I work as hired hands for satan himself (not directly for insurance companies but a consulting company specializing intelling pharma companies how to market themselves to insurance companies) and the industry is a shit show across the board.
The entire system is for-profit. Hospital systems make money by getting as much from insurance companies as possible. Pharmaceutical companies make money by selling drugs to insurance companies for as much money as they can. And the companies that hold the purse strings are the insurance companies of course (definitely the most evil).
Why is everything so damn expensive? Well, pharmaceutical company creates drug X and in order to recoup years of R&D and the strict rigor of government regulation, they need to charge a LOT of money—high skilled/high salaries positions to develop the drugs, many years clinical trials (most of which fail), government regulation, market strategy/assessment etc. You can’t get to the finish line without dumping a shit ton of money into development. So yeah, new drugs cost a lot. This doesn’t excuse corporate greed or all the schemes to keep exclusivity on a drug in order to maintain a monopoly, which is rampant and makes the situations worse.
New groundbreaking rare cancer treatment comes out—$1 million per patient. All the diseases that are easily treated with a pill are gone. So you’re left with rare disorders or ones requiring cutting edge treatment with a much much smaller market. So they have to charge an extraordinary amount to be profitable. Pharma companies don’t price drugs based on who can’t afford it, so they price it based on well insured patients that can. Insurance companies also can’t pay for everyone, so they come up with limits and preexisting conditions.
Meanwhile hospital systems, like any other corporation, seek profits by cutting costs, consolidating expenses (your treatment) and charging as much as they can for your treatment.
What the public isn’t aware of is that when negotiating prices, hospital systems come up with an inflated menu of costs as a bargaining chip. So that MRI that is listed as $5,000 a pop doesn’t is negotiated down behind closed door’s with insurance companies (in-network vs out-of-network). But what price do you pay when you don’t have insurance or your insurance company doesn’t want to pay it? You guessed it!
Insurance companies pay for the whole lot and they too are out there to make money by NOT paying so they can hold onto your insurance premiums.
Oh and let us not forget that manufacturers operate at a global scale and all those countries that have single payer systems do the reasonable thing (this does include Medicare and Medicaid too) and tell everyone that they will only pay a fair price based on Real World Evidence. Guess who picks up the slack? USA! Greatest country in the fucking world, with congress paid for by everyone of these corporations.
I work as hired hands for satan himself (not directly for insurance companies but a consulting company specializing intelling pharma companies how to market themselves to insurance companies) and the industry is a shit show across the board.
The entire system is for-profit. Hospital systems make money by getting as much from insurance companies as possible. Pharmaceutical companies make money by selling drugs to insurance companies for as much money as they can. And the companies that hold the purse strings are the insurance companies of course (definitely the most evil).
Why is everything so damn expensive? Well, pharmaceutical company creates drug X and in order to recoup years of R&D and the strict rigor of government regulation, they need to charge a LOT of money—high skilled/high salaries positions to develop the drugs, many years clinical trials (most of which fail), government regulation, market strategy/assessment etc. You can’t get to the finish line without dumping a shit ton of money into development. So yeah, new drugs cost a lot. This doesn’t excuse corporate greed or all the schemes to keep exclusivity on a drug in order to maintain a monopoly, which is rampant and makes the situations worse.
New groundbreaking rare cancer treatment comes out—$1 million per patient. All the diseases that are easily treated with a pill are gone. So you’re left with rare disorders or ones requiring cutting edge treatment with a much much smaller market. So they have to charge an extraordinary amount to be profitable. Pharma companies don’t price drugs based on who can’t afford it, so they price it based on well insured patients that can. Insurance companies also can’t pay for everyone, so they come up with limits and preexisting conditions.
Meanwhile hospital systems, like any other corporation, seek profits by cutting costs, consolidating expenses (your treatment) and charging as much as they can for your treatment. What the public isn’t aware of is that when negotiating prices, hospital systems come up with an inflated menu of costs as a bargaining chip. So that MRI that is listed as $5,000 a pop doesn’t is negotiated down behind closed door’s with insurance companies (in-network vs out-of-network). But what price do you pay when you don’t have insurance or your insurance company doesn’t want to pay it? You guessed it!
Insurance companies pay for the whole lot and they too are out there to make money by NOT paying so they can hold onto your insurance premiums.
Oh and let us not forget that manufacturers operate at a global scale and all those countries that have single payer systems do the reasonable thing (this does include Medicare and Medicaid too) and tell everyone that they will only pay a fair price based on Real World Evidence. Guess who picks up the slack? USA! Greatest country in the fucking world, with congress paid for by everyone of these corporations.