5 ms·
I know it's a worn-out stereotype to point out, but from an European, I just hope you realize how jarring it sounds that there is a medication that a doctor det
by alluro2 2y ago
I know it's a worn-out stereotype to point out, but from an European, I just hope you realize how jarring it sounds that there is a medication that a doctor determined you need, and TWO companies - entities driven by and existing exclusively for profit - are involved in deciding and communicating with each other on whether you will get it or not.
I do think that this should still actively be regarded as scary and abnormal, even if it's the norm for so many people in the US.
- Cumpiler69 2y agoIT IS a worn out stereotype. I'm also European and here the doctors are also limited by the national health insurance company on what medication and treatments they can prescribe you due to cost reduction pressure. Their hands are also tied except not by a private corporation but by the government. Often you'll encounter the infamous "these tests or procedures aren't covered by the national insurance anymore so you'll have to pay out of pocket", or they're covered, but the nearest appointment on the national insurance is 15 months away, at which point you'll either get better or you'll be dead. My boss recently moved from Germany to the US and was pleasantly surprised how much better the diagnostic, treatment and medication options are for his child who suffers from some rare mental disorder that's basically ignored in Germany by comparison. US seems to always be on the cutting edge of medical research and treatment which of course comes at a cost since research is very expressive.
- pavlov 2y agoYour boss is presumably a high-value employee at a prosperous company. They will have good health insurance, but that’s not the norm for most people. When I worked for Facebook in the US, it was conspicuous how doctors would run extra tests on me because the health insurance was paying for everything and anything. That’s not balanced either because less fortunate people pay for that in their insurance premiums.
- nxm 2y agoCompanies negotiate for all employees without tiers for „high value” employees. What do you consider the norm? 90%+ of Americans have some form of health insurance. I don’t have a bad one, but it’s not as great as some public sector employees do. Am I in the norm? If so, that’s ok
- btylke 2y agoWhile companies may negotiate for all employees, the percentage of the cost covered can be tiered, and some employees will pay less for better plans.
- Cumpiler69 2y ago>Your boss is presumably a high-value employee at a prosperous company. The company he worked at in Germany was even more prosperous yet had worse healthcare there. What's the deal?
- slowmotiony 2y agoCrazy right? Here in europe they just tell me that my medication isn't covered and I have to pay the whole price for it - if I don't like it, I can switch the government and move somewhere else.
- pavlov 2y agoIt’s not like you can just switch insurance companies in the US. Most people have healthcare coverage through their employer.
- baggy_trough 2y ago[flagged]
- PhasmaFelis 2y agoA lot more. More than the majority of people are able to.
- deleted 2y ago[deleted]
- baggy_trough 2y agoI'm skeptical of that claim. Of course, they'd prefer not to pay more.
- PhasmaFelis 2y agoYou can do your own research on how much disposable monthly income the typical low-to-middle-class American has, and how much good (i.e. significantly better than employer-provided) insurance costs.
- dfxm12 2y agoOnly under very special circumstances and at one time of the year. Claiming you can switch without qualification like this is disingenuous.
- ensignavenger 2y agoYou do realize that Euroean countris also decide what drugs and procedures they will cover on their national health plans too? Because you have a more limited set of options, your doctors will know what is covered and only recomend tose options, but it doesn't mean there aren't things that aren't covered.
- alistairSH 2y agoAt least the set of approved drugs is known. In the US you don’t know until you try to fill the orecription, then it becomes a 4-way game of telephone (patient, MD, pharmacist, and insurance) with each trying to outlast the other.
- ensignavenger 2y agoI concur, it is a pain. The US absolutely needs to improve! The point I was making is that the idea of free, unrestrained, unlimited healthcare in Europe is a myth.
- dcrazy 2y agoMy health insurance plan publishes a formulary.
- heavyset_go 2y agoAs does mine, but many drugs require either a prior authorization that insurance companies can fight or an exemption which can also be fought. It's not a guarantee that you'll get coverage for a specific drug just because you have an insurance plan.
- graeme 2y agoDoes your country cover ozempic for obesity? In Canada we don't for non diabetics. Americans get more drugs covered on average is my impression.
- hellcow 2y agoAmericans get no drugs covered--at all--unless you're over 65, have insurance through your employer, or pay thousands for insurance yourself (and often thousands more to meet your out-of-pocket deductible each year). I would take the default of "some" coverage over "no" coverage any day.
- knuckleheadsmif 2y agoOver 65, outside drugs delivered in a clinic, hospital or doctors office you don’t get drug coverage UNLESS you pay for it through Part D Medicare, have a Medicare Advantage pan (the privatized version of Medicare that now 50% of the Medicare population has stupidly picked), or a retirement medical policy that acts like a Medicare supplemental policy that many government employees and some company’s offered their retirees. That said it’s still a good deal and you can switch Part D policies year to year in case there are formulary issues. Plus with the IRA changes the max out of pocket is 2K which before you had no cap on—some new drugs are so crazy expensive that without this even the co-pay would wipe people out. That’s only recent fixed. In our own case, my wife who 3 years ago our out of pocket for some daily cancer pills went from 15k in 2023, to 8K in 2024, to 2K this year as the IRA fully kicked in.
- absolutelastone 2y ago
- rib3ye 2y agoYou think that is jarring? How about a drug company giving kickbacks to doctors to tell patients they need a drug?
- matthewdgreen 2y agoOzempic in Europe seems to be cheap, under $100 in many cases. In the US it costs 10x or more that. So as much as I hate to defend insurance companies, it's not just them.
- NeutralCrane 2y agoIt is just them. The way insurance works in the US is that insurers negotiate with pharmaceutical companies to get steep rebates so that they are paying far less for the drug than its list price, typically much closer to what you might pay in other countries. If they can't come to an agreement, they won't cover the drug. Sounds reasonable. But in practice, what happens is that if a pharmaceutical company simply cuts the list price to what the rebate would be anyway, the insurance company ends up dropping them from coverage. This seems counter-intuitive, but it happens for two reasons. First, the middle-men who negotiate and develop the formularies for insurance companies, called pharmacy benefit managers, get a cut of the reduced cost. So they make more money from a drug being $1000 and rebated to $100 than they would from the drug just being $100 all along. The pharma company makes the same amount per unit, $100, but they are much more likely to get onto an insurance plan if they go through the sham of marking it up to $1000 and then cutting it down. Secondly, extremely inflated list prices that get rebated down simply mean that it becomes that much more critical for patients to pay for an insurance plan, because it is increasingly untenable to be without one. These "negotiations" that PBMs do have been closely guarded "trade-secrets" but pharma companies have in recent congressional hearings have essentially said this is the situation. This seems to be supported by the fact that in their financial reports for products like insulin, the actual profit per unit has largely kept pace with inflation over the last few decades, despite the listed price of insulin skyrocketing during the same timeframe. This is pretty much entirely the result of there not being a non-profit seeking government provided insurance option available to all in the US. If there is a reasonable alternative to private insurance that isn't engaging in the insurance cartel, no one is forced to use private insurance and the private insurers are actually forced to compete in a market. Completely socialized medicine isn't required, we simply need a Medicare-for-all option available to destroy the anti-competitive behavior that currently exists in the US insurance market.
- 2y ago
- phaedrus 2y agoFour companies. The doctor's office which may be controlled by profit-optimizing administration, the big profit pharma corporation, the for-profit medical insurance company, and the company the insured works for who picks the available insurance plan(s).
- NeutralCrane 2y agoDoctor's office won't make money from prescriptions for a drug, and the pharmaceutical company will sell their drug to whoever will buy it. Both those entities also exist in non-US medication transactions as well, so I'm not sure it's relevant. The point is that the insurer and the employer are two extra middlemen.
- pyuser583 2y agoI get this sounds crazy. But what’s more crazy is the prospect your doctor is motivated by profit. Does that mean it’s less likely to be true? I’ve had some interactions with doctors that would chill your soul. “Here’s some long acting opiates. Take three a day for a month.” I’ve had doctors offer me antibiotics for the flu. I’ve been offered surgeries for conditions that don’t require them. I’ve seen doctors offer a week in the psych hospital over mild distress.
- Lord-Jobo 2y agoI mean yes but there is no solution to that problem, but there are many tried and true solutions to the other problem, so this just reads as deflection
- pyuser583 2y agoI’ve lived abroad and I’ve seen the solution: massive wait times for rationed care. I never had the problem of doctors pushing treatments I didn’t need in UK, Canada, Italy, or any of the other places I’ve lived. Seems to be an American thing, but maybe I’m missing something.
- fastasucan 2y agoDon't forget getting an e-mail about it from HR??