Health Care Cost: What Happened To the Truth the Whole Truth?

At Patients Rising we believe price is an issue for insurers. But for patients, the critical issue is access to life changing medications. That’s why we call for a discussion based on fact not rhetoric, because the whole truth is we can save lives and save money.

Today we read with interest a report from CNN Money on the “Candidates plans for drug prices may miss the mark”. The premise is correct, but relies largely on the National Coalition on Health Care.  We believe it tells just one side of a complex story.

Here are some fact we would have liked to see as a balance to the piece:

  • Prescription medicines account for less than 10 percent of total healthcare spending and less than one percent of the cost of cancer care.
  • Hospital care accounts for nearly a third of all healthcare spending.
  • Claims for seven cancer drugs in North Carolina, the Charlotte Observer and The News & Observer of Raleigh found that charges for all but one drug were significantly higher at hospitals and hospital-owned clinics – usually more than 45 percent higher. As a specific example, analysis of claims by the newspapers and CMS showed that while the average sales price of Avastin was about $6000, patients were billed from $7649 to $22,680 depending on where they were treated.  We reported on this type of price gouging recently in our commentary – A Healthy Dose of Accuracy.  Is this a cost problem? Or a coverage crisis?

A balanced discussion needs to include multiple sources of information.

According to a March 2015 analysis conducted by financial consulting firm Milliman.  Looking only at plans under the Affordable Care Act as an example, capping the copays or coinsurance for prescriptions would increase premiums by less than 0.5 percent. These premium increases would be offset by lower prescription costs. For other insurance plans facing more significant increases from capping copays, there are painless ways to offset costs by increasing the copays for doctor visits by just $5, for example. Another report from the non-profit Aimed Alliance, “Reveals True Drivers of Health Care Costs in the United States.”

Let’s have more data and analysis like this introduced into our healthcare conversation.

Bottom line: There is a lot of drum beating about the high costs of pharmaceuticals — it is true; they are expensive. But it’s time to stop pointing fingers and start making sure patients get both the medicines they need and their share in the savings.

That’s why we advocate for a realistic conversation about the problems within the entire system – which includes, but is not limited to, cost. This is where many stories fall short.

Some of the most talented and creative people we know are in the healthcare field. It’s time for a far different policymaking environment that introduces new ideas, challenges the stale status quo and doesn’t play games with the lives and livelihoods of patients.

Jonathan Wilcox is the Co-Founder and Policy Director of Patients Rising and Patients Rising NOW.  He is a fellow with the University of Southern California’s Unruh Institute of Politics and was a speechwriter for California Gov. Pete Wilson (R).


You’ll receive updates about new resources, patient stories and insights, advocacy work, and alerts about patient-support events.