This Is Not a Healthcare System

 The United States is a nation deficient in providing healthcare to its citizens. It is not that we lack world-class hospitals, excellent personnel (physicians, nurses, and every category of specialization that provides high-tech care), spectacular medical schools, residency and fellowship programs, research labs – you get the idea. What we lack is a system of healthcare that provides this basic need to everyone who lives here. 

The stimulus for this short piece is an interaction Margan had yesterday at the local CVS pharmacy. I have used CVS for my medications since moving to California and found them to work well. I am not writing to bash CVS. We have great insurance and my meds are regularly refilled and mailed to me with only my co-pay. All of my meds are generic so my cost is minimal. Margan needed to begin medication to lower her cholesterol after her last visit to our internist. She and our internist agreed that given her labs and risk (using the American College of Cardiology’s risk calculator here: https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/) that low dose atorvastatin (Lipitor) would be appropriate. The physician phoned in the script to CVS.

On going to CVS, Margan indicated she was there to pick up a prescription. They took the usual name and DOB information, the tech said ok, then came back to say that the medication would cost $325!!! They had not asked for insurance information and when informed that we have insurance, Margan was sent to another window. Another person (male, not too friendly) took her insurance card, entered it into their database, then said it would be no charge! Within 10 minutes she had a bottle of atorvastatin (90 day supply) and we were on our way home.

So, what set me off? First, I knew from my experience (I am also on atorvastatin) that the cost through my insurer (same insurer) was a $3 co-pay for me. Lipitor was introduced in 1997 and has been available as a generic since 2012. Second, the $325 price tag without insurance is, well, obscene. Statins have large benefits to public health. Concern about side effects may be impairing the application of the benefits of statins for patients. There is no reason for overpricing the generic versions of statins to add to that underapplication. Lastly, why present a patient with the price of the drug before asking their insurance coverage? That seems a clumsy way to deal with a person going to get a prescription. Margan and I, as physicians, were not deterred. But the average patient with no medical background may be.

This brings me to systems. As a Navy physician, I practiced within a system. I did not have to worry that my patients did not have other insurance; as beneficiaries of care within the military health system, they could take my prescription for a medication to the pharmacy (in the same building) and have it filled. No questions. That is a system. What we have for most people in the U.S. is not a system. It is a bunch of disjointed parts that only loosely fit together. If Ms. Jones is my patient now and Ms. Jones is uninsured or underinsured, she may really need that atorvastatin to reduce the risks of myocardial infarction and stroke, only to find her wallet emptied when she goes to get it. Why? Because every part of the non-system is focused on maximizing returns to the investors rather than on providing healthcare. Check out what the CEOs of insurance companies are paid. Compare that to nurses, pharmacists, or internists. 

Let’s face it – healthcare is important but the funding for it via insurance includes a lot of administration costs leaving less for payment for actual healthcare. While there is controversy about the administrative cost for Medicare, it is always much lower than private insurers. Big Pharma lobbied hard for Medicare not to be able to negotiate drug costs. Republicans in the House just voted against capping the price of insulin at $35 per month. The “system” we have is unfettered capitalism squeezing maximal profits from people who are suffering, rather than a system designed and funded to provide healthcare to everyone. 

If being pissed about how healthcare is delivered in the United States, count me in. I applaud all of the healthcare workers giving their best to people – physicians, nurses, techs, housekeeping, maintenance, all of them. I do not applaud corporate greed and I do not applaud a political system that buys legislators so that profits keep flowing to the fat cats. Call me a socialist. I think that is a better and more humane way to go than what we have. Better yet, take me back to Navy medicine – a socialized system that didn’t say $325 for your atorvastatin.