Against an Epidemic of Rising Drug Prices, Medicare for All Offers a Cure
By Peter Cooch, MD
Dr. Cooch is a Pediatrician and Pediatric Infectious Diseases Fellow practicing in San Francisco, California.
When it comes to treating infections in children, the cost of drugs can be scarier than the germ. As a pediatrician specializing in infectious diseases, I have witnessed first-hand the burden of soaring drug prices on families in Northern California. Given the daily injustice of drug pricing, it’s no surprise the Kaiser Family Foundation finds 56% of all Americans support a Medicare for All system. Here’s why doctors like me agree.
Albendazole, for example, is the first-line medication for the world’s most common intestinal worms, which infect hundreds of millions of children. Albendazole was licensed in 1987 and is available for pennies around the world. In the United States, the pharmaceutical industry found out it can charge $400 for one dose. You’d be lucky if your insurance pays for any of that.
I’ve seen children be admitted back into the hospital because they couldn’t fill their prescription, or even families resort to purchasing expired veterinary formulations on eBay.
Pyrimethamine (“Daraprim”) — licensed 65 years ago — remains one of the only medications to treat toxoplasmosis, a parasitic infection that is devastating in pregnant women and for children with cancer. There was public outrage in 2015 when the only company making Pyrimethamine raised the price from $800 to $45,000 a month. Despite the outcry, the price hike on Pyrimethamine is unchanged today.
Emtricitabine/tenofovir, or “Truvada”, is yet another example. In a 2012 UCSF study funded by taxpayer dollars, Emtricitabine/tenofovir prevented HIV when taken as daily preexposure prophylaxis (or “PrEP”). Expanding PrEP use in youth at risk of HIV is a national priority in the fight to eliminate AIDS. Once the FDA licensed Truvada for PrEP, Gilead set the price at $20,000 per year, paralyzing AIDS prevention among teens, minorities and the uninsured.
All this is just within infectious diseases. From albuterol to chemotherapy to the “EpiPen” to insulin, Americans pay ten — and sometimes a thousand — times higher prices than citizens of any other nation. Even for those fortunate enough to have “good” insurance, these costs are routinely passed directly to the patient.
This happens despite the offices full of billing specialists every U.S. hospital employs to negotiate coverage and pricing with insurance companies. And this happens despite the hours doctors, nurses, and pharmacists spend every day on hold or faxing forms to appeal rejected coverage. This byzantine process — designed to deny care to patients — is also a primary driver of burnout and dissatisfaction in young healthcare providers.
Pharmaceutical companies would like to tell you these costs are needed to develop new therapies. In fact, every major drug that was introduced from 2010–2016 was developed through federal government funding. Instead, pharmaceutical profits and CEO payouts are soaring, while they pour money into lobbying our elected officials. Pharmaceutical lobbyists have influenced legislation that actually banned the US government from negotiating the price of prescriptions, and spent a record $25 million in 2009 trying to sink the Affordable Care Act. That sum has been surpassed in 2019 as they preemptively draw battle lines against a proposal for Medicare for All.
Why are we the only nation paying such high prices for drugs? I don’t believe it is a coincidence that we are also the only developed country without a national health program. America’s chaotic patchwork of insurance, supplemental coverage, and undercoverage discourages pricing negotiation at every level, from the patient on up. The actual cost of a medication has no relation to what drug companies charge (as much as they can) or what insurance companies cover (as little as they can). Each plan covers different medications, formulations, or amounts. Of course, patients who are poor, vulnerable, or underinsured are most likely to be taken advantage of. Doctors and providers are also kept in the dark, too confused to advocate for our patients. For me, it feels impossible to guess how much a family will be charged for any medication I prescribe. Until the bills arrives.
In contrast, nations with a single payer set clear, reasonable price for every medication. Rising numbers of physicians agree that only a single-payer program like Medicare for All can restore rational pricing to healthcare for us, too. Bernie Sanders has the vision and integrity to lead Americans to the excellent and affordable benefits that every other developed nation enjoys. Under Bernie’s plan, a single payer program negotiates fair and firm drugs prices through the Medicare Drug Price Negotiation Act, pegging prices to the median in five major countries. Until those negotiations are in place, Bernie’s plan allows patients and pharmacies to buy low-cost prescription drugs from Canada and other industrialized countries.
As Americans, we pay over and over for the same healthcare — through our insurance premiums, tax dollars, supplemental insurance, lost wages, co-pays, and bills. Under Medicare for All, drugs will be paid for once — by Medicare. Only then will my patients and their families be free to focus just on getting better.
When it comes to Medicare for All, the question is not how can we afford to change — it is how can we afford the status quo.
