Healthcare in the US
Corporate Medicine and the American Consumer
Whether anyone intended to or not, the big business model of medicine has unfortunately failed the American consumer in a variety of ways.
The Dark History of "Big Pharma" and Corporate Kickbacks
At one point in the history of our healthcare system, doctors were wined and dined by pharmaceutical companies which included getting “kickbacks” and gifts. Drug representatives (“drug reps”) used to reward doctors for prescribing their drugs by sending them on luxury vacations to places like the Bahamas. Drug reps were notorious for dropping off freebies in doctors’ offices, including anything from branded pens, to samples of medications.
Today, these practices have been greatly reduced, not only from within the profession, but outside as well. There are now laws in place to protect patients and consumers from this sort of activity, and all relationships between doctors and pharmaceutical companies must be reported, greatly increasing the transparency of their exchanges. Additionally, there is a long list of lawsuits such as this that have been filed related to this activity. While these “kickbacks” have not been entirely eliminated, today they take the form of lunches and small, cheap office supplies that that are legally required to benefit the patient in some way.
Brand Name vs. Generic Name Medications
Have you ever been prescribed a medication and gone to pick it up at the pharmacy, only to realize that it has a completely different name than what the doctor assigned you? This mystery medicine is most likely a generic medicine being used in place of the brand name medicine that the doctor prescribed you. For example, you may have been prescribed Prozac (brand name), but you actually received Fluoxetine, the generic form of this medicine. Many patients get very confused by this, as these generic names are very hard to pronounce, write, or remember.
Some say that this is a marketing scheme by the pharmaceutical companies. Medications approved by the Food and Drug Administration (FDA) are given a generic name based on the chemical composition of the product, and a brand name that is a simplified word, sometimes used to describe the function of the drug. Pharmaceutical companies specifically market drugs under this brand name, as it is easier for both the doctor and consumer to remember. The more readily available a name is in the doctor’s mind, the more likely he/she is to prescribe it, and the more money the company makes on the product.
Pharmaceutical companies are allowed to hold their patents in America for a medication for 20 years, and after that other companies can produce copies of the medication and market it by the generic, harder to pronounce name.
In this way, the pharmaceutical company retains some leverage against the competitors, though their profits are significantly reduced once the patent expires.
The Pharmaceutical Company-Insurance Provider Relationship
Brand name medications typically cost 2-3 times as much as generic medications, and therefore insurance companies tend to not cover brand name medicines. The fact that every insurance company covers different types of medications is an additional complicating factor, and another way medicine has failed the American healthcare consumer.
In general, insurance companies pay considerable amounts of money for acute accidents, or surgeries, as opposed to preventing problems. This is very different in mental healthcare, because there are very few surgeries completed in the field. A key responsibility of a physician is to not only treat acute conditions, but also to prevent future problems. This is generally, not high on the insurance companies priority list.
Additionally, pharmaceutical, insurance, and related companies are becoming increasingly intertwined in their relationships, forming semi-monopolies within the American healthcare system (such as that between Anthem, Blue Cross Blue Shield, and WellPoint). Luckily some legislation is stepping in to block a complete monopoly. Still, in 2017 alone, Anthem’s annual revenue was $90 billion with earnings of $3 billion.
The industry is booming, and they continue to increase the amount they charge consumers and decrease the amount that they pay to out to doctors. They add to this profit by forcing consumers to see physicians (or more recently physician’s assistants and nurse practitioners) who are “in network,” because this way they can choose who is cheaper to send patients to. Clearly, insurance and pharmaceutical companies are a bit more interested in profit than the health and well-being of the individuals in their care!
Personal Note: Because I have an independent/outpatient practice and do not take insurance, you are paying me directly for my services. I do not receive kickbacks and never visit with drug reps. Personally, I almost always prescribe generic medications, because they are more affordable, and have more years of research backing their effectiveness. My interest is always having your best interests in mind, both health-wise and financially. I strive to provide the highest level of care possible in hopes of improving your life.