (Though I can't recommend the pre-parent classes…and neonatal care classes…full of nonsense. I had to spend 30 minutes imagining my cervix opening up like a flower, one time. My imagination's not quite good enough.)
Ike says:
And it's not just the big rich socialist countries. My fiance lives in the Philippines, makes $300 per month, and has better access to medical care than I do.
Tim H. says:
The private health care system is bit like welfare for the investor class. I guess they'll surrender self respect for enough money.
j says:
Wow, sorry about that Ed!
Someday I hope all these horror stories will finally convince people that there is a better way…
ladiesbane says:
Sigh. If I can be of any assistance, please let me know. As a person who has worked in insurance for most of her adult life, I've untangled that exact problem from most of the angles.
But (to you and to all who read this), let me stress that if you have a qualifying event that changes your enrollment status, you should notify the carrier within 30 days. Also, most carriers have online registration that allows members to make enrollment changes and orchestrate prescription refills online (along with online physician consultations, viewable EOBs and claims, and other useful tools.) Both KP and BC have very rich online options.
Though it's true that hiring a few web consultants replaced a swarm of phone reps, but phone reps are often confused, harried, improperly and incompletely trained. The website gets it right more often, with no waiting.
Jude says:
So where's bb? It seems like he should show up to tell us how we're all wrong, and that government-insured (or, perish the thought, government-run) healthcare is wildly inefficient and the first step on the road to OMGCOMMUNISM!
bb in GA says:
bb here…
Ed, sorry for your distress especially w/ a life altering situation.
I have worked w/ folks in similar situations in our homeless ministry where the paperwork was behind the curve. The usual resolution in the short run if you have a valid prescription is that you can get a day, or a few days worth of the medicine to bridge the gap until the admin hairball can be coughed up.
I am suprised and very sorry nobody helped you on that level. It is quite common.
I think Jude, you are offering a false choice besides putting a bunch of words in my mouf. The European/Canadian model or what we have now are not the only two choices.
Anyone who is not knee walking stupid knows we need to do something different. But it is not some BS concocted into 2000+ plus pages, read by nobody, and passed on Christmas Eve that won't really take full effect till 2014.
We can do better than that, and I believe we will…
//bb
AL says:
You should consider yourself lucky. I have to pay full price for my prescriptions each year until I meet a $1000 deductible. That means I pay $360 in January and $360 in February…but in March I only pay about $342, because after I reach the deductible, the insurance company pays 80% of the prescription's cost (after a $40 copay each month!) By the way, I work at a university in the US.
AL says:
…I forgot to mention this in my previous post. This glorious insurance plan costs only $403 per month! Thankfully, my employer pays $343 of that total.
Tosh says:
Apples and oranges…
I can not speak to a GOV run Healthcare system as
my experience is VA and I think they do REALLY GOOD job.
You were caughtup in a PRIVATE RUN INSURANCE system.
Which is exactly what is to be prevented…
Tosh says:
I have said this before and I will reiterate:
YOU ARE ALL, WITHOUT EXCEPTION, GOING TO GET SICK AND DIE.
How you get there is another story
MarilynJean says:
I think Ed did everything he could do within his power. It also states in his narrative that he checked and double-checked that he submitted the correct paperwork at the appropriate time. I don't think Ed needs any wouldacouldashoulda advice. This is what it is: a prime example of bureaucracy fucking over an individual and why, as bb states, we need to do something different about our healthcare system. (Did I just sorta agree with him???!)
Kulkuri says:
I guess things have changed. 30 years ago when I worked for Lockheed in Beautiful Downtown Burbank I had "Miser" for the family health plan. They had their own hospital and numerous clinics in the Valley. I didn't have any problems and was happy with their service. My glasses only cost me the charge for the 'photo-gray' treatment. The Old Lady on the other hand had to wait over a year for an appointment for her female parts, by then we had moved to Tucson.
Kim says:
As someone with several chronic health issues, I can identify all too well with this post. The sad thing is that the insurance companies seem to always get away with this shit because we haven't been united enough to present a viable alternative. It's not about notifying your insurance company in time (as was said, he did that multiple times), it's about the fact that we Americans don't seem to see even the most basic health care as a human right while, at the same time, finding it a right to carry semi-automatic weapons as if our lives depended on it.
It makes me sick. But I guess I should fix that because if I'm sick no one will pay for my trip to the urgent care.
ladiesbane says:
@MarilynJean: I hope you understand that recommending practical steps to keep from falling through the cracks should not be construed as an endorsement of those cracks. Until we switch to single-payer (sometime before I die, hopefully) the cracks will exist. And learning how to navigate the labyrinth will help.
MarilynJean says:
Yes, I understood it…and still found it unnecessary and condescending. But that's just me. Ed may have found it enlightening. So, either way it's cool.
Monkey Business says:
Honestly, I can't empathize. I work for a major nonprofit healthcare system. If I got sick enough, I'm pretty sure my insurance covers transferring my brain to an android body, either permanently or until they clone me a new one.
JohnR says:
Sorry, Ed. Hope you at least got some Nietszchean (sp?) benefit from the experience, and I'm glad that at the core it worked out all right. I won't go into the whole terrible health-insurance mess; what is there left to say? Except of course, "bb, you incredible wild-eyed optimist, you!"
"We can do better than that, and I believe we will…" snork.
BigHank53 says:
To help unpuzzle our non-USAian readers, here are the two reasons why Americans won't enact a decent single-payer system.
#1. Poor people will use it. Poor people are UNDESERVING, because if they deserved anything they'd have MONEY to prove it. (Do not bring up Jesus at this point unless you enjoy watching people writhe.)
#2. Also, many poor people are BROWN. A doctor might touch a brown person and then touch you, and you will catch POOR BROWN COOTIES.
JohnR says:
Also, too, stickers + shipping don't thrill me at all, so tell me why should it be true, that I can't Paypal stuff to you?
jazzbumpa says:
He is a major, and illustrative, piece of the problem
Apparently, says the pharmacist, Miser uses some subcontractor to manage its prescription billing and they have no record of my existence. My ID number and other information from Miser is useless.
Subcontracting is only done to save cost. People like Ed get in the way of Miser's bottom line.
What this illustrates is the the free market system is fundamentally incompatible with a certain subset of societal goals, and the general health and welfare of citizens makes that list.
I don't believe there is any mechanism for private insurance to add value to a health care system. All it can do is limit access and raise costs – with no societal benefit.
JzB
Wes says:
Perhaps a government run system would yield better results for you, but it seems strange to blame this on the "free market." Surely reasonable people would agree that our current health care system is a mixed system subject to both serious government intervention and market forces.
Getting the healthcare run-around really does suck though.
mangrilla says:
"the complete inability of anyone in Georgia to drive a car in winter conditions"
I think you mean: "the complete inability of anyone in Georgia to drive a car."
There.
Similar thing happened to me when I lived in DC during Snowpocalypse. I was on Healthcare set to go up $100 a month and switched plans for the beginning of February. Then Snowpocalypse came and when a random homeless person attacked me in March, they still hadn't processed the paper work. I got the privilege of paying $800 out of pocket for a doctor to shine a light up my nose and inform me that it was broken. Then I got to pay another $40 for my extra strength tylenol prescription and some antibiotics.
But yeah, America's healthcare system is totally number 1.
Edward says:
What you need is the health care plan available to members of congress.
jazzbumpa says:
He is a major, and illustrative, piece of the problem.
Shit.
Here is . . .
JzB
Expatriesse says:
@ Tosh:
Apples and oranges
Expatriesse says:
Sorry – something interesting happened when I posted –
@ Tosh – if by VA you mean Veteran's Administration, you ARE using GOV healthcare.
Southern Beale says:
I guess this is one of those scenarios where having "choice" among a variety of "health insurance plans" might have worked. I mean, I've said from day one that "choice among insurance plans," which was held out to us during the healthcare debate as some kind of shiny-sparkly panacea that would cure all of our ills, was just to my ears one gigantic fucking hassle. Who wants to spend their time combing through the BS advertisements and reading the fine print to find the perfect plan for them? All any of us want, ever, is to go to the doctor of our choice when we want to and nut get reamed in the wallet in the process. And add to that: get our prescriptions when we need them and not get reamed in the wallet in the process.
The fact that American healthcare can't do these two simple things efficiently, economically or even adequately is proof that the current system is broken. But don't listen to me, I'm just a silly little housewife, what the fuck do I know.
Southern Beale says:
Sorry for the typos. I'll go away now.
comrade x says:
I will agree with bb on one point… seems that the major point of the Obama healthcare plan was to shelve the discussion of a single payer plan until 2014.
Denn says:
Quintessentially American. This is, indeed, a result of our "free" market – that is, one where the five-billion pound gorilla makes the rules. For our aristocracy, the system is not broken in the least. In my world, a free market is a level playing field, needing rules and refs.
Along with his nefarious backroom deal with Pharma, Pres. Obama fucked us with his pro-private emphasis on employer-provided insurance at a time when long-term unemployment numbers were heading skyward. WTF???? Taxes and regs are not the job killers.
Paul W. Luscher says:
But it's all OK, because "government is evil," whereas corporations are "wealth producers" (just don't ask for whom).
merl says:
After reading that I am even more thankful for my government run healthcare. When I need a refill, I just call the VA pharmacy line and get it in the mail less than a week later.
jim says:
http://www.economist.com/node/17723223?fsrc=scn/fb/wl/mr/doctorate
Thought you might appreciate this. Not relevant to this post in particular but certainly to many others you've made.
sluggo says:
Even when everything goes well with insurance, it is still a mess. Between what I pay and my employers portion, the premium is more money than my mortgage.
That is before any co-payments or deductibles.
leon says:
I'm sorry to hear about your struggle with Miser, Ed. And to think, Miser is one of the most highly-rated systems in our fractured health care non-system (along with the VA and Medicare).
Which is really kind of telling; we already have highly-functioning gov't-run health care: the VA (similar to the NHS from what I can tell), and Medicare (similar to Canadian-style single-payer). Neither is perfect, but both are systems that participants realize are better than the alternative.
I can only hope that Obama's giving away single payer before debate began, and not doing anything to make the "public option" very public or much of an option before doing away with it entirely, was a masterful chess move to give us single-payer in 2014 (as Comrade X said earlier)… but I'm not holding my breath. We'll be lucky to keep any of the good parts of the bill after the Repubs get their hands on it. Repeal may be a hollow threat, but gutting it is a very real probability.
marismae says:
I wouldn't mind private run health insurance if it was a not-for-profit when it came to to 'basic' healthcare. And by basic I mean the preventative care, as well as the latest life-saving treatments for the diseases we're inflicted with, and in-patient hospital care, etc…
Most insurance companies probably wouldn't operate on an entirely not-for-profit basis though, because they've gotten too greedy now that they've had a taste of capitalising on the illness and suffering of others. So, they could offer premium or extra services to people willing to pay. Private rooms, plastic surgery, vision, dental. The vision and dental would probably be more affordable for people if they didn't have to pay so much right now for basic health insurance anyway.
It's really quite disgusting and disturbing that someone who has dotted their i's and crossed their t's still had to jump through hoops to get a lifesaving medicine that should have been easy for them to obtain. Having grown up in Canada with the "commie socialist" universal healthcare… I just cannot understand the reticence down here. It gives you MORE freedom and MORE choice then many of the health plans offered through employers. Sure you pay for it with your taxes, but it winds up costing less then the money I see flying out of my paycheck every other week for the crappy insurance I have now that chains me down to a specific medical group and 'primary care' physician.
The Man, The Myth says:
As a citizen and resident of the United States of America I am continually perplexed by our obsession on individual rights. We want to have personal choices and make personal decisions for everything, but most particularly for those things we don't have the technical expertise to adequately make choices on. In the last several weeks (ok, longer) we have become obsessed with talking about how the Constitution has given us these rights and how the government is abusing personal rights, etc.
My question is… why? Can you think of any problem in the world that is best solved by individuals? I admit to being a bike/pedestrian advocate who tries to make Missoula a nicer place for people & not cars. However, the fact I talk to folks about this issue and ride the bus instead of driving really makes a very small difference in the scheme of things. I would think that hundreds of people drive by me as I'm standing on the side of the street waiting for the bus. The work I do as an individual is meaningless. Until the Sate Department of Transportation breaks its current model we are doomed…
So the moral of the story is: people! get over yourselves! you are not important as individuals! we are a society and we have to work together. we sure as heck know the corporate entities which have an influence on us work together to screw us.
Greg says:
Prescription fees are high in Canada too, unless you are covered. I hear it's better in the UK.
Xynzee says:
Ah! But Ed, you should have been more responsible. As you knew your script was running out, that it would take 6+ weeks to see a doc, the holidays were a-comin' and there was a chance you'd get lost in the shuffle, that a fly would fart causing a subatomic particle to shift causing the collapse of the imaginary parallel universe… etc. etc. Sorry couldn't resist. ;)
I've been wondering for those with better political and legal understanding, would it be possible for the voters in a state to run as a ballot measure forbidding their Senators and Congress members from receiving the congressional health insurance?
You know a: We the people who are *your* employers, aren't going to offer you subsidized health insurance. Therefore you want it, you gotta front for it yourself. Granted it won't work across the entire Fed Govt, but it works on a state by state basis.
Thoughts?
Renee says:
Greg: I've been on expensive medications and they're nowhere near as expensive (like, 10x less) than an equivalent dose in the US. We leverage our large population to get discounts on drugs. It's why American seniors pay for trips across the border to see Canadian doctors and fill their prescriptions here.
If you're covered by extended healthcare they're usually off the top at 100%. The worst plan I've ever had was 80% with a $25 annual deductible. I paid $10 a month for my drugs. Also, if you make less than $20k a year, prescriptions are free anyway — even if you're not on income assistance.
Prescriptions are also tax-deductible, so when I was poor (but didn't know to apply for the means-tested exemption) I always got back the $70 a month I paid out of pocket for my drugs. It was still a lot of money, but hey, deviated septum operation? Free. Wisdom tooth extraction (in a hospital by an oral surgeon)? Free. Annual checkups? Free. X-rays? Free. Cat scans? Free.
I've only recently hit the tax bracket where I get less back than I put in; and I am *happy* to pay it.
Renee says:
By the way, this is a great read: http://ojs.library.ubc.ca/index.php/newproposals/article/view/237/366
DS says:
Greg, there is a flat rate in the UK (free for seniors and those below the poverty line) but I would guess that it will be phased out in the near future and they will adopt something like we have in Canada. I personally don't think our drugs are expensive at all. I had a root canal about a year ago and paid about $25 for some penicillin. The same stuff would have been 60 or 80 in the US.
ladiesbane says:
DS, I paid $4 for my last penicillin script (last year, granted, but coincidentally also prior to a root canal.) Target, Wal-Mart, and Sam's Club all have a list of $4 generics. The companies are vile, but they offer some affordable drugs. It's the people who have to pay $5000 to $10,000 per month for their specialty meds that I worry about.
Graham says:
Not only does America have a dysfunctional and heartless medical insurance system, but it tries relentlessly to export it.
In this country we have something called the Pharmaceutical Benefits Scheme, which subsidises 600 major medications. This ensures that the working poor such as myself can afford essential medication.
But The US Government has been trying for two decades to get our Government to abandon it. I fear that one day enough pressure will be brought to bear for them to succeed in this.
John says:
For-profit health insurance is, entirely and completely, a basic conflict of interest.
You pay them a premium. If you get sick, they pay for the doctor/meds.
This would be reasonable if it were some sort of savings account (although that is not at all the solution, as the average person wouldn't be able to afford most treatments even with a savings account). But it is not. The company derives profit from not paying you. It is in the company's best financial interest to not pay when it comes time to shell out for doctor/meds. Wendell Potter testified to the same before Congress.
This is the source of Ed's problem here. The insurance company sets up very specific deals, including working with subcontractors and the like, to minimize their outlay as much as possible in the event they actually do have to pay. It is not in their interest to make this work well for the customer, because any time the customer actually makes use of the services, the company loses money. The ideal situation would be a person that paid into medical insurance every month for their entire life, and never ever got sick. Pure profit for the company.
This is obvious to anyone that actually examines how this process works. But most people don't examine it. They hear "then why do people come to the US for treatment", and get immediately swept away with nationalistic pride. They do not consider that the statement itself is telling — why yes, the system *does* work nicely for people who don't actually have any American health insurance, and who have the time and money necessary to go halfway across the world for medical treatment. The system works great, when you don't actually use it.
David R says:
John makes a good point about the question of "why do people come here for treatment?"
To add to that point, what such nationalists don't get is that, increasingly, Americans are going ELSEWHERE for treatment, so much so that there is an entire travel industry that revolves around "medical tourism." Here's just one sample from the Internets:
http://medicaltourism.com/destination/destination.php?lang=en
bb in GA says:
Would I be wrong in suggesting that American medical tourism is based on price?
When Sheik Yo' Money flies in from the Emirates to get his care from a Jewish Doc in a NY Hospital (sweeeet irony) he is shopping for quality and doesn't give a rip about price.
//bb
David R says:
bb—
Would I be wrong in suggesting that quality means nothing if the price is too high?
Also, I've received health care (including inpatient and surgery) while fully government insured in both South Korea (a popular medical tourist destination) and the U.S.
I feel I got a better price AND better quality care in SK. Not saying every medical tourism destination is better quality. But one of them is, and you can hardly paint such a wide variety of countries with such a broad brush.
Have you received substantial health care abroad, BB? Most people who've actually lived and worked in other first-world countries don't assume that America has the best quality health care, and don't have a strong certainty of which country is "best" at anything, because they realize it's a big world out there. I suspect your opinion that we might have the absolute highest quality care in the world is informed by little or no comparative experience.
Ozymandias, King of Ants says:
Our heath-care system is fucked up. It is especially fucked up because people do not know how to navigate its tortuous paths. And this is no accident
Ozymandias, King of Ants says:
(cont'd)
So, as a fellow epileptic, I feel obligated to share my own way of dealing with this exact same problem.
I live in California and this works for me here and it worked for me once in Illinois. It would be worth trying, at least, in other states. I first tried it because I was in the situation you were in and a pharmacy assistant who was in a generous mood just told me what to do over the phone.
1. Take your empty pill bottle to any pharmacy you can find open.
2. Ask to talk the pharmacist and show him or her the bottle, which is important because the label will have the date it was filled, the unit count, and the dosing instructions. (And if the label says no refills, explain to them the situation.)
Ozymandias, King of Ants says:
(cont'd)
3. Say that you take the medication(s) for seizures, which is important because some anti-seizure drugs work wonders for totally unrelated things, like the peripheral neuropathy often developed by diabetics.
4. Show the pharmacist a picture I.D.
And that’s it. Pharmacists can usually dispense about three days worth of medication without approval from anyone if they recognize that it is potentially catastrophic for the patient to stop entirely. You might end up having to pay full price, but it’s a lot cheaper to pay for, say, 18 units than for 180 units. This will give you at least a few extra days to clear up whatever is causing the delay in getting the full prescription.
It’s a pain in the ass, but trust me: it’s whole lot better than status epilepticus.
bb in GA says:
David R:
You have done a heap of assumin' out there…
I said that I thought the American medical tourist was shopping price (obviously at a quality level he or she determined was OK)
I said the mythical Sheik was shopping (perceived) quality with no thought to the price.
I made no representations that mine was bigger than yours…that's all in YOUR head. But since I'm an ugly American, that just has to be huh..
//bb
Osric1 says:
I too have a story from Vancouver BC. I went to school up there (I live in WI) and once had an emergency where in the middle of the night I needed medication which had run out. Desperate I walked into our local all night pharmacy and said that I didn't have a prescription but that I needed meds right now or I wouldn't be able to walk in about 4 hours. They simply gave me two days worth of medication and said to stop back when I got a prescription from my doctor in the morning, they then deducted that from the official prescription. It was basically the most humane treatment I have ever received from anyone in the medical industry and it was wonderful. Does the Canadian model for health care have flaws, yes, but they are fewer and much farther between than those in the US.