JustCare

Tag: Prices

  • Drug prices continue to be around three times higher in the US than other wealthy nations

    Drug prices continue to be around three times higher in the US than other wealthy nations

    The Assistant Secretary for Planning and Evaluation or ASPE, a government research agency, released a report showing that US drug prices–brand name and generic–are almost 2.78 times the price in 33 other wealthy countries. Even for people with Medicare Part D prescription drug benefits, drug costs can be high. That will only change when the US negotiates prices for all drugs as every other wealthy nation does for its residents.

    ASPE hired RAND Health Care to conduct the analysis. When RAND compared brand-name drug prices in the US to prices in OECD countries, it found that they were more than 3.20 higher even after adjusting for rebates. It also found that the preponderance of new drugs were first available in the US.

    The US is responsible for a disproportionate and ever larger share of total spending on new drugs as compared with other wealthy nations. The Inflation Reduction Act gave Medicare the ability to negotiate the price of several dozen drugs, beginning with 10 drugs in 2025. But, there are thousands of drugs on the market and working people do not benefit from Medicare’s negotiated prices.

    The price of drugs is rising faster in the US than in other wealthy countries. If you do not factor in rebates, which insurers usually pocket, we pay more than four times the price of people in other wealthy countries for our drugs.

    We pay about two-thirds less for generic drugs than people in other wealthy countries. And, these drugs represent 90 percent of US spending on prescription drugs. These drugs only represent about 41 percent of spending on prescription drugs in other countries.

    Some drugs are particularly expensive in the US. For example, insulin prices are almost ten times higher in the US than in other wealthy countries. We pay more than 10 times what people in France and the UK pay for insulin. We pay six times more than Canadians for insulin. Rebates for people with insurance and people who have met their deductible bring the price of insulin down to 2.33 times what people pay in other wealthy countries.

    While most new drugs launch first in the US, a large number of them launch in other wealthy nations soon after. The researchers found that the drugs that are most beneficial are available in all wealthy countries within a short time.

    Here’s more from Just Care:

  • Biden administration should do more to lower drug costs

    Biden administration should do more to lower drug costs

    In an opinon piece for Scientific American, James Love, Director of Knowledge Ecology International, explains how the Biden administration could do more to lower the cost of prescription drugs in the US. You might not know this but the federal government has the authority to drive competition in the brand-name prescription drug market for brand-name drugs developed with taxpayer support. Many brand-name drugs are developed with your tax dollars.

    Federal agencies can grant licenses to pharmaceutical companies to manufacture drugs that compete with patented drugs with high prices, if the patented drugs were developed with taxpayer dollars. Of course, these are licenses that the pharmaceutical companies that developed the patented drugs do not expect or want to be issued. And, historically, the government has not issued them.

    The federal government has what are called “march-in” rights. It can issue licenses to develop drugs whenever it believes it is necessary to fix a pharmaceutical company’s “abuse or nonuse” of a patented drug. New draft federal guidance clarifies that an excessively high drug price can be considered abusive.

    These “march-in” rights were first established in the Bayh-Dole Act of 1980. Their goal is to ensure that the public benefits from drugs that that are patented, if public dollars contributed to their development. But, over four decades, the federal government has never exercised “march-in” rights, even when pharmaceutical companies set unconscionable prices for their drugs.

    The Biden administration’s new take on the law is significant but still limits the government’s use of its march-in rights and still allows the pharmaceutical companies to set excessively high prices for drugs that were developed with taxpayer dollars. The administration does not suggest that pharmaceutical companies have an obligation to set their drug prices no higher than levels citizens of other wealthy countries pay for the same drugs when US taxpayer dollars funded their development. Right now, we often pay five to ten times more than people in other wealthy countries for the same drugs, developed with our tax money.

    There are not that many new drugs developed with federal funding. And, some of those drugs include patents that were not developed with federal funding. In the administration’s draft, timing, including a patent’s life, could mean that march-in is not a good tack for the federal government to take.

    Moreover, pharmaceutical companies can appeal the federal government’s exercise of march-in rights, which would freeze government action. Essentially, pharmaceutical companies can slow down the march-in process for years, until their drugs lose their patents. And, for obscure reasons, sometimes pharmaceutical companies do not disclose government funding, as in the case of Gleevec, a cancer drug that has generated billions in revenue for Novartis.

    But march-in rights are not the federal government’s only tool for lowering drug prices. Our government has “worldwide royalty-free licenses for a taxpayer-funded invention, and a separate statute allows government use of any patent with compensation—zero for government-funded inventions—set by a judge.” There’s no reason our government should not be using all these rights to ensure Americans can afford the medications they need, especially for Americans in federal programs like Medicare and Medicaid.

    [Editor’s note: I continue to believe that the simplest and swiftest way to pressure the pharmaceutical companies to lower drug prices in the US is to open our borders to prescription drugs from verified pharmacies abroad and require insurers to cover them just as they cover drugs from pharmacies in the US. The Biden administration is now allowing some states to import drugs from Canada, which is another small step in the right direction.]

    Here’s more from Just Care:

  • Some hospitals gouge Americans because they can

    Some hospitals gouge Americans because they can

    One of the many benefits of Medicare is that your costs are the same no matter where you get care in a community. Consequently, people with Medicare do not have to “shop” for where they get care in order to keep their costs down. But, as Bloomberg News reports, some hospitals gouge non-elderly Americans because they can; people can reduce their costs only if they are willing to “shop” for where they get their care.

    Our health care system should not encourage shopping for health care. Everyone in a given region should pay the same price. Otherwise, people who need care urgently, people with cognitive conditions, people who cannot drive long distances, among others, could be forced to forgo needed care or to pay a premium to get that care. Moreover, since the cost of hospital services is generally not bundled and rarely do people know the range of services they will need, it’s near impossible to know whether the whole bundle of costs will be lower at one place or another.

    Bloomberg News describes how one woman, who was in labor, drove 45 minutes to get to a hospital that would charge her less to deliver her baby. It  saved her “thousands of dollars.” Her total cost was $8,354 and she was responsible for $2,500. But, had she gone to a hospital closer to home in Monterey County, the cost for delivery of her baby could have been as much as $40,000.

    Throughout the US, some hospitals charge a lot more than other nearby hospitals. And, there is no correlation between higher hospital prices and better quality care. But, high hospital costs drive up health insurance premiums.

    In 2023, Americans spent $4.5 trillion on health care. A lot of that money goes to hospitals.

    As a result of recent legislation, hospitals must post their prices for public review. But, is that enough? And, what explains the large price disparities within a region?

    While high hospital costs can stem from high staffing or maintenance costs or the simple ability of hospitals to set their prices as they will, some hospitals charge some insurers way more for their services than others because some insurers deny a lot of their claims or otherwise require them to expend more resources to get patients the care they need.

    Today, according to Rand research, companies pay more than double what Medicare pays for the same services. In Indiana, companies pay almost three times what Medicare pays.

    Hospital prices are likely to continue to rise at an unsustainable rate if the government does not step in. Meaningful hospital competition is lacking. Ninety-six percent of hospitals are in non-competitive markets. MedPAC, which oversees Medicare payment and quality issues, recommends that Medicare continues to put financial pressure on hospitals to keep costs down.

    Here’s more from Just Care:

  • Drug prices: Biden v. Trump

    Drug prices: Biden v. Trump

    Heather Landi reports for Fierce Healthcare on how Donald Trump’s former Secretary of Health and Human Services, Alex Azar, and Joe Biden’s current Secretary of Health and Human Services (HHS), Xavier Becerra, would address high drug prices. Not surprisingly, their views differ significantly.

    Azar does not recognize that pharmaceutical companies in the US engage in price fixing. Or, that the pharmaceutical companies often delay the release of new drugs in order to maximize profits on older drugs, hampering innovation. Or, that it’s much easier for people in France to fill their prescriptions than people in the United States because out-of-pocket costs in the US are so high.

    Azar does recognize the power of pharmacy benefit managers, PBMs, to drive up people’s out-of-pocket costs, but does not suggest a plan to fix that issue,. For example, he does not propose removing PBMs from the process of deciding which drugs are covered and at what price to patients.

    Last year, Congress passed the Inflation Reduction Act or IRA, giving Medicare drug price negotiating power for 10 drugs in 2025; the Centers for Medicare and Medicaid Services have chosent the 10 drugs, based on which cost the Medicare program the most. The IRA also capped out-of-pocket costs for each insulin product people with diabetes use at $35 a month. And, it imposed an out-of-pocket limit of $2,000 for drugs covered by Medicare Part D plans beginning in 2025.

    President Joe Biden’s HHS Secretary Becerra touts Medicare’s drug price negotiation power as an effective way to lower drug costs, pointing out that the IRA now caps the cost of insulin at $35 per month for seniors who have Medicare.

    Of note, the Trump administration had proposed that Part B drug prices–for inpatient drugs–be tied to prices paid abroad for these drugs. That sounds to me as if it would have been a smart move. But, the Biden administration rescinded that proposal, likely under pressure from the pharmaceutical industry.

    Here’s more from Just Care:

  • Will Rx provisions in the IRA disappoint?

    Will Rx provisions in the IRA disappoint?

    Michael Hiltzik writes for the Los Angeles Times about the prescription drug provisions in the Inflation Reduction Act (“IRA”). He makes the case that they could disappoint Americans. Pharmaceutical companies will fight hard to ensure that the drug price negotiation requirements do not achieve their desired outcomes.

    On one hand, as Stat News declared, the drug price negotiation provisions in the IRA are a “crowning healthcare achievement.” And, that’s true. But, frankly, it’s unsettling that these provisions could be a crowning achievement, given that all other wealthy democracies have far more comprehensive negotiation provisions for their entire population in place.

    Medicare spends more on prescription drugs than any other purchaser in the US, and Medicare’s costs are only rising. Medicare is responsible for about one in three dollars spent on prescription drugs and about one in five dollars spent on health care. The IRA is not going to bring down those numbers in a meaningful way.

    Hiltzik focuses on the fact that drug price negotiation won’t begin for three and a half years and, then, only for 10 drugs. Moreover, only drugs that have been on the market for at least nine years are eligible for price negotiation. All in, the Congressional Budget Office calculates a 1.3 percent reduction in Medicare spending as a result of the drug price negotiation provision.

    Hiltzik imagines that the pharmaceutical companies will find ways around even this narrow piece of legislation. I agree. I imagine drug companies will sue if their drugs are chosen to be the ones whose prices are negotiated. And, even if they don’t, prices will still likely be well above what other wealthy countries spend on these same drugs, since the IRA does not give Medicare the tools to drive a hard bargain.

    Unlike the Veterans’ Administration, Medicare is not allowed to cut drugs from its list of covered drugs. So, it cannot use the leverage of walking from the table if the negotiated price the drug company agrees to is too high. Part D drug plans can already negotiate drug prices and walk, in some cases, if they’d like. But, insurers offering Part D plans are looking only to maximize their revenues, which is a far cry from wanting to bring down the price of drugs.

    Pharmaceutical companies surely will also raise launch prices to more than make up for any cuts in their drug prices. Hiltzik alludes to one new treatment for a rare drug disease with a launch price of a whopping $2.8 million.

    This all said, Medicare drug price negotiation provides a much needed opening, a big foot in the door, for lower drug prices in the US. And, that’s a big deal.

    Here’s more from Just Care:

  • Drug provisions in the reconciliation bill should lower your costs

    Drug provisions in the reconciliation bill should lower your costs

    Last week, I laid out the Medicare prescription drug provisions in the reconciliation bill. They are noteworthy. Among other benefits, for the first time, people with Medicare Part D prescription drug coverage will spend no more than $2,000 out of pocket for their drugs, and Medicare will be allowed to negotiate the price of 100 prescription drugs through 2030. If you’re taking costly medicines, these provisions should lower your drug costs significantly.

    Beginning in 2023, Medicare drug prices cannot rise faster than inflation. If they do, the manufacturer must pay a rebate to the federal government. So, you should no longer see your Part D prescription drug costs rise more than the rate of inflation. The base year for measuring cumulative price changes is 2021.

    In 2024:

    • if you reach the catastrophic coverage phase of your Part D coverage, meaning that you have spent $7,050 out of pocket for covered drugs, you will no longer have to pay five percent of the cost of your drugs. You will have no drug copay.
    • if your income is under 150 percent of the federal poverty level, you will be eligible for full Extra Help benefits, which cover your Part D out-of-pocket costs.
    • your Part D premium cannot increase more than six percent a year.

    In 2025, your maximum out-of-pocket Part D drug costs will drop to $2,000 a year.

    In 2026, Medicare will begin negotiating drug prices for 10 Part D brand-name drugs. The law is silent as to the drugs for which Medicare will negotiate prices, other than that they must be high-cost and have been on the market for at least nine years since FDA approval. The Secretary of Health and Human Services will choose the drugs for which prices will be negotiated.

    In 2027, Medicare will negotiate drug price for 15 Part D drugs.

    In 2028, Medicare will negotiate another 15 drugs in Medicare Part D and Part B.

    In 2029, Medicare will negotiate the price of 20 drugs.

    It’s not clear when we will know which drugs will have negotiated prices or how these prices will affect people who take these drugs. Even today, each Medicare Part D drug plan might charge you a different amount out of pocket for a particular drug, depending upon a variety of factors.

    Steve Maas points out in the Washington Post, that a blood pressure medicine, lisinopril, could cost you nothing or as much as $29 at the same pharmacy with Part D. Without insurance, it costs $4 at Walmart. Maas takes a basket of drugs and reveals that, overall, at least for the five drugs he chooses, you will save a lot of money using the pharmacy at your local Giant supermarket over going to CVS, $11 v. $46.55.

    How will the Secretary of HHS arrive at the negotiated price? We don’t know yet whether the Secretary will be able to achieve the deep discounts that other wealthy countries are able to negotiate or a much smaller discount. But, most likely the latter, given politics in the US. And, then there’s the question of how much of the discounts the Part D plans will pass along to their members in terms of out-of-pocket costs.

    There is a price ceiling for drugs whose prices are negotiated, which depends upon how long the brand-name drug has been on the market. The lowest ceiling is 40 percent of the drug’s fair price (which there’s a formula for calculating), for drugs that have been on the market for at least 16 years. The highest ceiling is 75 percent for drugs on the market between nine and 12 years.

    There is a penalty on manufacturers for non-compliance. Manufacturers must pay an excise tax of 65 percent of the prior year’s sales of that drug, which increases by 10 percent every quarter up to 95 percent. And, if the drug has a negotiated price that the manufacturer opts not to charge, the manufacturer could pay a penalty of as much as 10 times the difference between the price it charges and the negotiated price.

    What does this all mean for the Medicare Part D plans? If there’s any way they can avoid including the negotiated drugs on their pharmacies, they might try to do so, because they might not profit as much from them. We know that CVS excludes some generics from its formularies, forcing enrollees to pay more for their brand-name equivalents, surely because CVS maximizes profits in that fashion.

    Part D prescription drug plans have way too much freedom to take advantage of the system and drive up costs for their enrollees. Enrollees are at an enormous disadvantage because drug tiers and coverage can change at almost any time. People truly cannot choose the Part D plan that’s right for them.

    Unfortunately, Congress does not have the authority to include drug price negotiation for working people in the reconciliation bill. It can only include provisions that affect the federal budget directly. As a result, millions of Americans will continue to import drugs from abroad for personal use. While it is not technically legal, to date, the government has never prosecuted anyone for doing so.

    Here’s more from Just Care:

     

  • Hospitals still not disclosing their prices, violating the law

    Hospitals still not disclosing their prices, violating the law

    Since January 2021, hospitals have been required to post their prices. While this recent legal requirement is not likely to bring down costs, it is helpful for understanding hospital pricing. But, hospitals continue to flout this requirement and instead choose to keep their prices secret. Aditi Ramaswami reports for The Lever on hospitals’ failure to comply, based on new research.

    The idea behind the requirement for hospitals to post their prices is that it would promote competition and help people price shop before going to a hospital. On its face, that’s absurd. People go to the hospital in their community or where their doctors work or which their doctors recommend. And, for the most part, people have no clue or control over what services they will receive in hospital in addition to the principal service they go in for. The cost of those ancillary services add up quickly. Moreover, a lot of the time people end up in the hospital as a result of an emergency, for which they could not plan.

    So, the provision in the Affordable Care Act requiring hospitals to post their prices–even if done in a consumer-friendly way–is not likely to make health care more affordable. And, hospitals are not complying with their obligations.

    CMS reports that halfway into 2021, fewer than one in 18 hospitals were making their prices available for public scrutiny. The Lever reports that many states have hospitals charging patients more than three times Medicare rates.

    Health and Human Services Secretary, Xavier Becerra, committed to ensuring that hospitals comply with the requirement to disclose their prices, when he was confirmed. But, how? HHS can impose fines on hospitals, but it has failed to do so, except in two Georgia hospitals.

    Meanwhile the hospital trade association, the American Hospital Association (AHA), sued to block the federal government from implementing this provision. The AHA made the laughable argument that disclosing hospital prices would undermine competition. The hospitals themselves make the laughable argument that it would cost them too much to implement the provision–as if it’s OK for people not to know hospital prices or as if price information is not stored on a computer system and easily accessible for hospitals to use for billing purposes.

    What’s more concerning is what the hospitals’ non-compliance says about hospitals’ ability to manage care and otherwise take proper care of their patients. Something as simple as reporting their prices should not present a challenge to any hospital, let alone the largest hospitals. For the biggest hospitals, some experts suggest the reason for nondisclosure is financial–concern about not losing revenue. Moreover, experts say the fine for non-compliance is less costly to hospitals than complying.

    Colorado is working hard to impose a penalty on hospitals that helps ensure compliance. There’s a bill in the state legislature, which passed with bipartisan support, despite heavy lobbying against it by the hospital trade association, that would prohibit hospitals from sending unpaid patient bills to collection agencies unless they are in compliance with the federal price transparency law.

    Here’s more from Just Care:

  • Health insurance prices are soaring

    Health insurance prices are soaring

    The national uproar over rising prices is justified. Every family on a budget — and that’s most of us — suffers when prices rise faster than wages for the basic necessities of life like food, fuel, housing and health … Whoops, I was about to write health care, but when I dug deep into yesterday’s inflation report, I discovered medical services prices rose just 3.5% over the past year, less than half the 8.3% rate for all goods and services.

    This is pretty much in line with the past decade’s trend in overall medical prices, which have gone up only 2.8% per year on average. That’s one reason why overall healthcare spending as a share of the economy remained relatively stable over the past ten years at around 17-18% of gross domestic product.

    That is, it was stable until COVID-19 came along. The massive government injection of cash into hospitals and physician offices, just as the economy was going into a tailspin, ballooned the sector’s share of GDP to 20%. In other words, health care spending remained steady while the rest of the economy tanked.

    However, the economy has recovered rapidly from the pandemic lockdowns. The latest government forecast projects health spending’s share of the economy will return to pre-pandemic levels by the end of this year, largely because prices in the sector have remained relatively tame while prices elsewhere skyrocket.

    So if prices for the delivery of health care remain under control, why are insurance prices, which presumably are based on the underlying cost of care, soaring? Last year, prices for health insurance rose a stunning 10.4%, which is even faster than inflation in the rest of the economy. While insurance prices are notoriously volatile and are even known to decline in some years (it’s known as the insurance cycle — don’t ask), prices for coverage have gone up on average 5.3% over the last decade or nearly twice the overall rate of health care inflation.

    How can that be? While the mainstream press has focused on hospital concentration as a major culprit behind rising health care costs, very little attention has been paid to insurance industry concentration.

    Just four publicly-traded insurance companies (UnitedHealth Group, Anthem, Aetna and Cigna) control 48% of the private health insurance insurance market. The top ten organizations (five of the next six are nominally non-profit) control 71% of the market.

    The American Medical Association’s 2021 survey of insurance industry concentration found 73% of the the nation’s 384 metropolitan areas are “highly concentrated,” according to federal guidelines. Just one insurer had over half the market in 46% of those regions.

    With access to medical services returning to normal, you’d think the profits for health insurers would be taking a hit. Not so. Samantha Liss at HealthCareDive this week reported insurer profits for the first quarter of this year saw every player posting sizeable gains over a year ago, including 21% higher for Centene and 13% higher for Molina (both highly dependent on Medicaid programs); 12% higher for Humana (highly dependent on Medicare Advantage); 8% for Anthem; 4% for CVS/Aetna; 3% for UnitedHealth, the nation’s largest insurer; and 2% for Cigna.

    Somewhat higher costs = much higher profits

    My former colleague Bob Herman, now at Stat, culled through annual proxy statements to report today that the CEOs at those seven firms raked in $283 million in salaries and bonuses last year. Herman points out that insurers, whose profits over the life of the insurance cycle are guaranteed since they recoup any short-term losses with higher rates in the succeeding year, have little interest in haggling for lower prices. The more health care providers charge, the more money insurers make since they eventually pass along their higher costs to their customers — the nation’s employers who purchase health insurance.

    “Employers in general are not well-served by the carriers,” Sabrina Corlette, a health insurance researcher and professor at Georgetown University told Herman. “The incentive structure is messed up. At a certain point, when is the employer community going to start storming state capitals and Congress with pitchforks?”

    If past is prologue, the answer to her question is never. One reason is that CEOs at many major companies are very familiar with the tactics being used by their compatriots in the insurance industry and have no interesting in calling them out. A new survey by the Groundwork Collaborative, a progressive think tank, shows that corporate CEOs and their finance officers admit on earnings calls that they are using war- and COVID-driven supply chain disruptions to hike prices over and beyond the actual increased costs they are experiencing.

    “Companies that historically might have kept prices low to pick up profit by gaining additional market share are instead using the cover of inflation to raise prices and increase profits,” Groundwork executive director Lindsay Owens wrote in this recent New York Times op-ed. “Consumers are now expecting higher prices at the checkout line, and companies are taking advantage. The poor and those on fixed incomes are hit the hardest.”

    Food, oil, household goods — the companies in the survey represented a broad cross section of the U.S. economy (although it didn’t include any insurers). Clearly, monopolistic pricing power is driving a significant share of today’s inflation.

    President Biden this week correctly noted that inflation has become America’s top “kitchen table” concern. But where’s the jawboning of America’s corporate leaders? He should take a page from one of his Democratic predecessors, John F. Kennedy, who in a 1962 press conference called out steel industry executives for price hikes that were “wholly unjustifiable and irresponsible defiance of the public interest” at a “serious hour in our nation’s history, when we are confronted with grave crises in Berlin and Southeast Asia, when we are devoting our energies to economy recovery and stability.”

    At this serious hour 60 years on, when the U.S. is backing Ukraine’s valiant fight against the kleptocratic-autocratic Putin regime in Moscow and Covid still poses a serious threat to our economy, is the current price gouging any less irresponsible or in any way justified? Clearly, our own kleptocrats are taking advantage of the current situation.

    Certainly, some of the recent short-term price spikes were inevitable given the war- and Covid-driven supply disruptions. But enough time has gone by for the economy to adjust, and it hasn’t.

    If Democrats facing tough election fights in the mid-term election are looking for an answer to voters’ chief economic frustration, they should point out repeatedly who’s behind ongoing and excessive price hikes — the leaders of America’s monopolized corporate sectors, our own version of the global kleptocratic class that is undermining peace and prosperity.

    This post was originally published in gooznews on Substack.

  • Hospitals forced to pay nurses a lot more

    Hospitals forced to pay nurses a lot more

    This is what you call hubris. Healthcare Dive reports that the American Hospital Association is complaining to the White House that nurses are demanding higher wages. And, because there’s a nursing shortage, the hospitals are forced to pay their nurses more.

    If you’ve been reading Just Care, you know that hospitals largely have monopoly power to set exorbitant rates for their services, driving up our health insurance premiums considerably. But, hospital staff largely have not benefited from those higher rates. Hospitals spend the money on executive pay and other line items. For-profit hospitals can generate big profits for shareholders.

    The hospitals have no problem requiring patients to pay exorbitant prices for their care, but they do not like the fact that they now must pay their nurses more for their services. For those readers who are fortunate enough not to have been hospitalized in the last few years, get this: New York University hospital recently charged $400,000 to reset two broken bones in a young person’s leg. Max was in the hospital for all of two days. His insurer bargained the charges down to $200,000. $200 000 to reset a broken bone and spend two days in hospital!!!! Insanity.

    Still, the American Hospital Association claims that the nurses’ advocates are  “exploiting” the staffing shortages. Really? It’s the pot calling the kettle black. Members Congress should be standing with their constituents to regulate health care prices.

    Rather, some in Congress appear to be standing with the hospitals, claiming the nurses’ pay is inflated. The feeling is that the hospitals are already under too much pressure because of the novel coronavirus pandemic. Of course, this is a setup for the hospitals to demand even higher rates from insurers. Since health insurers profit more the more they pay hospitals, it’s not unlikely that the hospitals will get the higher rates they demand.

    The nursing shortage is affecting nursing homes and long-term care facilities as well.

    The only solution is for Congress to regulate hospital and doctor rates for everyone, as well as the price of prescription drugs. But, that does not seem to be happening any time in the foreseeable future.

    Here’s more from Just Care:

  • Without hospital price regulation, expect gouging

    Without hospital price regulation, expect gouging

    President Biden and Democrats in Congress, unlike Republicans, speak to the value of data and science. But, when it comes to hospital prices, too many of them disregard the data and allow the health care players in the market to engage in price gouging. David Lazarus reports for the LA Times on one typical hospital’s cost markups.

    Hundreds of thousands of Americans unnecessarily die or suffer serious health conditions every year because they cannot afford the health care they need. A new Gallup West Health poll finds that three in ten “chose to” skip or forgo necessary care in the last three months because of the cost. Regulating health care prices would easily cut prices in half.

    But, instead of reining in health care prices to a reasonable level, as every other developed nation does, our Congress looks the other way. Hospitals, in turn, often hike up prices for their services four, five and six times. Do they really need to or are their outrageous prices paying for a new marble wing and multi-million dollar CEO salaries?

    At Scripps Memorial Hospital, price hikes of 675 percent, nearly seven times actual cost, apparently are routine. For a simple suture that costs $19.39, the hospital charges $149.58. And, many hospitals use the same EPIC software Scripps uses to drive up prices.

    Hospitals lay blame for these markups with insurers. They say that they need to increase prices a lot or insurers won’t pay them a fair price for services. But, that’s Orwellian. The answer to insurer issues is not price gouging if you care one iota for ensuring patients can afford needed care; it’s advocating for a different payment system.

    Of course, hospitals can’t justify the price gouging, and they don’t have to. They simply are trying to make up for the fact that insurers deny coverage for a lot of the services they deliver, often 20 percent of them.  So, prices for services bear no relation to cost.

    Of course, there’s a simple solution. Regulated prices for all medical services and treatments. And, government-administered coverage, with the insurer middleman out of the mix or playing the role of claims administrator, not doctor and price-maker.

    If . . .

    • we stopped allowing corporate health insurers to come between doctors and patients,
    • insurers could not decide what care is medically necessary,
    • insurers could not profit from denying care,
    • government, not insurers, was responsible for setting the prices we pay for health care services and treatments,

    the science and data show costs would come way down and quality would improve.  Why are we gambling with people’s health when we know how to reduce the number of unnecessary premature deaths in the US considerably?

    Every other wealthy nation follows the science.  It’s not complicated. It’s time we joined with them.

    Here’s more from Just Care: