I filled a prescription recently, and the drugstore said they wanted more than 700 bucks… for an old-line generic drug. My insurance ended up knocking that down, but it was WEIRD. And it meant a big homework assignment for me.
Luckily, I got help. Both from some experts, and from the classic Christmas movie It’s a Wonderful Life (source of the pictures above and below, of course).
I mean, what I actually learned was not a hundred percent cheerful.
We get these unpredictable prices thanks to companies that — surprise! — make a big profit from driving prices up. (They’re called “pharmacy benefit managers” — PBM for short.)
Theoretically, they work for insurance companies and employers who pay the premiums, and they’re supposed to keep drug prices down.
They got sued in several states, saying, ‘Hey, you should be acting in the best interest of your clients.’ And they’ve won in court saying, ‘No, we have no obligation to do what’s best for our clients. We do what’s best for us.’
So, not all sunshine.
But: Feeling a little smarter about the whole thing? It’s a victory. Also kinda fun.
Hospital bills are too high, and insurance doesn’t cover enough. Turns out, that’s a crisis for hospitals too: more and more of us aren’t paying those bills, because we can’t. So, they’re getting creative about collecting — and offering discounts. Which raises questions about why the bills are so high to begin with.
We start with Chicago woodworker James Crannell, who — and there’s no non-scary way to say this — stuck his finger in a table saw.
Even more scary: He didn’t have insurance. “I don’t know which was worse. The pain in my hand, or the fear of: What is this going to cost me?”
Spoiler alert: The emergency-room didn’t charge him full price.
This episode kicks off a series where we start asking: How did prices get so high to begin with?
First: Kaiser Health News is not affiliated with the giant health care provider Kaiser Permanente. They share an ancestor — which is a fun story I’ve written all about here.
Second: They ARE a great non-profit newsroom covering health care in America, an editorially independent project of the Kaiser Family Foundation. (There’s that name again. And again, here’s the story.)
Third: Their editor-in-chief is one of the people who inspired this show.
YEP. The whole story is worth reading. I am so pleased and proud to be working with these folks.