In managing our 99-year old, there are some indispensable tools. In our home, that includes a bottle of Ondansetron, the anti-nausea medicine. When retching hits Mother, these magic pills bring her instant relief. I hang on to the bottle with dear life. If I have to flee home in an emergency, that might be the only thing I grab as I run out of the door!
Recently a friend of mine was hit by the stomach flu, the unwelcome guest of this season. As I heard her feebly tell me that she had lost track of how many times she had puked through the night, I knew what to bring her (after a quick check with our resident doc). Later that day I went to the pharmacy to get more of this med for her and paid $15 for as many pills. This is after insurance paid its share. Today, I went to pick up Mother's refill for Ondansetron and paid $3.40 for 30 pills, while Medicare paid $99.
Holy pill!! What the heck? Why the difference? What's going on?
This, my friends, is the crux of the medical system in the US. The mantra is to charge whatever you can. For my friend, her private insurance company might have also charged $99 or higher perhaps, and the patient's share was a dollar a pill. For Mother who is on Medicare, we paid less than 12 cents per pill.
Welcome to the staggering world of government-funded healthcare, which most of us will be on when we hit age 65.
In 2017, 57M people were enrolled in Medicare, i.e., over 18% of the US population. Enrollment projections are: 64M by 2020 and 81M by 2030.
Medicare accounts for 20% of the National Health Expenditure (NHE). Medicaid accounts for 17% of NHE.
The largest share of NHE was paid for by the federal government (28.1%). Then households (28%), then private insurance at 19.9%, followed by states (17.1%), and other sources.
The federal government and state governments together pay for 45.2% of the NHE. That is NEARLY HALF!! Whoever says we don't have socialized medicine in this country is...umm...smoking pot.
And Medicare spending in 2017 was the same as defense spending. If you add Medicaid and CHIP then spending on healthcare by the government exceeds that on social security. Did I say staggering?
Our politicians don't like to discuss these facts because the holy grail of healthcare is privatized insurance so that they can charge $1 instead of $0.12 for one tablet of Ondansetron. The jaw-dropping irony is that private insurance does not deal with the older population needing high-priced healthcare and meds; the government does!
If the government offers a national health plan to everyone - "Medicare for All", as it is called - it will be game over for the private health insurance companies for their current model. ACA saved our rear end when we couldn't afford the 4-digit premiums per month that a private insurer was charging Mother. It offered lower premiums with higher deductions. We were willing to take the risk and relieved at ACA's lower monthly premiums compared to private insurance. It was a no-brainer to choose ACA. Sadly, it did nothing to reduce costs. And here we are, staring at the endless saga of $1 vs. $0.12!
When you hear the pundits wax poetic about the current healthcare model or read about the healthcare debate - whether it is the Republicans wanting to tear down ACA or the Dems offering Medicare for All, sit up and pay attention. Ask what portion of the NHE is borne by the government already and why. Ask how much are we as "households" paying and where is the transparency on those prices. Ask how will increasing costs be checked.
With healthcare now being 17.9% of the GDP...we are talking about 3.45 trillion - with a T - annually and rising! The nausea these stats cause me has absolutely no cure in sight!
[Stats in this post are from CMS and Kaiser Family Foundation.]