Healthcare, Drugs and Cost

Shannon Bohrer

(6/2019) Our president recently told us that his justice department was going to court to have the Affordable Care Act (ACA) repealed, by having the judiciary declare it unconstitutional. Of course he also told us not to worry, since his party would be rolling out a better health care system. However, less than a week later, he said his new health care law would be instituted after the 2020 election.

The Justice Department is still going to court, and if the courts declare the ACA unconstitutional and since the new promised law is at least a year and a half away, what happens to all of the people that currently use the ACA? What happens to all of the people that have pre-existing conditions? Before the ACA, individuals with pre-existing conditions were often not insurable. The cost was prohibitive and/or insurance companies often would just not insure them.

When The ACA was enacted it changed the rules, requiring insurance companies to insure individuals with pre-existing conditions. Additionally the ACA prohibited insurance companies from charging higher premiums to people with pre-existing conditions. Prior to the ACA, people with pre-existing conditions, that could obtain insurance, were placed in high risk pools, with much higher premiums.

The cost of our heath care is the major issue. In 1970, our health care cost was about 6 percent of our GDP. In 2017, our health care cost was 17 percent of our GDP, which equates to one sixth of our economy. This means heath care cost have exceeded our normal growth. One out of every six dollars goes to health care.

According to the Kaiser Family Foundation, we spend about twice as much for health insurance than eleven comparable countries. The other countries spend an average of $5,280 per person for health care cost per person and the U.S. average per person is $10,224.00. While we pay more for medical insurance, we don’t receive more. The Commonwealth Fund Report ranks the U.S. 11th in health outcomes, which is below the other countries. "Most troubling, the U.S. fails to achieve better health outcomes than other countries, and… the U.S. is last or near last on dimensions of access, efficiency and equity."

The need for health care reform to control cost seems obvious to everyone, and yet the president’s party has tried to repeal the ACA over 70 times, with no success, and with nothing to take its place. With the last attempt to repeal, which was in 2017, the president said the ACA would be replaced with a better system, but no such system was offered. So, if the justice system is successful in repealing the Affordable Care Act through the courts, – what happens?

While our current health care system cost twice what other industrialized countries pay, the cost of prescription drugs has gone up faster. There are people paying over $500 a month for insulin alone. Currently, one in four diabetic people are using less and even missing doses of insulin because they cannot afford the cost.

What many people may not know is that insulin was discovered and formulated by two Canadian scientists in 1921. The scientist; Frederick Banting and Charles Best, knew the value of the discovery and sold the patent to a University for one dollar. The formula for insulin was freely given to the drug manufactures, for the sole purpose of always keeping the cost of insulin low. Market research expects the global "insulin market will top $48 billion" in 2020.

While the cost of insulin has quadrupled in the last decade, other drug prices are also going up. We all remember the $700 Epi-Pens, a 700 percent increase in just a few years. While there does not seem to be any limits on prescription drug prices, at least many of us have prescription drug insurance. However, even with insurance the co-pays are also increasing.

Related to the increased cost of health care insurance and prescription drugs, is the fact that we are experiencing a nationwide problem with drug additions. The United States, like every other county has always had problems with addictions, but starting in the late 1990’s our opioid addictions began to escalate. With the growth of addictions the number of overdose deaths has also grown.

Over 217,000 people died from prescription opioids overdoses from 1999 to 2017. The rate of overdose deaths was five times higher in 2017 than it was in 1999.There is a correlation between the number of opioid prescriptions and opioid deaths, as the number of prescriptions has grown. In 2017, there were 58 prescriptions for opioids for every 100 citizens. Over 17 percent of our population had a prescription filled for opioids. An estimated 80 percent of all opioid prescriptions use and supply are consumed in the United States. That is a significant number since we are less than 5 percent of the world population.

From another perspective, that of the drug manufactures, the estimated 300 million pain prescriptions written each year is a 24 billion dollar market. A large part of this market has been owned by the Sackler family, the owners of Purdue Pharma, which produced an estimated 35 billion dollars in revenue since 1995. It was in 1995 that Purdue Pharma started marketing and selling OxyContin, as a long term product to alleviate pain. When introduce, OxyContin was marketed as safe to use with very few addictive qualities.

We all know that the marketing for OxyContin was deceptive and we now know this because of all of the law suits against Purdue Pharma and other manufactures. Whistle blowers and company insiders have told us that bribes were paid to doctors. From court documents, "We’re going to pay you five times as much if you can get him to prescribe the strongest does possible." Sales representatives made more money – by selling more products, even if the product was not needed.

"According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription pain killers." Yes, we have a drug problem and we need to be diligent to deter the importation of illegal drugs. However, the manufacturing of legal drugs in the U.S. has created the demand for the illegal drugs. Capitalism has worked for the owners, the manufactures and the sales force in our pharmaceutical industry.

We are the only large industrialized county that supports a health care system for profit. The services we have include paying more for insurance and medical care, while we often receive less than other countries. The services also include 80 percent of the world’s opioid prescriptions, which has been responsible for higher addiction rates. It is not a coincidence that the U.S. consumes 80 percent of the world’s opioid prescriptions, since we also consume 75 percent of all prescription drugs in the world.