Throwing money at insurers

And other healthcare news from this week.

Happy Sunday! Make sure you read my interview with Emily* from this week, a former customer service worker at a pharmacy benefit manager, on the despair of trying to help patients whose medications were too expensive or weren’t covered—without actually being able to help them.

Speaking of which, I had a fun encounter with that very system this week when I went to fill my prescription for Nurtec, a migraine drug. Nurtec is one of a new-ish class of drugs called calcitonin gene-related peptide (CGRP) receptor antagonists; you take it when you feel a migraine coming on, and sometimes it actually gets rid of the migraine, if you time it right. Because it’s new and complicated, it’s also expensive, as I discovered when I opened the CVS website and it said it would cost me $1092 to fill that prescription. I was confused by this, because it had been free when I picked it up in January, so I called my local CVS. They said they had added a coupon last time, which I didn’t know about, but that coupon was maxed out now. I called my insurer to check, and as suspected they said it needed a prior authorization.

So, now I have to wait an unknown amount of time to get my Nurtec, assuming my insurance agrees to cover it, which they very likely will—so what’s the point of the prior authorization, exactly? I have two tablets left, which might last me two weeks or two days. Whee. (The company also has a co-pay assistance program, but I don’t want to use it if I don’t have to. And my insurance should be paying for this stuff anyway. $463 a month for this level of Shit.) But I made sure I was extra upbeat to the woman on the phone at CVS Caremark, after talking to Emily.

Here’s a Digby from the archives, during the brief period of time where she actually enjoyed her little shark-shaped bed.

She quickly forgot it existed and it sat around in our apartment for months, unused, so I gave it away to someone on the local Buy Nothing Facebook group. Her cat also didn’t care about it, so she re-gifted it to someone with a ferret.

And the ferret was much happier with it. The End.

Sorry, I forgot this isn’t just a newsletter about pets, although maybe it should be. Here’s the news.

Coronavirus news

ProPublica has an infuriating round-up of all the barriers in place that have contributed to inequitable distribution of the coronavirus vaccine. Things like the necessity of internet access, the lack of Spanish-language help, and the use of exclusively drive-thru sites have all reduced access for people who were supposed to qualify early on. It’s a very well-done piece with first-hand accounts of these problems, all of which were avoidable with a bit more planning and a lot more ‘giving a shit about poor people.’ Also, having a healthcare system would have helped.

HuffPost published a helpful explainer for why you shouldn’t care too much which vaccine you get, even though the Johnson & Johnson vaccine does have a slightly lower efficacy rate. Bottom line: All of them are extremely effective at preventing severe disease, as in hospitalization and death. From a public health perspective, it’s important that as many people get protection as fast as possible, making J&J a huge improvement—it’s one shot, not two, and it’s stable at higher temperatures, unlike the prissy Moderna and Pfizer vaccines. In New York, the fire department was able to go door-to-door offering J&J vaccinations to housebound seniors. That’s great! So if you go to the vaccination site and they say it’s Johnson & Johnson today, don’t worry—you’re still going to be way less likely to catch coronavirus, and if you did, it would be much milder. The sooner you get any vaccine, the more time your body has to build up an immune response. And you’re doing the rest of us a favor by getting whichever vaccine is available rather than trying to hold out for Pfizer.

A new study in Health Affairs (paywalled) reveals the high turnover rates at nursing homes, which undoubtedly made it much harder for those facilities to combat the coronavirus. Even without a global pandemic, these jobs are incredibly hard and underpaid—although The New York Times reports that the study found turnover rates were highest among registered nurses, who are paid better than nurses’ aides and assistants. As the Times notes, these turnover rates, combined with vaccine hesitancy among staff, make it much harder to ensure every staff member is vaccinated against coronavirus. Turnover was “higher at for-profit institutions, owned by chains and those serving Medicaid beneficiaries.” No kidding. A recent working paper found that deaths at nursing homes spike after private equity firms purchase the home, leading to more than 20,000 extra deaths over a 12 year period. We put people through hell to make a few guys millions of dollars.

Also in the Times, a bracing look at the devastation wrought on Britain by coronavirus and the Boris Johnson government’s awful response to the pandemic, with excellent photos. The UK has the second-highest death rate in the world, after the Czech Republic. Boris has shared with his American counterparts a desperation to re-open, to get things back to normal, but with a particularly British sort of stupidity. It’s like Get Brexit Done but for Getting Back to Normal—doesn’t matter how, or how idiotic or dangerous it is, just got to Get Reopening Done, Bozza! Spitfires! The Blitz! Keep Calm and Carry On! Must be able to go to Wetherspoons or England will fall!!!!

And, of course, Boris is also cutting nurses’ pay after inflation. You’ll get your ‘Thank You NHS’ signs, but you won’t get them to stop cutting spending. You’ll get banal cultural signaling about how important the NHS is, but they won’t fucking fund it properly. It’s all meaningless, just like the empty ‘gratitude’ for essential workers in the US. People will still line up to vote for the Tories, and the Labour leader is like some lost substitute teacher who doesn’t believe in anything except not being Jeremy Corbyn. Sick island. (Speaking of the NHS, look at how fearfully the British press writes about American health insurers getting their hands on NHS contracts—and quite rightly, too.)

Non-Coronavirus news

The Covid relief bill includes an expansion of ACA subsidies, a key part of Biden’s healthcare plan. It’s very hard to talk about this kind of improvement accurately, because it’s hard to convey how thoroughly awful the situation already was. Take the example in that Times piece about the expansion: “a 64-year-old earning $58,000 would see monthly payments decline from $1,075 under current law to $412 with the new subsidies.” $412 is obviously a lot lower than $1075, so that’s good for this hypothetical person—and it’s also still way too high! The fact that people are paying a thousand dollars a month or more for health insurance is completely insane, and you can’t just compare proposed policies to the current reality; you also have to compare them to a good reality. This is to say nothing of the fact that it’s awful policy to throw more subsidies at private insurance companies, when we have government programs that do exactly the same thing but better and without the profiteering.

Also, there’s no public option in the bill, or on the horizon at all. It seems impossible to imagine this Senate, the one that can’t even get a majority to vote for a $15 an hour minimum wage, going for that anytime soon—because the public option is what the healthcare industry really fears. As it stands, the government is throwing more money at private companies to provide health insurance without mandating any sort of cuts to reimbursement for providers and hospitals, i.e. the reason American healthcare is so expensive to begin with. Or getting rid of deductibles, or co-pays, or co-insurance. Or lowering drug costs. Or, God forbid, doing anything to tackle the scourge of employer-provided insurance. They can all get on board with this stuff; it’s just a gravy train.

Speaking of this ridiculous system: Many Americans who have already filed their taxes got a shock when they found that the super-dole unemployment payments from last year bumped them into a higher income category for 2020, meaning they owe the government for subsidies they received for health insurance, reports The Washington Post. (The Covid relief bill that just passed the Senate should forgive these tax bills, according to the Post.)

This is why I will never call pouring more subsidies into the ACA a ‘fix’ of any kind. The basic structure of the ACA marketplace is a bad way to pay for healthcare; you can’t ‘fix’ it without getting rid of it. They just wrapped a whole bunch more duct tape around it and stuffed some money in the cracks. It is absurd to make people guess their income for the year, subsidize their private insurance based on that, make them pay it back if they underestimated their income, and still allow their insurer to charge them thousands in deductibles and co-insurance anyway. It’s stupid to make people pay for their own personal health insurance at all, instead of just paying for everyone’s healthcare at once via taxes, and to even have an option where people can just not have insurance (and be liable for thousands of dollars in costs if they have to go to hospital). You don’t have to say it’s good because they made it a little less awful. I certainly won’t.

Finally, a terrifying story: A Kentucky woman whose hospital told her she didn’t have cancer when she did, leading to months of unchecked spread—and then seemingly altered her medical records to cover up their mistake. It’s infuriating but a must-read, to help you understand the depths of evil that hospitals can reach to protect themselves.

That’s it; see you next week!