U.S. Healthcare is just too damn profitable and we are all paying

SUMMARY: Now that President Biden’s attempt to lower Medicare drug prices is dead, pharma can get back to business, and their business, of course, is making money. Using social media analytical tools, I was able to determine that there are a lot of outraged voters out there. Politics is broken and is too often about money, not what’s best for people.

PhRMA has delayed the inevitable. Eventually, politicians do what they were elected for instead of voting based on money. The CEO of Pfizer did raise a good point, though when he said, “our healthcare system is broken.” Prescription drugs only account for twelve cents of every healthcare dollar spent.

An article in today’s WSJ about hospital costs is eye-opening and scary. Hospitals and insurers have long set prices through confidential negotiations. Starting Jan. 1, hospitals were required to make their fees public under a Trump administration policy that sought to expose the sector’s pricing to more significant market pressure. Compliance with the rule has been spotty, but the available data show that prices vary widely among the plans that negotiate contracts with hospitals. While the data remain difficult for consumers to use, knowing the full range of rates could ultimately help patients negotiate their bills.

In other words, going to the hospital can lead to bankruptcy.

President Biden also tried to get a caregiver tax credit in the latest legislation, but of course, that was eliminated. It would have provided a tax credit of up to $2,000 for eligible caregivers. At one point, the distinction was as much as $5,000. But in fierce negotiations to get something through Congress, the credit was cut from Biden’s budget plan. It could have offered some relief for the millions of unpaid caregivers in the United States.

In the United States, about 48 million individuals provide unpaid care to an adult family member or friend. THIS YEAR, an AARP study found that three-quarters of the family caregivers reported that they regularly spend their own money on caregiving expenses. On average, family caregivers spend $7,242 annually, or 26 percent of their income.

KFF Health Tracking Poll found that 42 percent of unpaid caregivers experienced financial strain because of their inability to work.
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While Merck’s is right to share the formula for their new Covid pill, we should also remember that Keytruda has a list price of almost $175,000 per year (and Merck just raised that price by another 2% this month). Keytruda is close to becoming the highest-selling drug globally and would be a Fortune 200 company on its own.

PBM’s are also getting into the act of trying to block new legislation.

In late 2020, the Department of Health and Human Services (HHS) finalized the Transparency in Coverage Rule. Set to effect in 2022, part of the rule is designed to take the mystery out of drug pricing. This new rule requires health insurers to disclose to consumers the out-of-pocket costs for covered services. Part of the rule requires insurers to publish negotiated pricing about prescription medications. But the Pharmaceutical Care Management Association (PCMA), a group representing pharmacy benefits managers (PBMs), issued the federal government to block it. 

There is a lot wrong with healthcare and politics in this country. Healthcare is very profitable, and every player wants a bigger slice of the pie. Yes, the drugs that pharma develops save lives, but they also can lead to bankruptcies for thousands while pharma CEOs live a life of luxury.

When the silence of the good people, who understand that our industry contributes to a better quality of life, continues at the voices and money of Wall Street and executives who on compensated on stock prices nothing will change. Voters are noticing and change WILL come.