Well, we just survived the horrendous 2 year election cycle. It finished last week with a convincing win by my candidate. Leaving politics aside, I am happy that Obama was re-elected for many reasons but probably the biggest was for the Affordable Care Act (ACA). What ever you may think of the legislation, either a take over of the health care system by government (hysterical right wing conservatives) or a horrible compromise (whiny liberals advocating for single payer), it does have some provisions that I think are important for individuals and our country as a whole to have. The biggest is the pre-existing condition clause, where someone cannot be refused insurance for any reason. For healthy hale individuals out there this is probably no big deal but for those of us that no insurer would want to touch this is a big deal.
I have great sympathy for people who are disabled through illness and find they can no longer work and as a result lose their insurance. This loss of insurance guarantees that they also lose access to care, because care in the country, even with insurance, is still very, very expensive. This point was hammered home to me recently when my provider switched specialty pharmacies. Since going off trial, I have had my medicine filled by a specialty which overnights my temperature sensitive medicine to me every 1 or 3 months (as for how this can be cost effective, I have no idea). On the switch I was actually able to see the cost of the medicine which is shown below. Yes, it is $3791.81 per month. That works out to roughly $950 a shot! Certainly more beneficial but maybe not any less expensive than heroin?
So if the worst is to happen and I can no longer work, I sleep easier knowing that I can at least still get insurance. Whether that would still mostly shield me from the full costs of the medication, I hope I never have to find out. But before the ACA we had a system that seems to be designed to truly kick people when they are down.
But the question remains, how much does my medicine really cost? All the other first world countries have national formularies that negotiate in bulk with drug suppliers. Basically, they use the economies of scale and purchasing power to negotiate better prices on drugs. That is why some drugs are much cheaper in Canada. But even that price is a bit mysterious, as a few minutes of googling did not reveal what Avonex cost in the UK, Canada, or Australia. We in the US, however, don't have a formulary, so pharmaceutical companies can charge the price they think they need to. But that is a whole other discussion - how much money can they charge for life saving medicine. I know intimately that research is expensive (thats what I do for a living) and the costs to bring a drug to market can be immense. Research is an investment, and one I think that companies can rightly go for. So I agree that removing the profit motive from medical research (ugh, just made my skin crawl a little bit) is certainly not the correct way. But it goes beyond this. For example there has been a dearth of research in antibiotics right now because it is simply not profitable. How do we allocate research toward medical conditions whose solutions may not be profitable?
I think it very naive to believe that the "free market" would fix everything in our health care system. The free market is great on identifying profitable markets and then extracting profits from them. But it is terrible at allocating resources otherwise (as highlighted by the antibiotic research above), and I think that health care as a whole should not and can not be run as a for-profit enterprise. Humans life is fragile and sometimes very expensive to keep functioning. It all comes down to putting a price on the human existence A horrifying thought, and I am happy there are better minds than me trying to figure this out, from ethicists and medical care experts. I think that the ACA is a great step forward, I do not think it is the best solution to our shared problem (the fragility and expense of life versus allocating finite resources).
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