Posted by Damozel | Now that there's a recession on ---or, according to the Bush Administration, a 'slowdown' --- insurance companies have abandoned the traditional fixed-price co-payments for insured patients and requiring them to pay percentage for certain expensive drugs that could end up costing them thousands every month. (NYT) And the subscribers pay because they have no choice. These are drugs that treat "diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without."(NYT)
That may seem harsh, but there's a reason: the insurance companies are just trying to look out for their subscribers. Truly!
They're doing it for us. "Insurers say the new system keeps everyone’s premiums down at a time when some of the most innovative and promising new treatments for conditions like cancer and rheumatoid arthritis and multiple sclerosis can cost $100,000 and more a year."(NYT) Of course, there is a down side:
[T]he result is that patients may have to spend more for a drug than they pay for their mortgages, more, in some cases, than their monthly incomes.(NYT)
The new system started because employers who pay for medical insurance wanted to keep costs down.
Private insurers began offering Tier 4 plans in response to employers who were looking for ways to keep costs down, said Karen Ignagni, president of America’s Health Insurance Plans, which represents most of the nation’s health insurers. When people who need Tier 4 drugs pay more for them, other subscribers in the plan pay less for their coverage.
But the new system sticks seriously ill people with huge bills, said James Robinson, a health economist at the University of California, Berkeley. “It is very unfortunate social policy,” Dr. Robinson said. “The more the sick person pays, the less the healthy person pays.”
Traditionally, the idea of insurance was to spread the costs of paying for the sick.
“This is an erosion of the traditional concept of insurance,” Mr. Mendelson said. “Those beneficiaries who bear the burden of illness are also bearing the burden of cost.”.(NYT)
But what of it, eh? What of it? You and I are not sick, after all. Why should we have to bear the burden of someone else's medical costs? We might be the lucky ones. We might spend our whole lives free of the burden of paying for our own or any family member's monstrous, ruinous prescription drug costs. We could be the winners in the sickness lottery!
Or not.
[O]ften, patients say, they had no idea that they would be faced with such a situation.
It happened to Robin Steinwand, 53, who has multiple sclerosis.
In January, shortly after Ms. Steinwand renewed her insurance policy with Kaiser Permanente, she went to refill her prescription for Copaxone. She had been insured with Kaiser for 17 years through her husband, a federal employee, and had had no complaints about the coverage.
She had been taking Copaxone since multiple sclerosis was diagnosed in 2000, buying 30 days’ worth of the pills at a time. And even though the drug costs $1,900 a month, Kaiser required only a $20 co-payment.
Not this time. When Ms. Steinwand went to pick up her prescription at a pharmacy near her home in Silver Spring, Md., the pharmacist handed her a bill for $325....“I charged it, then got into my car and burst into tears,” Ms. Steinwand said..(NYT)
That'll teach her to get MS.
And here's another sob story for you --- the story of a Florida woman who thoughtlessly developed metastatic breast cancer.
Julie Bass, who lives near Orlando, Fla., has metastatic breast cancer, lives on Social Security disability payments, and because she is disabled, is covered by insurance through a Medicare H.M.O. Ms. Bass, 52, said she had no alternatives to her H.M.O. She said she could not afford a regular Medicare plan, which has co-payments of 20 percent for such things as emergency care, outpatient surgery and scans. That left her with a choice of two Medicare H.M.O’s that operate in her region. But of the two H.M.O’s, her doctors accept only Wellcare.
Now, she said, one drug her doctor may prescribe to control her cancer is Tykerb. But her insurer, Wellcare, classifies it as Tier 4, and she knows she cannot afford it.
Wellcare declined to say what Tykerb might cost, but its list price according to a standard source, Red Book, is $3,480 for 150 tablets, which may last a patient 21 days. Wellcare requires patients to pay a third of the cost of its Tier 4 drugs.
“For everybody in my position with metastatic breast cancer, there are times when you are stable and can go off treatment,” Ms. Bass said. “But if we are progressing, we have to be on treatment, or we will die.”
“People’s eyes need to be opened,” she said. “They need to understand that these drugs are very costly, and there are a lot of people out there who are struggling with these costs.”.(NYT)
Find the money or die? Is that what America is really all about? As my British husband points out, all over the world elsewhere, health care is free. Here, it seems, people who can't afford drugs are free to die.
OTHER BN-POLITICS POSTINGS
Shortage of Primary Care Providers Proves an Obstacle to Universal Coverage
Hillary's Health Care Plan, One Way to Help Pay for it
Buck Naked Bloggerama: Obama's "Harry and Louise Ad"
Obama's Health Care Plan versus Hillary's
Private Insurers Milking Medicare (i.e., Seniors & Taxpayers)
NY Times on Why Healthcare Costs are so High
Brit Perspective: Minette Marrin's Attack on Michael Moore
John Edwards: Congress Thinks Universal Health Care is Necessary (for Congress)
Insurance Companies Get Away with Overbilling Medicare
Jane Hamsher on the Trouble with "Getting Sick in George Bush's America" -- and She's not Alone
The Cost of Health Care for the Seriously Ill: A Survivor Speaks to the Edwards Campaign.
A lot of insurance plans do that in order to force the insured to use giant mail order pharmacies where the medication is cheaper.
Posted by: Dyre42 | April 15, 2008 at 10:07 PM