Monday, June 11, 2018

Healthcare Cost Drivers


Medical providers have to comply with federal and State regulations and reporting requirements and are subject to lawsuits. Private hospitals are required to treat all emergency room patients and indigent care costs are shifted to paying patients.

Healthcare is no longer cheap. Labor costs are high and healthcare is labor-intensive.  The Catholic Nuns who used to serve as nurses and administrators for room and board in a convent and a $50 per month salary are long gone. In 1960, hospital room and board was $24 per day and major medical insurance was $25 per month.

The US federal government started over-subsidizing healthcare in 1965 with Medicare and Medicaid and healthcare costs have been quadrupling annually ever since.
Federal subsidies removed healthcare from the free market economy and consumers lost control of prices based on supply and demand.

Obamacare added a new level of subsidies in 2009 to make the 50% healthy pay for the 5% highest cost patients and
Obamacare has not been completely repealed. Health insurance costs are now unaffordable and unsustainable.
  
Medical Malpractice Insurance Costs tend to vary among states. For example, malpractice costs in Minnesota could cost anywhere from $4,000 to $17,000 per year, depending on your specialty. But in California, a surgeon can expect to pay anywhere from $22,000 to $34,000 per year. Cost is also dependent on the amount of coverage you purchase.

Big Pharma price gouging is a scam. The 11 Most Expensive Drugs in the U.S.A. are:

1. Actimmune – $52,321 - Approved for osteoporosis and chronic granulomatous disease, a rare disorder that causes the immune system to malfunction, Actimmune is manufactured by Horizon Pharma. Patients typically take Actimmune three times a week, and on average will go through about 12 single-use vials a month at $4,360 per vial.
2. Daraprim – $45,000 - You might recall 2015 when Martin Shkreli sparked outrage for hiking the price of Daraprim from $13.50 per pill to about $750 per pill in a matter of days. While this caused a national conversation about drug prices and a class-action lawsuit, the price for Daraprim has still remained high – with the list price for a one month supply (60 tablets) coming out to $45,000.
Daraprim is commonly given to AIDS and transplant patients to prevent infection and is used to treat toxoplasmosis in otherwise healthy people. Unlike other drugs on this list, patients are rarely on Dariprim for more than a couple of months.
3. Cinryze – $44,140 - Manufactured by Shire, the list price for a typical one month supply (16 vials) of Cinryze runs at $44,140. Cinryze is used to treat hereditary angioedema, a rare life-threatening genetic condition that causes swelling in various parts of the body including hands, face and throat.
4. Chenodal – $42,570 - Chenodal, used to dissolve gallstones, is manufactured by Retrophin, which was founded by Martin Shkreli – the same person responsible for Daraprim’s price hike.
Back in 2014, while Schreli was still CEO of Retrophin, prices for Chenodiol increased five-fold. What’s more, Chenodal is currently off patent, which means it is technically legal for affordable generics to be manufactured. However, Chenodal is protected under what is referred to as a “closed distribution system,” which prevents generic drug makers from purchasing a brand name drug.
While many patients take 90 tablets per month, some can take as many as 210 tablets per month, at a whopping $473 per tablet.
5. Myalept – $42,137 - Myalept is an orphan drug used to treat leptin deficiency in patients with generalized lipodystrophy. Myalept is self-administered once-daily, and patients typically use 10 vials per month, at $4,213 per vial. Since Mylapet is the only option to control this rare condition there are no other cost-saving options available.
6. H.P. Acthar – $38,892 - H.P. Acthar, also referred to as Acthar, is used to treat multiple conditions like Lupus, rheumatoid arthritis, multiple sclerosis, infantile spasms, ophthalmic conditions, psoriatic arthritis and more. It is manufactured by Mallinckrodt Pharmaceuticals and was approved back in 2010. Patients usually use one vial per month, which is priced at $38,892. 
Just like many drugs on this list, Acthar has also seen its fair share of price hikes. Back in 2001, when Acthar was still manufactured by Sanofi, the list price for one vial ran at about $40. 17 years, and 1 new manufacturer later, the list price for one vial of Acthar runs at $38,892.
7. Juxtapid – $36,992 - Juxtapid is manufactured by Aegerion Pharmaceuticals to treat people with homozygous familial hypercholesterolemia, a gene mutation that leads to cardiovascular disease. Patients typically take 28 capsules of Juxtapid per month with a list price of $1,321 per capsule. 
8. Firazyr – $32,468.40 - Just like Cinryze mentioned above, Firazyr is manufactured by Shire for hereditary angioedema. However, unlike Cinryze, which is used to prevent swelling before an attack, Firazyr is used after an attack. Since patients suffer an average of two to four attacks per month, most fill one carton (3 syringes) of Fyrazar every month at a list price of $32,468.
9. Harvoni – $31,500 - Harvoni is manufactured by Gilead and is the first once-daily combination drug used to treat Hepatitis C (HCV). Treatments for Hepatitis C are notoriously expensive, and the cost for Harvoni is no different. Patients typically take Harvoni for 12 weeks, and a one-month supply runs at $31,500 for 28 tablets – $1,125 per tablet. 
10. Cuprimine – $31,426 - Cuprimine is the oldest drug on this list and has been around since the 1970s. Manufactured by Valeant, Cuprimine removes copper build-up caused by Wilson’s Disease. Patients take one capsule of Cuprimine after every meal. With a list price of $261.89 per tablet, the cost of treatment quickly adds up.
Cuprimine’s price has been a hot-button issue and has even sparked debate in Congress and inspired an episode in a Netflix show Dirty Money.
11. Sovaldi – $28,000 - Like Harvoni, Sovaldi is manufactured by Gilead to treat Hepatitis C. Patients take Sovaldi for 12 weeks; the fair price for a one month supply runs at $28,000.00 – $1,000 per tablet. 

The US Healthcare cabal spent $2.22 billion on digital advertising in 2018.

The US will spend a total of $3.5 trillion in 2018.  Healthcare

Employers pay $10,000 per year per employee on health insurance.  Employees pay an average of $4200 per year.

US employment in healthcare reached 9.1% in 2017.

HEALTHCARE WORKERS. Healthcare is the fastest-growing sector of the U.S. economy, employing over 18 million workers. - May 9, 2018

Norb Leahy, Dunwoody GA Tea Party Leader


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