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Everything posted by Polisci

  1. Thanks for your comment! Of course, you are correct. Generic drugs are cheaper than the advertised product and that is the point of my article. Advertisers spend hundreds of million dollars a year so that the consumer will ask their doctors to prescribe the advertised product, not the generic, even though the generic may equally well. The doctor may also recommend an alternative medication that is a better fit for the patient. I am not against the medications, only the direct to consumer advertisements.
  2. Thanks! I researched and wrote all four articles a while back, thinking that I would include them as a chapter in a book. However, the content really didn't fit the book that I published: Greed, Power and Politics The Dismal History of Economics and the Forgotten Path To Prosperity.
  3. (This Is The Fourth Segment In A Four Part Series) The current system is not only burning a hole in our public deficit but adding an untenable amount to our unfunded liabilities. Meanwhile, both houses of congress are debating ideas that tinker with healthcare’s current paradigm: Allowing interstate exchange competition; transferring the federal penalty revenues from the federal government to the insurance companies; adding work requirements to Medicaid recipients; cutting the Medicaid budget related to Obamacare; incentivize providers for quality care; replacing the current subsidy program with tax credits for those not covered by an employer; removing the individual mandate; and expanding the scope and number of group health plans. One plan under consideration reduces health insurance premiums by removing benefits, such as: pregnancy/maternity; mental health/substance abuse; prescription drugs; emergency services; hospitalization; outpatient care; laboratory/diagnostic tests; preventative/wellness; pediatric care. Wow, I guess my question is: What’s the point of insurance if it doesn’t actually cover anything? None of these exclusions reduce healthcare costs, they simply shift the burden off of the insurance company and on to the patient. The idea of insurance is to spread the risk among the largest possible pool of subscribers, not to reduce the size of the pool. By increasing the pool, an insurer can afford to cover everything. In other words, dancing around the edges of a bad system doesn’t change the fact that it is a bad system that requires a major overhaul! We should remember that all groups lobbying congress are smart enough to make arguments that, on their face, sound as if they are in the public’s interest. In fact, all of these corporations and associations that represent healthcare entities, are only interested in advancing the interests and earnings of their corporations and/or their members. Conservative republicans in congress believe, on philosophical grounds, that a free market, private enterprise approach will solve our current healthcare crises. And everyone in congress is terrified of butting heads with the entrenched healthcare interests. But, the current systems at play have enjoyed government protections designed to enrich the players and feed their monopolistic tendencies. They bear very little resemblance to free enterprise as envisioned by Adam Smith. Sorry conservatives, there is not a feasible free market approach that can even come close to fixing our convoluted, cobbled-up healthcare nightmare. What We Should Do First, rather than spending $70 billion per year on a hodgepodge of grants, programs and departmental research, we should create a federally funded patent pool. All pharmaceutical and medical device companies that want to sell products in the U.S. would be required to participate in pre-competitive R&D. (This is currently an experimental program at the Structural Genomics Consortium, Oxford University.) In addition to commonly shared therapeutic goals, all dead-end research would be compiled, if appropriate, re-examined and included in the consortium’s work-load. All participating companies would share in the research costs and investments. When drugs are approved for phase III trials, the commercial sponsors would be allowed to purchase the product rights and bring them to market. The idea is to reduce and in some cases, eliminate waste and redundancy. Under the current system, each drug company wants its competitors to waste time and resources. They are always looking for an edge to stay on top; hoping for the next drug monopoly. The goal of this plan is to create an infrastructure that fosters cooperation at the R&D stage, while still allowing companies to compete for the manufacturing and marketing of the final products. (Clay, Alexa and Phillips, Kyra Maya (2015) The Misfit Economy, Lessons in Creativity from Pirates, Hackers, Gangsters, and other Informal Entrepreneurs, Simon and Schuster Paperbacks, Simon and Schuster, Inc., New York, page 101) Second, the prices paid for prescription drugs sold in the U.S. would be mandated to not exceed the average prices paid (for identical drugs) in all other approved countries. Third, a commission would be established to oversee the Food and Drug Administration. This group would work closely with European Medicines Agency, Health Canada, Australia’s Therapeutic Goods Administration, Japan’s Pharmaceuticals and Medical Devices Agency (PMDA) and others to determine and approve drugs, which are approved in other countries but stalled by the FDA. It would also fast track generic drug company approvals. Fourth, Congress should authorize Eminent Domain Condemnation for the patents of all drugs deemed life-saving or critical to the health and well-being of its citizens. This is a drastic legal tool and should be reserved for those drugs which serve relatively small markets and are outrageously priced. The research would become public domain. Companies would compete to manufacture and market the drugs, which of course would require FDA or commission approval. A legally mandated royalty would be paid to the current patent holders. In this country, we believe in the freedom of choice and that the free enterprise system is the best way to achieve prosperity. We have always been wary of too much government control, and after Hitler, Stalin, Mussolini, and Mao we have 20th century evidence to back up the American way of life. However, as a country, we have also concluded that government can be a force for good. I’ll give you some examples: We believe that everyone has a right to drive on our roads; send and receive mail; be protected from foreign adversaries; and participate in public education. It is just as American to believe that everyone has an equal right to adequate healthcare. Aside from the United States, every other civilized country has looked at healthcare and decided that only a singular, unified system will work. And I agree. Given the purchasing power and clout of the United States government, we should have the lowest healthcare costs per capita, not the highest… And with a unified, single payer system, everyone in the country could be covered and as a nation we would not be paying a penny more! Nationalizing health insurance, would increase federal expenditures, but that isn’t the most important factor. The question is: will less wealth be drained nationally under the current system or under a national health insurance program. The evidence overwhelmingly is that our current system costs the country far more than if we were to switch to a unified national system.
  4. (This Is The Third Segment in A Four Part Series) The following quote will give you an idea as to the importance of prescription drugs: “Empirical estimates of the benefits of pharmaceutical innovation indicate that each new drug brought to market saves 11,200 life-years each year. Moreover, new drugs save money by reducing doctor visits, hospitalizations, and other medical procedures, ultimately for every dollar spent on new drugs, total medical spending decreases by more than $7.” (http://www.realclearhealth.com/articles/2016/09/22/a_social_contract_for_the_drug_industry_110110.html. © 2016 RealClearHealth.com.) However, the cost of drugs in this country are a huge drag on both the economy and on our federal budget. Particularly since about half of all healthcare in this country is paid for by the government. In addition, we not only pay the highest drug prices in the world, but then, through our taxes, pay another $70 billion in medical and health related research. Therefore, politicians love to bash price-gauging drug companies. As candidates, they promise tough action, in congress, they hold televised hearings to berate drug company executives. The executives then leave the capitol building smiling. They know the tough talk and hard questions are for television audiences and the news media. Nothing substantive will change and profits will continue to soar! According to prescription-benefit manager Express Scripts Holding Co., from 2008 through 2014, the average price for commonly used brand-name drugs rose by 128%. All this power, however, comes at a cost. In 2016 alone, pharmaceutical lobbyists spent over $244 million of their clients’ money. Drug companies complain about: high R & D costs; the fact that relatively few drugs ever make it to market; the Food and Drug Administration (FDA) for a slow, costly and overly risk-averse approval process; market forces; price gauging by middlemen; and steep discounts demanded by the big insurers. In some respects, the drug companies have a point. “The costs to bring a new drug to market with FDA approval are now estimated at over $2 billion, and only 1 in 10 drugs that begin clinical trials are ever approved by the FDA.” (See the Real Clear Health reference above) There are several problems with our current paradigm in pharmaceutical research that emphasize weaknesses in our convoluted free-market/government interventionist system: · American exceptionalism insists that if it isn’t American then we can’t trust it. Therefore, we will test it to the Nth degree and make it American. Only then will it receive FDA approval. · Regulatory Capture puts pressure on regulators to maintain the status quo. The pharmaceutical lobby wants a return on the $244 million that they invest annually to protect their clients from competition. · The current system of patent protection for pharmaceutical research is outdated, monopolistic and excessively costly for both consumers and taxpayers. · The FDA, like other regulatory agencies, are prone to an unhealthy degree of risk aversion. They are scared-to-death of making a mistake or being criticized, so it’s easier and safer to just say no. Let’s take a look at research and development costs relative to marketing, revenues, profits: Company  Total Revenue   R&D Marketing  Profit  Margin J&J (US)  71.3   8.2  17.5  13.8  19% Novartis (Swiss)   58.8    9.9    14.6  9.2  16% Pfizer (US)   51.6  6.6  11.4  22.0 43% Taken from: http://www.bbc.co.uk/news/business-28212223. Unless otherwise noted, all figures are in billions of dollars. These companies all spent significantly more money on marketing than Research and Development. Speaking of marketing… Let’s assume that you are one of the 28 million Americans not covered by insurance. How much will you actually pay for some commonly advertised drugs? The following samples will give you a pretty good idea: · Cocentyx: is a drug used for psoriasis and psoriatic arthritis. A carton of 2 sensoready pens cost about $8,600. The total cost for the first month of treatment comes to $33,200. Thereafter, you will pay $8,600 per month. The first year of treatment will set you back $127,800. · Humira: is a drug used to treat rheumatoid arthritis. The cost per month is $4,700. Administered by bi-weekly injections. Total annual cost: $56,400. · Symbicort: is a drug used to treat asthma. One inhaler (120 doses) costs about $377. The cost per month: $188 or $2,256 annually. · Linzess: is a drug used to treat irritable bowel syndrome. You can expect to pay about $12.72 per pill or $382 per month. Annual cost $4,584. · Trulicity: is a drug used to improve blood sugar control in adults with type 2 diabetes. The maximum dosage is one, $189 injection per week. That comes to $756 per month and $9,072 per year. · Eliquis: Reduces the Risk of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation. The dosage is two $8 tablets daily. The monthly cost is approximately $480 or $5,760 annually. · Keytruda: is a monoclonal antibody that is used to treat certain types of cancer. The dosage varies, but it is common for 200 mg to be administered intravenously once every 3 weeks, at $2,250 per injection. Annual cost: $29,250. · Viagra: is a drug to treat erectile dysfunction. The cost for one, 100 mg pill is $59. · Cialis: is also a drug to treat erectile dysfunction. One, 10 mg pill costs $41. There are only two countries in the world that allow direct-to-consumer prescription drug advertising: The United States and New Zeeland. In the United States, drug companies spend over $5 billion annually in direct-to-consumer advertising. I may be old fashioned, but I believe that you should go to a doctor, get a diagnosis, and then take your physicians advise. He or she may very well prescribe a more appropriate medication or cheaper generic equivalent than the product you see on television. Advertising is fine if it helps you make the decision between a Ford or a Chevy, but not when it comes to your health. Listening to your doctor’s perspective after reading a news report or article may help put your mind at ease, but the happy images, coupled with “voice over” side effects, contained in a drug advertisement add nothing to the conversation and is a waste of yours’ and your doctor’s valuable time.
  5. (This is the Second Segment In A Four Part Series) The healthcare system that Obama and other liberals preferred was a single payer expansion of Medicare that covered everyone. However, Obama learned a valuable lesson from previous democratic presidents who had attempted to take-on the various healthcare interests, and failed. Being a pragmatist, he realized that any change in healthcare would require the buy-in of all major players: the pharmaceutical, hospital and health insurance industries; and of course, the powerful American Medical Association. If Obama could have garnered the support of all democrats, even without a single republican vote, he could have passed any bill he desired. But, the democrats from red and purple states were representing voters that were less liberal and therefore more skeptical of a system run by the government, so the compromise plan that he settled on was a nationalized version of Mitt Romney’s Massachusetts program, including sweeteners that lobbyists believed would increase their revenues and profits. The Affordable Care Act was never a shoe-in. Even with the support of lobbyists and moderates, the bill was never very popular with the public and barely squeaked through congress. Obama’s main goal was to decrease the huge number of uninsured Americans, not to fix the costly and fragmented systems and organizations that controlled healthcare. To accomplish this mission, he reinvigorated individual health insurance by setting up a state to state network of health insurance exchanges and then mandated that everyone in the country be covered under some form of government approved health plan. This was a necessary ingredient, because to induce insurance companies to include preexisting conditions there needed to be a huge pool of participants. Children could continue under their parent’s policy up to age 26. Anyone choosing not to participate were to pay a special mandated penalty (or as the Supreme Court ruled, a tax). Low income participants qualified for graduated federal subsidies; paid for through a series of new or increased taxes to help pay the cost of insurance premiums. There was also an expansion of Medicaid payments to the states. The result has been mixed. Many of the provisions are very popular and about 17 million more Americans are now covered by health insurance than before Obamacare. And the rate of increase in healthcare costs has been slightly lower in recent years, however, the fundamental flaws that existed before, have not gone away. While healthcare expenditures are increasing at about 5.5%, healthcare premiums for individual plans are increasing at a rate of about 25%! Although, taxpayers may groan, almost 85% of plans purchased through the various marketplaces receive federal subsidies. This is to help participants pay for otherwise unaffordable health insurance premiums. Of course, to qualify their incomes must be below federally determined thresholds, the lower your income, the greater the subsidy. I admire Obama’s goal of providing everyone with health insurance, however, all he accomplished was to load more and more people onto an incredibly expensive and inefficient system. The poor may benefit, but at a huge and growing cost to the federal government, which is already stretched to the breaking point. And many who don’t qualify for subsidies won’t participate. And finally, if insurers can’t cover expenses, then one by one they will drop out of the various individual marketplaces. If we compare the health outcomes with other developed countries, we still have a long way to go: Costs There are many reasons for the big increases in individual healthcare plans. First, Obamacare did very little to halt healthcare inflation, and in fact contributed to the huge rise in pharmaceutical prices. This is because, under the law, Medicare is banned from purchasing generic drugs, only name brand products; and second, Medicare is also banned from negotiating drug prices, which has allowed the pharmaceutical industry to raise retail prices to obscene levels — for Medicare and the uninsured — while offering attractive discounts to big group insurers. Second, many young and healthy Americans have found it cheaper to incur the penalty, rather than pay the high cost of individual health insurance plans. And this trend will likely increase as premiums purchased through exchanges continue to soar. Thus, with fewer participants in the pool, premiums will rise even further. Third, Obamacare created a new and untested model for insurance company actuaries and executives. They simply overestimated the actual number of participants and underestimated the loss ratio and the costs of participating in the various exchanges. The result has been huge losses for smaller insurance companies that primarily focused on individual plans; and huge profits for the big insurance companies that focused on group plans. Many big companies were smart enough to see the “writing on the wall” and have dropped out of the exchanges, refusing to participate in the unprofitable individual healthcare markets. And fourth, by adding 17 million newly insured consumers there was logically more demand for hospital services, clinic visits and prescription drugs. In 2015 we spent $3.2 trillion on healthcare, almost $10,000 per person in the United States, representing 17.8% of our Gross Domestic Product. The fact that healthcare as a percent of GDP keeps rising means that, as a nation, a greater percentage of our national resources are diverted from other sectors of the economy. Healthcare in America is collapsing under its own weight. The administrative costs (including services that are ultimately written off as bad debts) are enormously inefficient, cumbersome and must serve a myriad of requirements by federal and state governments; as well as numerous insurance plans; including the coding and pricing of countless medical services and prescriptions. Nothing is easy or uniform. The price of every service and product is based on thousands of separate negotiations. And of course, if you are not included in a plan (or covered by Medicaid) then you pay the retail, listed price for everything. To give you some comparisons: French hospitals have about 67% fewer administrative personnel than the U.S.; Our health insurance industry spends 20 cents on every dollar for non-medical costs, France spends a nickel. In America, we spend about $3.2 trillion dollars on healthcare. 20% of that figure comes to $640 billion dollars. If we could bring down our non-medical costs to 5% that would be an annual savings of $512 billion or over the next ten years: $5.1 trillion! Aside from administration, other drivers of increasing costs are the American Medical Association (AMA) and drug prices. First of all, as a nation, we need a huge increase in the number of qualified doctors and other medical professionals. On the other hand, the AMA wants to greatly limit the number of doctors to keep their member’s salaries high. General practitioners have felt the squeeze between higher operating costs, including high medical malpractice insurance and the ability to raise prices. Many have found it in their best interests to form group practices, own their own labs,hire their own technicians and replace MD’s or DO’s with Physicians Assistants; doctors, therefore become more managers than practitioners, resulting in poorer care for patients. There is also a logical tendency to over-refer their patients for testing and lab-work. Many of these tests may be justifiable and reimbursable, but not medically necessary or even desirable. Every time there is a new study that questions the value of some test or procedure, the AMA immediately refutes the study. Unfortunately, then, every visit to your doctor becomes a game to see how much money can be extracted from the insurance company. Still the general practice doctors are not making a fortune and many are struggling. The specialists, however, are making a fortune and their prices continue to rise well above the rate of inflation. It is not surprising then, that in England about 60% of medical doctors are general practitioners, but in the United States about 65% are specialists. My experience with a Urologist provides a good example. When I was about 60, my primary care physician discovered that I had a slightly enlarged prostate and my Prostate-specific Antigen or PSA was high enough to cause concern (In England PSA tests are rarely given, as they are not considered a reliable test for prostate cancer screening). Therefore, I was referred to a Urologist, who started asking questions about erectile dysfunction and how many trips I made to the bathroom at night. He then scheduled an ultrasound for my prostate, which apparently wasn’t conclusive, so he then scheduled a biopsy, which showed no cancer. In the meantime, he also scheduled an ultrasound of my bladder to determine how much fluid remained after urination and then scheduled a separate test to determine the strength of my urine flow. These tests resulted in the prescription for a drug, the side effects of which were worse than the minor annoyance of a couple of trips to the bathroom at night. Two years later I was diagnosed with colon cancer. As part of the surgery, a Urologist was needed to insert stents. A pre-op consultation was required in the doctor’s office (the same office that I had visited a couple of years earlier), at which time the Urologist asked about my PSA, my nighttime bathroom habits and if I experienced erectile dysfunction. After finishing with his initiated Q and A, he got up to leave. I had to stop him, sit him back down and ask: “What are stents and why are they important to my procedure?”
  6. Adam Smith’s invisible hand theory has proven to be the most effective means for a society to prosper, however, it only works when there is a level playing field. That means fair and free competition, supported by equitable government policies. On the other hand, government granted monopolies, government sanctioned price fixing and other interference can weaken competition, thus squashing prosperity. As Trust Busting Teddy Roosevelt discovered, even with no government interference the monopolistic tendencies of private sector players can be equally harmful. Another important aspect of Smith’s invisible hand theory is non-coercion. Business transactions need to be both mutually beneficial, and the free will of each party. Free will, however, does not exist when you introduce the elements of pain, illness and fear of death. I’ll give you an example from personal experience: About eight years ago, I started experiencing a nagging pain in one of my molars. Over the next couple of days, the pain increased and by the Fourth of July it was close to intolerable, so the following day I started calling dentists. Since it was now Saturday most offices were closed or unable to fit me in for an appointment, but after several calls I was finally successful. It turned out that I had an infection underneath one of my molars, requiring a root canal, and a new crown. I had dental insurance, but my available benefit only covered a fraction of the cost. I also had some money saved, but unfortunately, was still about a thousand dollars’ short. Because the dentist wanted his money at the time of service, the billing clerk had me fill out a finance company’s loan application before starting the procedure… At that moment, the cost of the procedure and the terms of the contract meant nothing to me… All I cared about was having them take away the excruciating pain! This is only one small instance. What if you happen to be one of the 28 million Americans without health coverage, and you require a lifesaving drug? And what if this drug costs thousands of dollars a month? And what about expenses from the hospital, doctors, technicians, and labs that run into tens of thousands of dollars? History The history of health care legislation in the United States is a story of special interest influence, which has not only corrupted the political process, but also driven costs to ridiculous levels. Prior to World War II, medical expenses were typically paid by the consumer. However, in the 1930’s Blue Cross began providing guaranteed services for a fixed fee. Also in the 1930’s Roosevelt worked on a plan to create a national health insurance program, but was forced to cancel it due to fierce opposition from the American Medical Association (AMA). During World War II, Roosevelt implemented wage and price controls, which angered the labor unions, so to appease the unions, the War Labor Board exempted employer-paid health benefits from wage controls and income tax. As you can imagine, employer paid group health plans became very popular and eventually replaced individual health insurance plans, which by 2008 were prohibitively expensive to obtain and excluded pre-existing conditions. The system worked pretty well, if you happened to be employed by a firm large and generous enough to provide health insurance as a benefit for its employees. In 1945, President Truman proposed a national health insurance program that would benefit all Americans. The idea was very popular with everyone except the Chamber of Commerce, the American Hospital Association and the American Medical Association. Guess who won? In 1993, President Bill Clinton formed a task force to tackle health care reform. It was to be the centerpiece of his first term. He even appointed his wife Hillary to be its chairperson. Unfortunately, the task force was fraught with controversy from its inception and the plan itself was a complicated mix of public and private mandates, making it an easy target for the pharmaceutical and health insurance industries. It turned out that even though he took office with a majority in congress, Clinton couldn’t even get his own party to completely buy into the plan. By 1994, it was dead. Later that year the democrats lost their majority in the House of Representatives, killing any prospect of a renewed effort. What’s the Problem? We have an incredible health care infrastructure in this country; when you consider the advancements in medical technology, lifesaving drugs, and world class medical facilities. Plus, we have the best educated doctors and nurses. Why then, in 2007, did only 18% of people polled believe that our health system was working well and some 79% believed that the system needed “fundamental change” or “a complete overhaul”. Healthcare as a Percent of GDP 1995  2005   2014 USA  13.1 — — — — 15.3 — — — — 17.1 Switzerland    09.3 — — — — 11.6 — — — — 11.7 France 10.1 — — - — — 11.1 — — — — 11.5 Germany  09.4 — — — —- 10.7 — — — — 11.3 Canada  08.9 — — —- — 09.8 — — — — 10.4 Sweden    08.0 — — — — 09.1 — — — — 11.9 UK  06.7 — — — — 08.3 — — — — 09.1 Japan   06.6 — — — — 08.0 — — — — 10.2 Mexico   05.1 — — — —06.4 — — — — 06.3 Taiwan     05.2 — — —  06.2 — — — — 06.5 Sources: 2005: Health at a Glance, 2007; Government of Taiwan, (Taken from the book: The Healing of America, by T.R. Reid). 1995, 2014: World Health Organization, Global Health Expenditures Database. 2014 Taiwan: CIA World Factbook. Part of the answer was affordability. By 2008, health insurance premiums in the new millennium had increased by 119%. The insurance companies were frantically attempting to keep up with soaring increases in costs. Health care in the United States was consuming 16% of our GDP, the highest percentage of any OECD nation. And we were also the only nation in the western industrialized world to not have a uniform system, offering universal healthcare for everyone. The basic programs in use around the world are as follows: · A national health service · A single-payer national health insurance system · A multi-payer universal health insurance fund Prior to Obamacare, Japan (which offers universal coverage); had the oldest population in the world, and per capita averaged fourteen visits to the doctor’s office per year. By comparison, we averaged five… yet Japan only spent about $3,000 per person on health care each year, 8% of GDP. We spent $7,000, over twice as much. But, you may ask, what about the quality of care? Surveys showed that Americans who saw a doctor tended to be less satisfied with their treatment than the Japanese. We were also less satisfied than Britons, Italians, Germans and Canadians. At the same time 1 in 6 Americans, about 45 million people were without health coverage and if you looked at the under 65 population (those who were not yet qualified for Medicare coverage), 1 in 3 went without coverage at least part the time during a two-year period. In 2009 we had a new democratic President, filled with the promise of hope and change, and for the next two years a democratic majority in both the house and senate. This seemed like the perfect time to face the daunting task of tackling America’s health care system. But to call it a system is a misnomer. We essentially had four totally different health care systems operating simultaneously, each mimicking one of the four basic models in use around the world. Four Health Care Systems · If, for example: you are under 65 and worked for a company that provides health coverage for its employees, then health insurance is a part of your compensation package. Your employer pays a portion and you pay a portion of the monthly premium. When you go to the doctor or hospital you typically make a co-payment or pay a percentage, but the insurance company picks up most of the bill. There are currently about 160 million Americans or 66% of the population covered by their employers. This system was designed in Germany by Otto Von Bismarck (1815–1898) and is therefore called the Bismarck plan. · If you are in the military or a veteran (14.14 million Americans); or Native-American (2.2 million Americans) you can go to U.S. government owned clinics or hospitals and your doctor or care-giver will be a federal employee. You will never get a bill; your health care is free. This is the British (or Beveridge) model. · If you are over 65 then you qualify for Medicare (50.5 million Americans), which is a National Health Insurance system that pays for basic medical care, hospitalization and prescriptions. Many seniors also purchase supplemental policies for more complete coverage. Medicare is modeled after Canada’s health care system. Medicaid (61.65 million Americans) is similar to Medicare, but only for certain groups, primarily: the elderly, blind, disabled or families with dependent children. · For everyone else (28 million Americans) it’s a pay as you go system, which is the same as your average third world country, except of course we have vastly more facilities. In other words, you have access to care as long as you can pay the doctor or hospital bill. If you can’t pay and you’re sick enough or seriously injured, then you will be given basic treatment in an emergency room, however, you will still be billed and the costs could force you into bankruptcy. Your last option is a charity clinic, if you are lucky enough to find one.
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