A Patient Complained about the Cost of Her Medical Care. Here's How Her Doctor Responded.
The oncologist had prescribed Xgeva hoping it would strengthen her bones while also delaying the progression of Angela Kahn’s breast cancer. But Kahn (a pseudonym) couldn’t get over the price of the drug. Before the oncologist had a chance to ask how she was feeling, she blurted out that the medication cost “$15,000 a shot.” “That’s crazy,” the oncologist replied, continuing by saying the price “fits right in with the rest of the insanity” of U.S. healthcare pricing. At that price, Kahn concluded, “I don’t think I should get it.”
The oncologist assured her “You’re getting it,” and they both laughed.
Not that either thought Xgeva’s price was a laughing matter. In fact, like many medications, Xgeva costs much more in the U.S. than in any other developed countries, with a single injection costing more than $2,000.
There’s too many reasons for these high prices to delve into them in the space of a short essay. Instead, I want to show how the insanity of American healthcare prices played out in this one, real oncology appointment. (Note: The appointment was recorded by a marketing company, Verilogue Inc., with the permission of the doctor and patient. I gained access to an anonymized transcript of the appointment for a research project approved by the Duke University IRB.)
After assuring Kahn that she’d remain on the Xgeva, her oncologist explained how he believes healthcare pricing plays out in the U.S. “It’s totally outrageous. What usually happens is the hospital or the clinic will charge 300 times what they think they can get, and the insurance company pays 1/20th of the original.”
“Oh, okay,” Kahn replied, with a touch of confusion.
“So it’s just a game, it’s a total horrible game,” the oncologist continued. “That’s crazy,” Kahn reiterated.
(To read the rest of this article, please visit Forbes.)
Should Presidential Candidates Be Vilifying Physicians For The High Cost Of Medical Care?
When asked what enemies she was proud to have made during her political career, Hillary Clinton mentioned, in order, “the NRA, the health insurance companies, the drug companies [and] the Iranians.” Pretty villainous company to place healthcare industries into. But Clinton is not alone among presidential candidates in vilifying pharmaceutical and insurance industries for, as Bernie Sanders puts it, “ripping off the people.” Donald Trump called pharmaceutical profiteering “disgusting” and claimed that “insurance companies are making a fortune because they have control of the politicians.” Marco Rubio blamed high drug prices as “pure profiteering” by pharmaceutical companies. It is a strange world when Republicans join Democrats in vilifying people and companies who pursue profits through the marketplace.
Even stranger, neither party is taking aim at a group of people in the healthcare industry who have been making a fortune by exerting enormous influence over healthcare spending. No one seems to be vilifying physicians.
Yet if candidates are looking to blame someone for high healthcare costs in the United States, they should include physicians, whose decisions–to order tests or treatments–are responsible for the bulk of healthcare spending. Yes, pharmaceutical companies are charging exorbitant prices for many of their products. But patients do not receive expensive medications unless physicians prescribe them. True, insurance premiums are very expensive and rising rapidly. But those premiums reflect the cost of paying for all those services that physicians order for their patients. And some of those services reflect physician fees, which for some subspecialists are quite high. Many American physicians are extremely well paid for their work, with the median allergy doctor making almost $300,000 a year, and the median gastroenterologist making almost $400,000. Indeed, American physicians often take home 50 to 100% higher annual incomes than their peers in Europe or Canada.
So why aren’t politicians vilifying physicians? Because when they turn their attention to the role of physicians in driving up healthcare costs, candidates shift from blaming people to blaming the system. When laying out her healthcare plans, for example, Clinton remarks that “we need to shift away from the fee-for-service payment system that rewards providers who prescribe excessive tests and unnecessary procedures.” Jeb Bush also criticizes the reimbursement system, complaining that “providers are not being held directly accountable to patients for the value of the care they deliver.”
When pharmaceutical and insurance companies drive up healthcare costs, they are villainous. When physicians drive up costs–it is the system that is to blame!
(To read the rest of this article, please visit Forbes.)