Want to know why our health care system, sponsored by venture socialism and crony capitalism, looks like a mini-bar in a hotel room and not like Amazon? Here is my most recent experience with this dysfunctional system, owned and operated by the government or those empowered by government intervention.
My original “Healthy Blue” insurance plan from CareFirst of Maryland for my family of five cost $425 a month, subject to a $5,000 deductible, and covered most doctor visits and generic drugs. I didn’t mind paying the rest out of the pocket, even though those costs were already too high and distorted even before Obamacare. The lower premium was worth it. In came Obamacare and tripled my premium in return for a $13,100 deductible and less coverage!
Thankfully, I’m healthy and my biggest ailment is the dreaded spring hay fever. The over-the-counter drugs and nasal sprays never work, but I got a prescription for Qnasl, which has worked for me in the past. Yet even though I already knew what I needed, I had to schedule an appointment with the allergist to get the prescription, because thanks to state regulations, I couldn’t rely on my visit two years ago and simply phone in this no-brainer prescription.
Thus, I took off time from work to over-utilize health care and charge the card for a visit just to get a prescription I already knew I needed —all for a spray that should be available over the counter anyway. Given that I’m a healthy male in my 30s with nothing to diagnose, the allergist and I did nothing other than talk about the dysfunctional state of America’s socialist health care and how my visit demonstrated the point. After a few minutes of small talk, costing me $40 and the insurance company well over $100, I went off to the pharmacy to fill the prescription. I was in for a surprise.
The pharmacist informed me that insurance was demanding a pre-authorization letter from the doctor in order to cover a nasal spray! I then had the allergist fax in an authorization letter, but CareFirst rejected it, asserting that I must try out a cheaper nasal spray first, Dymista. So after paying an enormous premium that doesn’t even cover much of the prescription anyway, I was informed that the company now controls the decisions about my health and medicines that should be up to me and my doctor. As such, I decided to pay out of pocket for the Qnasl. “Oh, that will be $230,” said the pharmacist.
Don’t get me wrong. I’d love to pay everything aside from catastrophic care out of pocket…so long as I can purchase catastrophic insurance and not pay a second mortgage for premiums and deductibles. But if I’m going to pay that much in premiums thanks to the Obamacare regulations Republicans love, you better believe I’m not also going to pay $230 for a nasal spray.
Next, I got a coupon from the doctor in hopes of discounting the price of the Qnasl and offered it to the pharmacist. The coupon knocked down the price of the Qnasl to $130. I told her to hold onto it for the time being and that I would first try out Dymista, the cheaper drug that CareFirst was recommending. When I came back the next day with the prescription for the less effective drug that the insurance company would actually be willing to cover, I was told the cost, even with insurance coverage, would be $180, only slightly less than the “cutting edge” Qnasl I was paying for out of pocket and actually $50 more than the price of the Qnasl with my coupon.
When I told the pharmacist technician that I’d opt for the Qnasl after all because it was actually cheaper, she told me the insurance company wouldn't let me buy it. Already frustrated, I told her that the pharmacist told me the day before I could pay out of pocket with my coupon and not go through insurance. The woman, who barely spoke English (a growing trend in pharmacies, I’ve noticed), mumbled something that it can’t be done. I just threw up my hands and left.
That is where I am today.
Folks, we’re not talking about heart medicine or life-saving cancer drugs. We’re talking about a nasal spray! I pay another mortgage in order to pay a $13,100 deductible … in order to have insurance block what I can obtain and not even pay for most of what it claims to cover. And given that CareFirst has essentially become a zombie government-sponsored entity with no profit motive or need to compete, its customer service is worse than the DMV, so I can’t exactly lodge a complaint.
The opportunity for Republicans to articulate a holistic vision of health care
This story demonstrates everything that is wrong with our system and how the big government/big pharma complex is to blame.
A few thoughts on policy are in order:
- Thanks to government-run health care and government-distorted conception of private insurance (the original sin of the market — distorting tax exclusion for employer plans), only 10.5 percent of all health care spending is out of pocket. This dramatically inflates the price for the few people actually willing to do spend out of pocket.
- Why are so many drugs not offered over the counter? Why is it that only drugs associated with cultural rotgut are backed by a legalization movement, but simple nasal sprays are still regulated to such an extent? It’s amazing to think how long it took to offer Claritin over the counter considering that it doesn’t even work.
- It costs billions of dollars to develop a drug thanks to the FDA’s onerous regulations and its monopoly over certification. Only large companies with massive lobbies have the economies of scale to deal with this. What a coincidence.
This is America, not Venezuela. We have a right to private enterprise, private property, and the right to engage in contracts or offer services unencumbered by government regulations. We have the right to pursue health care directly between consumers and providers without government, lobbyists, and insurance companies (the ones propped up by government) getting in the way.
My story is not unique. Almost everyone in the middle class faces the same predicament, particularly those who don’t obtain insurance from their jobs. Why is it so hard for Republicans to articulate a vision for free market health care? The GOP suffers from the ultimate pre-existing condition: political malpractice. Republicans are turning Obamacare into a losing issue, despite the damage it has wrought and how it has affected every ordinary family.
Rather than put out passive-aggressive tweets becoming of a junior high girl (and telling members details don’t matter), President Trump should relentlessly use the bully pulpit to drive home every negative and insolvent aspect of Obamacare.
And about that mini-bar — at least the prices are posted, the food is accessible, and there is a semblance of a menu — something that cannot be said of our venture socialist health care system, from which our political class refuses to divorce itself.