why insurance in the U.S. sucks, pt. 3

So I am going to repost this little section of my comment because I edited it a bit after my initial post (sometimes your writing at night and then realize a later that you need to clarify- so I'll clarify it here). But in the meantime if you want to catch up you can read pt. 1 here and pt. 2 here.

So Kaiser was  (and I think is) out there pushing good nutrition and encouraging their customers to exercise which of course also saves them money- which is a good thing! There are also other ways that seem logical for insurances to operate that (at least to the person on the outside) one would say "it seems like it would be cheaper for the insurance to do... [this]" because in the long run the patient is treated more efficiently and given better care if they're allowed to go to the doctor they need to get the doctor that treats they're migraines (for example) as opposed to continually just giving pain medication. So, profits are great if it's done to save sick costs and to raise the health and wellness of your patients. The problem was that those were not the only cost savings I witnessed at Kaiser and often the "savings" came at the expense of patient care.  
(end of the rewritten part)

Meanwhile, the pharmaceutical industry is making hand over fist on the medications I need to function. And at this moment, when I have gone through the last 6 days with a migraine each day, I am desperately hoping I can find a doctor who will find out WHAT IS WRONG and not just keep giving me more pills. I was looking over my billing on my insurance account and the cost for two of my Imitrex shots is $285.00! I was stunned by that but the shots work better than the pills so I am glad they cover it even if I can only get 2 for a 2 week period. What I don't understand is, why the same medicine in pill form is so much less ($24 for 4 pills). And it seems like we spend a lot more money on pharmaceutics than we do on how to get rid or prevent. I mean I guess I don't understand why our research isn't leaning that direction (well, I do understand- because pharmaceuticals are Big Business!). 

You might say that I am just uneducated about how the whole process works but I did check around and found this out: when my kids were first diagnosed with asthma, an inhaler cost $15. It was difficult to have two children needing a medication that was going to cost that amount as frequently as we would have to buy it but we did what we had to do. A few years later, the price dropped quite dramatically ($6 an inhaler) and I asked the pharmacist why. She said the patent had expired and they were able to offer a generic albuterol inhaler for a lot less. Then last year (maybe longer) the price suddenly jumped to $20 and I what that was all about- was I crazy? Did I need to get the medicine somewhere else? I asked a pharmacist what happened and he/she said that the pharmaceutical company had had the patent renewed and so the price had gone back up.

That's terrible. An albuterol inhaler is not a medication that solves just a pain problem (and I don't say that easily). Having had two children in the hospital, no one knows better than I the implications of not having an inhaler when it's truly needed. On the other hand, I can buy a full box of albuterol solution for my son for $4.00 which is great- if he's going to stay home from school and do a nebulizer (requires a machine) every 4-6 hours. That's not very realistic when usually what he needs is 2 puffs of his inhaler to help him get his breathing under control to get through the day in school.

So I would like to reiterate that my issue here is that it's not that I think it's a horrible thing that a person make money in medicine or healthcare (my daughter is in healthcare- and I definitely don't think she should work for nothing!) or should work for chickens as Michelle Bachman suggested. I just think that there need to be some changes in how we do things so that insurance is more affordable for people who don't have a 40 hr. job in the government.

So, right now I have decent healthcare that does not cost me too terribly much. I attribute that to United Healthcare recognizing they were going to have to offer something that was affordable under the ACA so they put a package together that was truly affordable- and for my income, it is! (Oh and when they offered the more affordable plan, my old plan doubled in cost! And all the co-pays went up!!) By and large I am happy with my actual plan and the insurance company although it's still The Decider about my pain medication (and when I am out of migraine meds and need more but can't get them, I don't feel that generous toward them) and they still decide about my treatment which winds up costing me a great deal of money (and time). In the words of one pharmacist, "The insurance companies are GOD."   

And sometimes it means that even with a good healthcare plan- because of the out of pocket expense- I still have to decide if I can afford the treatment or not. Do I go to the doctor for this or do we cut back on food? Which is where I am today because with the economy where it is today, it's not easy to have medical expenses on top of all the other expenses that just seem to keep going up. In other words, it's fine to have inexpensive insurance if you aren't sick but no insurance in America covers everything and that's where things get hung up.

In the meantime did you know that because of the Affordable Care Act that a family of 5 making $50,000 or less can get help subsidized on their insurance? If you didn't know that and if that applies to you, you should check out the website immediately because YOU should be getting whatever help is available to you NOW!!!