Iron poor blood? For many of a certain age, mere mention of that phrase conjures the major advertising campaigns of yore for a popular, over-the-counter nostrum called Geritol. The tonic is still around and sells for less than what a first-run movie ticket costs.
Which leads to a different question that may burn many patients: Why are doctors and hospitals peddling Injectafer, a new and hot treatment for iron deficiency that happens to cost $14,000 per vial? The drug also must be given intravenously by trained medical personnel at additional cost in a doctor’s office, a clinic, or hospital.
Shefali Leuthra reported for the Kaiser Health News Service and NPR that doctors are ordering Injectafer and other pricey prescription drugs like Feraheme for big numbers of patients, particularly seniors because they suffer a common condition:
“Anemia, the principal outgrowth of low iron levels, can cause headache, fatigue and an irregular heartbeat. People with certain medical conditions, including a history of heavy menstrual periods, inflammatory bowel disease and kidney failure, among others, are prone to low iron levels and anemia, which can be severe. [But recently, patients’] experience with pricey iron infusions is pretty common. Since 2013, the first year for which data are available, about 9 million Americans in the federal government’s health plan for people 65 and above have gotten iron infusions each year. That’s almost one infusion for every five Medicare recipients.”
As Leuthra reported, iron-boosting anemia drugs exist in “cheaper, older formulations — which can go for as little as a tenth the cost.” But these alternatives are seeing declines in use because the latest, gee-whiz medications may have minor improvements (such as in frequency of dosage or slightly lesser side-effects), while they also throw up much more revenue and profit for their makers and doctors, clinics, and hospitals. The new medications also may be practitioners prime choice now because, as is so often the case, Big Pharma seeks to maximize its profits on its latest products by advertising, marketing, and selling them aggressively, while letting older meds wither. Leuthra details well the pros and cons of the various options.
The major takeaway from her article, though, is this: Doctors, hospitals, insurers, Big Pharma, and others in the medical establishment can pretty much do what they darn please in not only picking what drugs patients get but also how much they will pay for them. They gouge us, just because they can.
Politicians’ frenzy over health care
That reality may raise lots of blood pressure readings nationwide. It also may be exceeded only in the anger that may be building over the political response that’s part and parcel of the churning 2020 presidential campaign.
The Trump Administration is pulling out all kinds of actions to show, late in the first term, that it can accomplish something on health care — other than taking a drubbing over Republican attempts to repeal but not replace the Affordable Care Act, aka Obamacare.
Officials have pushed out and are awaiting the push back on one plan, for example, to require hospitals to post on their websites the details of secret deals they may have struck with insurers to provide some patients discounts. Trump officials say this may help to curb ever-climbing hospital and insurer costs. Critics say this actually may boost prices, as competitors see what cut rates exist in markets but decline to match them. The administration also has not yet felt the brunt of the backlash from hospitals and insurers on this plan. The groups showed their recent clout by submarining efforts to deal with “surprise medical bills,” potentially big expenses that patients incur when treated by doctors and others who are not part of their limited networks of insurer-approved providers.
Meantime, the administration — faced with revolt within GOP ranks — is not only forging ahead with a proposal to tie some domestic prescription drug prices to what Europeans pay but also with, maybe, possibly, another option to permit the importation of select meds from markets most akin to the United States. In other words, rather than fixing domestic outrages with pricing, why not let Americans flood and pilfer Canadian supplies?
Democrats, meantime, seem to have swamped the powerful message that they had developed to triumph in the midterm elections, replacing it with excruciating policy minutiae and interparty bickering among an endless field of presidential hopefuls. Yes, a single payer system and universal coverage would be ideal. And perhaps it might be built on the solid achievements of Medicare.
But the policy wonks and idealists seem to have critical amnesia about their party’s past and the decade war over Obamacare. It survived President Trump’s sweep into his first year in office, with the GOP holding the House and Senate and U.S. Supreme Court by a single vote, cast by the late U.S. Senator John McCain. The GOP, notably the Trump Justice Department and administration officials in the Centers for Medicare and Medicaid Services (CMS) and the Health and Human Services agency have ripped and torn at the ACA since.
This has seen a decrease in the number of poor and middle-class Americans with health coverage, as well as increases in costs for those insured in ACA exchanges. Obamacare — notably its protections against insurers barring coverage for preexisting conditions and capping lifetime benefits — is at high and surprising risk in the courts, first at the trial and recently at the appellate level. Trump officials also have resurrected dodgy health coverages that appear to cost patients less but leave them stranded for help when they get sick or injured and need it most.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of therapies and prescription medications, too many of which prove to be dangerous drugs.
Voters have made clear that health care overall — not just health insurance — is one of the top issues on which they will decide their 2020 ballot choices. They’re sick to death of getting ripped off by Big Pharma, doctors, hospitals, and insurers. They want and need solid health coverage, including from employers who don’t stick them with high deductibles that mean they, effectively, all but lack insurance. The madding political crowd may make all kinds of noise through the dying summer and into the fall. But Americans are watching closely, waiting for realism, and solid action. They will not be disappointed and will vote accordingly if it happens.