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For those of modest means there is also the "fail first" insurance process where you need to use less expensive therapies before a more appropriate therapy is a
by clcaev 7mo ago
For those of modest means there is also the "fail first" insurance process where you need to use less expensive therapies before a more appropriate therapy is approved. Each failure can be costly to a patient's health, often exacting irreversible comorbidities, not even considering lost work, family wellbeing, and pain/suffering.
For those with rare diseases, insurance also doesn't help with "N of 1" efforts. A case report to consolidate critical details would be invaluable. Yet there's no administrative path to fund this personally let alone with insurance help. Without summary case report it's harder to see the big picture, get a care team on the same page, and dial in on the underlying disease mechanism.
Pharma is also not enthusiastic about "off label" use of their medications. They are happy to lower costs when insurance denies coverage for an indicated diagnosis, to demonstrate benefit so it then becomes covered. However, "off label" use is often full cash fare, making it impossible for common folk to perform low-risk physician-guided experiments when standard therapies are ineffective.
We can and should do so much better.
- observationist 7mo agoImagine if we let doctors do medicine instead of letting profiteering beancounters optimize for number go up.
- clcaev 7mo agoI can see why some things landed here. Medicine is expensive. Desperate people are more susceptible to fraud. Yet things are improving: someone like me would be long dead a generation ago. We should look at these challenges holistically and think about better fiscal/social engineering of our marketplaces. Alvin Roth's book, "Who Gets What and Why", is a good introduction to identifying market failures and thinking about how to address them.
- rf15 7mo ago> Medicine is expensive. The whole point is that, past a certain point, it really isn't.
- Citizen_Lame 7mo ago[dead]
- terminalshort 7mo agoWe do let them do that if you are willing to pay them for it. The fact is that if you "let doctors do medicine" without any cost benefit analysis, then you really aren't going to like the cost.
- autoexec 7mo agoYou mean we do let them do that unless you aren't able to pay them for it. If you're the minority that has very large sums of money your doctors can decide what treatment works best, but for everyone else their healthcare is dictated by some company whose only concern is increasing the amount of profit they rake in and they'd happily see you dead if it would improve their bottom line.
- terminalshort 7mo agoYour comment contains nothing of value. If you have a better way to allocate scarce resources please state it.
- maest 7mo agoIn the US the allocation process itself is very expensive. Something like a third of the cost goes towards paying the administrative costs of navigating the byzantine insurance rules.
- RobotToaster 7mo agoThese resources are only scarce because of artificial scarcity. This is especially true of patent medicines, where it's government enforced artificial scarcity.
- nradov 7mo agoIf not for the government enforced artificial scarcity then many of those medicines wouldn't exist in the first place. Bringing a new drug to market costs >$1B now, largely due to clinical trials. No one is going to do that without patent protection.
- Aurornis 7mo agoStep therapy is required in countries with universal healthcare, too. It can actually be harder to get access to new therapies in countries with universal healthcare because they’re more uniform and strict in what they allow. For a relatable example: The UK just raised the age of eligibility for COVID vaccines all the way up to 75 years old: https://www.mirror.co.uk/news/health/covid-russian-roulette-millions-cant-36146965 https://www.mirror.co.uk/news/health/covid-russian-roulette-... Contrast this with the US where COVID vaccine coverage is a basic expectation of health insurance for all ages. And that’s for a simple, cheap medicine without step therapy! It doesn’t matter if your doctor thinks you need it, the rules are set from the top.
- ch4s3 7mo ago> Step therapy is required in countries with universal healthcare, too. This is something Americans with strong opinions about healthcare but little time spent researching it never seem to know.
- sampullman 7mo agoIt can be harder, but it's specific to the country/system. Here it Taiwan you can walk into any clinic with stock and get a (NHI covered) vaccine any time. There are other things to complain about of course, but the rules for what's covered ate generally logical. Non-covered medication is affordable to, which helps.
- noobermin 7mo agoTo be honest, given the issues with the NHS, the UK isn't the best example to use for a "universal healthcare" system these days.
- arethuza 7mo agoWorth noting that "eligibility for COVID vaccines" is for "free at the point of delivery" NHS treatment - you can still get it elsewhere at any age. Boots (a major chain of pharmacies) do it for £98: https://www.boots.com/online/pharmacy-services/covid-19-vaccination-service https://www.boots.com/online/pharmacy-services/covid-19-vacc...
- 7mo ago
- renewiltord 7mo agoWe do. They just can’t charge it to a third party to the relationship. As a doctor you are welcome to provide services at cost.
- s5300 7mo ago[dead]
- nicofcl 7mo ago[dead]
- r1qdj0 7mo agoWe have something similar in Brazil. Our public system, SUS, has treatment protocols where you sometimes need to try drug A before you can get access to drug B. BUT the protocol is written by a medical committee - CONITEC -, not by an insurance company desperately trying to save money. When I need to skip a step, I write a lenghthy clinical justification and send it up. And it can take time, sometimes months. It's super frustrating, yes, but at the very least I know the person reviewing it is not incentivized to deny it. They are checking if my reasoning makes sense, not calculating how much it will cost their employer. That's the part that's hard to explain to Americans, that the bureaucracy here is slow and annoying but it's not adversarial. Nobody's profiting from telling me my patient doesn't need a medication. In the US model someone literally is. That changes everything about the practice.