US Healthcare Is So Screwed I Fly to Britain for My Medication

http://www.wired.com/2015/02/us-healthcare-screwed-fly-britain-medication/?mbid=social_fb

by AdeptusAquinas • 11 years ago

44 72 11 years ago

ptaipale6• 11 years ago

Is the author actually right to live and work in the US, and only fly back to Britain for getting medication subsidised by British taxpayers? And is the fact that he can do this just an indication of US healthcare being screwed?

The post doesn't tell too much about facts and I don't know the British rules for eligibility to NHS, but I think it's possible he could be committing fraud. If he were doing the same with my country's national system, it certainly would be fraud (though it would probably not be possible in the first place, because we have a Big Brother that knows more than the British one).

mgkimsal3• 11 years ago

From a moral standpoint, I'd say this person is in the right - they've paid in to the NHS at some point earlier, or their parents had - to cover this sort of thing. Legally, I don't know enough about the NHS to say for sure.

k-mcgrady3• 11 years ago

> "they've paid in to the NHS at some point earlier, or their parents had"

Yeh, to cover them for the time they were paying. If you're no longer paying your taxes or seeking employment or unable to work due disability the money you paid in the past should't cover you morally.

Edit: There's no doubt the price the writer has to pay in the US is a disgrace and if they couldn't afford it then I think using the NHS is a good temporary solution but the fact that he could afford it but uses that money for a holiday instead is very immoral imo.

VLM2• 11 years ago

From a moral standpoint in the USA the international megacorp will say "Oh, your health is worth anything to you? Hmm. Howabout everything you got minus $1" Like a semi-kind mugger. Its not a free market. Pay up or die, sucka!

In the UK the .gov will fight for you instead of the corporation so you pay a fair price. The UK gov is under no life and death pressure to pay up or die, and they have regulators who are educated and understand the market. It is a much free-er market than the USA market.

Arguably what he's coughing up in hotel fees and surcharges and taxes and hotel prop tax is Exactly how a visitor should be paying for medical care, so on an individual level he's moral and ethical.

Not getting screwed over when someone else gets screwed over does not imply some kind of survivors guilt is ethical.

adwf4• 11 years ago

Not to mention that most young ex-pats do eventually come back to the country and contribute. I'd rather they came back alive and well, even if it is me footing the bill for them in the meantime.

That's one of the big missing parts of the US healthcare debate. It's not just about immediate cost, it's about potential future tax revenue and economic value that you're losing when you let people die before their time.

jjoonathan• 11 years ago

Well the fact that drugs are twice as expensive (or more) in the US* and the fact that the US accounts for a huge chunk of government funding into the relevant sciences are part of the reason why drugs are so cheap overseas. British taxpayers buying drugs in Britain are effectively getting a subsidy from US taxpayers even though they don't pay into the pot, so this all seems like a stroke of cosmic justice where I'm standing. Of course, I doubt the British tax authorities care much about what I think.

* Why? Remember how bargaining works: the biggest customer gets the best deal. First imagine Kaiser, Wellpoint, and Aetna sitting down at the bargaining table. Now imagine Canada sitting down at the table. Now imagine the European Union sitting down at the table. But at least our insurance companies are more efficient due to competition, right? Spoiler: not even close, and that's before you take into account the costs they offload onto the rest of the system in the form of incompatible claims policies, paperwork, and exploitation of information asymmetry against consumers.

giarc• 11 years ago

I don't know figures, but I imagine Kaiser represents more than 35 million people (the approx population of Canada). Shouldn't they be able to negotiate the same price?

ptaipale6• 11 years ago

The European Union is not bargaining as a single buyer.

There are considerable differences between the health insurance systems of EU member countries, and each of them buys their medication differently. In fact, it looks to me that the US is closer to being a one buyer than the European Union, which would first need to do a lot of harmonizing and more or less set up a United States of Europe.

Kaiser, Wellpoint and Aetna each have as many health plan members as a medium-sized European country. That's not the problem.

As far as I understand, the problem is the unavailability of generic replacement medicines in the US, clearly for IPR reasons.

geographomics2• 11 years ago

Well the fact that drugs are twice as expensive (or more) in the US

You have to compare like for like though - looking at the cost to the end user is not relevant, you'd have to look at the cost to the NHS versus the cost to US health insurance companies.

For the NHS, this is publicly available data[1] and we can see that a course of once-daily apiprazole (the drug described in the article) costs the equivalent of $150-300 per patient per month, depending on formulation. Is such data (of actual cost) available for the US?

Also, regarding biomedical research - the British taxpayer funds this as well. Anyway, apiprazole was developed in Japan. It's not all US-centric.

[1] http://www.hscic.gov.uk/searchcatalogue?productid=14494

sveiss• 11 years ago

The rules aren't written in a particularly clear way, but in general the idea is that NHS eligibility is residence-based, and people who aren't ordinarily resident are entitled to urgent treatment only. Flying back just to pick up prescriptions is definitely against the spirit of the rules.

Enforcement -- or even understanding -- of the rules on a local level seems spotty. I've helped overseas visitors find their way through the NHS. Some GPs and out of hours services have treated them like a local patient and when asked about payment had no idea, whilst one GP pulled their wallet out in the consulting room and demanded cash there and then. Hospitals are supposed to be more consistent, but I haven't any experience there.

DanBC7• 11 years ago

EDIT: strikeout [In my opinion it's fraud.] /strikeout

http://www.nhs.uk/chq/pages/1086.aspx?categoryid=68

http://www.nhs.uk/chq/pages/1087.aspx?categoryid=68&subcateg...

But the rules are a bit complicated so maybe it's fine.

It's weird that he gets a six month drop of medications each time -- that is very unusual behaviour from the prescribing doctor and the prescription-filling pharmacist.

geographomics2• 11 years ago

It's not fraud. Such charges for overseas visitors only apply for hospital treatment - prescriptions are explicitly excluded, and are subject to the statutory price that everyone pays (unless they are exempt and get their medicine for free), see: https://www.gov.uk/government/uploads/system/uploads/attachm...

pacofvf• 11 years ago

why not Mexico? it's a big destination for Health Care tourists, it's cheaper than Canada or Europe and you would only need to go to a doctor once to get a prescription and re-use that prescription. Also you would get to spend a few days in places like the mayan riviera.

IvyMike2• 11 years ago

He mentions both Canada and Mexico in the article.

vonmoltke2• 11 years ago

Otsuka’s patent on Abilify will expire in April, costing it an estimated $65 billion over the next four years.

That statement is false, and demonstrated clearly in the author's source:

Drug makers face another patent cliff in which the industry will lose roughly $65 billion in revenue through the end of 2019, according to a research firm’s report.

...

GlobalData estimates Otsuka will lose $6.2 billion in annual sales due to competition from generics by 2019.

Edit:

Continuing on this theme, according to Google finance Otsuka's net profit margin is 10%, which I think is on the higher end of reasonable. Now, I'm not saying the price they charge in the US is fair (for some definition of fair), but one does need to consider how much the ridiculous American drug prices are subsidizing the $24/year NHS prescriptions. A government can regulate the price of drugs, but can't force the companies to sell them in the first place. Not directly, anyway.

CHY8722• 11 years ago

Now, I'm not saying the price they charge in the US is fair (for some definition of fair), but one does need to consider how much the ridiculous American drug prices are subsidizing the $24/year NHS prescriptions. A government can regulate the price of drugs, but can't force the companies to sell them in the first place. Not directly, anyway.

Remember that the cost to the NHS is far more than $24 - which refers to the £8 prescription fee paid in the UK, twice per year. It's actually £220.41 per patient per month for the NHS - about $335. So whilst it's still somewhat more expensive in the US, it's not much more expensive - and well within the bounds of shrewd negotiating (which I'd imagine insurers would normally do).

[1] http://www.awp.nhs.uk/handlers/downloads.ashx?id=9572

vonmoltke2• 11 years ago

I figured it was costing the NHS much more than that, but I did not know they were covering so much. Thanks for the information.

The issue of what insurers actually pay versus what the uninsured are expected to pay is a tangential hot button issue for me, especially since I started treatment for my sleep disorders.

S_A_P• 11 years ago

This article doesn't really make a compelling case. Facts would have been nice.(I would spend x dollars for the drug I need in the US which is more than I would spend flying to the UK and getting 6 months worth at a time. Or something like the drug I need is in short supply in the US so I go to where it's plentiful in the UK) What is so screwed about it in the authors eyes?

k-mcgrady3• 11 years ago

> "What is so screwed about it in the authors eyes?"

Maybe I missed something but it seems blantantly obvious. In the US he has to pay for health insurance PLUS $720 a month for drugs he needs. In the UK this is provided at almost no cost to the patient through taxes. No health insurance and no huge drug cost.

refurb11• 11 years ago

So maybe a more fair comparison would be to compare total costs in the US (insurance premium and drug cost) to the total costs in the UK (higher taxes and small Rx cost)?

Of course the end result would all depend on your salary level.

Cowen• 11 years ago

Vox did something a while back that's more along those lines.[1]

The cost of care in the US is much higher than in other countries. There are a bunch of reasons for this, and everyone has their preferred scapegoats and solutions, but the end result is that healthcare prices in the US are astronomically higher than in other countries. So it's often cheaper to just go somewhere else and buy the care you need there at a fraction of the cost.

[1] http://www.vox.com/cards/health-prices/america-is-getting-go...

pskittle• 11 years ago

I studied in the US for a bit, inspite of the university having a decentish setup for medication. I preferred getting treated by local doctors in my home country. Studying about the healthcare system in the US makes me sad. It shouldn't be so painful and expensive

strictnein3• 11 years ago

It isn't that bad in the vast majority of cases, and in many ways it's better. 5 year cancer survivability rates for instance are top notch, ability to see specialists with little to no wait, etc.

Example: My friend's son was diagnosed with leukemia on Monday. They went to their primary care doctor Monday morning for some gum bleeding that wouldn't stop, were referred to a specialist Monday afternoon, and is already in a children's cancer hospital receiving treatment where he will be for the majority of the next 8-9 months.

nerfhammer• 11 years ago

And if your friend doesn't have good insurance it would mean total financial ruin

6t6t62• 11 years ago

I'm happy for your friend, but this is anecdotal evidence.

Statistics don't agree with your story:

http://en.wikipedia.org/wiki/List_of_countries_by_life_expec...

IvyMike2• 11 years ago

I don't know exactly what's going on, but I'm on a mediocre Obamacare plan that costs less than the author's plan. Even though it's in the most expensive drug tier, as far as I can tell Abilify would cost me $70 a month.

I arrived in America just as Obamacare was rolling out. Since I couldn’t meet the deadline for insurance

Well it's been rolled out for a while now. Can't he switch now?

dragonwriter2• 11 years ago

Well it's been rolled out for a while now. Can't he switch now?

Not sure if the annual open enrollment periods are nationally synchronized or differ per state, but Covered California (California ACA Exchange) currently has an open enrollment period (ending 2/15.)

maxerickson3• 11 years ago

Apparently it varies based on the plan:

http://www.phrma.org/sites/default/files/pdf/exchanges-menta...

(In some bronze plans, up to $4300 of deductible applies to medications)

The article is not very careful. It goes from saying the drug is cheaper over in Queens to the "$720 a month my medication costs in America".

wyager2• 11 years ago

I would like to share my very positive experience with private Mexican health care.

A family member got in a kayaking accident. They were in severe pain (mostly from their chest area).

We had a concierge doctor drive out to our remote hotel. He did a basic checkup, gave us some pain meds, and called ahead to the nearest private hospital. $100

We drove about an hour and a half to the hospital. A doctor was waiting at the door for us. She was with us for the whole two hours we were there. We got 2 x-rays and an ultrasound. We also got more pain meds at the pharmacy. $150

It was the best medical service I've ever experienced in my life. I would be very happy if U.S. medical care was the same as Mexican medical care.

I realize I never checked up on this: how is the Mexican private medical system regulated? I remember we did very little paperwork, and it seemed like there was much less red tape than at US hospitals.

zaroth2• 11 years ago

"It was the best medical service I've ever experienced in my life. I would be very happy if U.S. medical care was the same as Mexican medical care."

What you are actually saying is you would be very happy if U.S. medical care was the same as Mexican medical care for tourists carrying US dollars.

The real question is, what is the standard of care for a 50th percentile Mexican national after their own kayaking accident? What percent of their annual discretionary spending does this incident cost them? And is the existing system improving, stable, or on the verge of collapse?

wyager2• 11 years ago

Well, yeah. I said "private", didn't I? And it's not like the good hospitals in Mexico rely on the bad hospitals to exist.

One would expect the average standard of care to be lower because Mexico is much poorer than the U.S.. If you took whatever the good Mexican hospitals are doing and brought it to the U.S., it would presumably be roughly as high-quality and inexpensive.

tsuyoshi• 11 years ago

I think a better title might be: I Missed the Obamacare Open-Enrollment Deadline, So I Fly to Britain for My Medication.

There are exceptions to the open-enrollment deadline. The author is not completely clear on his situation, but two exceptions may apply: gaining "status" (i.e. permission to work, or permanent residency) or moving to a new area. Either will allow you 30 days to apply through the insurance marketplace. It would be interesting to know if neither of these applied, or if even Obamacare-subsidized insurance wouldn't cover the drug he needs.

The fact that prescription drugs are more expensive in the US than anywhere else is not news to me, at least...

refurb11• 11 years ago

You could write the same article in reverse if you had atypical haemolytic uraemic syndrome (aHUS). Soliris, the only drug available to treat aHUS, was launched in the US back in 2011 (and all payers cover it), but only just this year did the NHS decide to fully fund it in the UK.[1]

[1]http://www.pharmaphorum.com/articles/nice-backs-full-nhs-fun...

koyote• 11 years ago

but only just this year did the NHS decide to fully fund it in the UK

So that means it is covered by the NHS now?

refurb11• 11 years ago

Yup, but for 3+ years it wasn't where it was available in the US.

stickperson• 11 years ago

Is there a way to find out how much drugs cost in other countries? I take a biologic that runs me $300/mo after insurance.

DanBC7• 11 years ago

For England: http://www.ppa.org.uk/ppa/edt_intro.htm

6t6t62• 11 years ago

So, if I understand well, people with mental disorders cannot access to medication if they cannot pay for it?

People with mental disorders use to have trouble to find a proper job if they cannot threat their issue with medication. So maybe they just end up in jail or living as homeless?

US Healthcare Is So Screwed I Fly to Britain for My Medication

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