Let's Talk Affordable Health Care (Briefly)
Yeah yeah yeah, I've been promising Nazi horror films and I'm actually gathering stuff for a third beside the two I've got now - The Keep (1983) and a hilariously bad entry from The Asylum that I can't even say without snickering so it's good I can type it - Nazis At The Center (mmph)... let me try again. Nazis At The Center Of... (bwahahahahahaaaa). Sorry. Nazis At The Center Of The Earth. Starring Jake Busey. Now excuse me for a couple of moments while I clean myself up.
Okay, health care. A hot button right now I'm not gonna push. Let's just say it's screwed all of us six ways to Sunday, unless you're one of those perfectly healthy people that's never needed so much as an aspirin. No, wait, it's screwing you too.
As it stands now, which I did not know, health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions. But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses to pay more for their drugs.
And don't think that makes everybody's insurance cheaper either. I'm sure whether it's the so-called Affordable Health Plan or a private insurance plan, you're paying more than ever before, sick or not.
"So go generic. What's the big deal?" Yeah, well there's a small problem with that. Insurance companies, while they now HAVE to take you, sick or not, still want their fingers all the way in the pie, not just a little so... what you don't pay in premiums or co-pays, you now may pay in buying your prescription, generic or not.
A lot of pharmacies now have 'tiered' generic drug plans. That's fine if you can get it through a program that allows certain ones who can't afford much a lower rate for their monthly meds. And now the insurance companies, desperate to make up some of their lost revenue by having to insure the sick, are messing with those.
If you've bought brand name drugs with your insurance, you know about tiers. You either pay A, B, or C after the co-pay. If you didn't want to mess with that, you asked for generic. That used to be good enough.
Not any more. Now even the cheapest of generic alternatives are on a tier system as well, and, if you don't watch the so-called 'lists' of available medications and their prices, they can charge you any damned amount they want, and change it from month to month without telling you. I know this from personal experience.
Never, NEVER refill your prescriptions without checking or you'll be one of those LOUD customers at the beginning of a long line, demanding to talk to someone about the outrageous amount of money you're being charged for something that cost, oh, say a third of the price only the month before.
Never, NEVER refill your prescriptions without checking or you'll be one of those LOUD customers at the beginning of a long line, demanding to talk to someone about the outrageous amount of money you're being charged for something that cost, oh, say a third of the price only the month before.
So now you can't be turned away, but you sure as hell can be charged more for your coverage, your ailment labelled as "non-preferred" and charged higher co-payments. The Affordable Care Act bans insurance companies from discriminating against patients with health problems, but that hasn't stopped them from seeking new and creative ways to shift costs to consumers. In the process, the plans effectively may be rendering a variety of ailments "non-preferred".
"It seems that the plans are trying to find this wiggle room to design their benefits to prevent people who have high health needs from enrolling," said Wayne Turner, a staff lawyer at the National Health Law Program, which filed the complaint alongside the AIDS Institute of Tampa, Fla. Turner said he feared a "race to the bottom," in which plans don't want to be seen as the most attractive for sick patients. "Plans do not want that reputation."
What is tiering (for those of you in other countries who don't have to deal with this sort of thing)? Generics, which come to the market after a name-brand drug loses its patent protection, used to have one low price in many insurance plans, typically $5 or $10. But as their prices have increased, sometimes sharply, many insurers have split the drugs into two cost groupings, as they have long done with name-brand drugs.
"Non-preferred" generic drugs have higher co-pays, though they are still cheaper than brand-name drugs. In some cases, the difference in price between a preferred and non-preferred generic drug is a few dollars per prescription. In others, the difference in co-pay is $10, $15 or more.
"Non-preferred" generic drugs have higher co-pays, though they are still cheaper than brand-name drugs. In some cases, the difference in price between a preferred and non-preferred generic drug is a few dollars per prescription. In others, the difference in co-pay is $10, $15 or more.
Even small differences in price can make a difference, though, the authors said. Previous research has found that consumers are less likely to take drugs that cost more out of pocket.
"There's very strong evidence for quite some time that even a $1 difference in out-of-pocket expenditures changes Americans' behavior" regarding their use of medical services, said the other co-author, Dr. A. Mark Fendrick, a physician and director of the University of Michigan Center for Value-Based Insurance Design.
"There's very strong evidence for quite some time that even a $1 difference in out-of-pocket expenditures changes Americans' behavior" regarding their use of medical services, said the other co-author, Dr. A. Mark Fendrick, a physician and director of the University of Michigan Center for Value-Based Insurance Design.
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| Don't even try to read this, it makes no sense anyway... |
And that's for those of the working class. Those who depend on Medicare for their monthly needs can be, in some situations, a hell of a lot worse off. Health plans that participate in Medicare's prescription drug program, known as Part D, have been moving rapidly to create two tiers of generic drugs.
This year, about three-quarters of plans had them, according to an article co-written by Jack Hoadley, a health policy analyst at Georgetown University's Health Policy Institute. The practical effect of such arrangements probably varies based on the difference in cost, he said.
Dan Mendelson, chief executive of Avalere Health, a consulting firm, has studied the way in which health insurers structure their benefits. He said the increasing number of drug tiers in some plans was confusing for patients. "Consumers often don't understand which drugs are where," he said. "They don't understand the purpose of tiering. They just get to the pharmacy counter and it gets done to them."
This year, about three-quarters of plans had them, according to an article co-written by Jack Hoadley, a health policy analyst at Georgetown University's Health Policy Institute. The practical effect of such arrangements probably varies based on the difference in cost, he said.
Dan Mendelson, chief executive of Avalere Health, a consulting firm, has studied the way in which health insurers structure their benefits. He said the increasing number of drug tiers in some plans was confusing for patients. "Consumers often don't understand which drugs are where," he said. "They don't understand the purpose of tiering. They just get to the pharmacy counter and it gets done to them."
All I know is, it's the same song, different words. Those of us depending on health care are being taken advantage of, no matter how the government supposedly 'fixed' it, and just trying to stay alive, much less healthy, is a costly endeavor.
I should say at this point that most of the 'facts' presented here were taken from an article from the ProPublica, a non-profit corporation that describes itself as providing investigative journalism in the public interest.
And now... back to the Nazis!
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