We have just paid( via insurance as opposed to bankruptcy ) for the chemo for our young family member. It did zero, other than nearly killing the patient before the cancer could, but the cost remains the same. At least they did not push the patient to continue.
But the OP's question is why? Well some good answers have been given to a potentially very complex question, but there is a bottom line for it all: because they can. It does not just apply to the drugs, but to the MD fees and scans and hospital bills.
Because we must pay or suffer and die( or maybe both) we pay. Of course we can't really pay, one day of it all would bankrupt most of us quickly. Somehow, insurance manages to pay and make a profit. I guess it is all actuarial, though I do wonder at the numbers needed. Before I went on Mcare, I was paying about
$13000-15000 a year counting the deductible. Leaving out the deductible just call it $10000 per year for my insurance. For quite a few years I never met the deductible and cost them nothing.
But then I got PC and wiped out all their profits for all those years in just a few months. Let's say the total cost that year was $100,000(sorry, I don't remember exactly). Minus say 5 years at $10,000 per year/50,000, that would leave them about
50,000 in the hole. But if there were 9 others paying the same price as me, but who never exceeded their deductible, they would collect 10,000X9=$90,000 minus my deficit of $50,000 leaves them a $40,000 profit on the group of 10 I was in.
Of course, I have no idea what the #s would actually work out to. Maybe 9 out of 10 in any given year never actually cost them anything or never exceed the deductible, or maybe only 5, or maybe 95 out of a hundred. Apparently it works out so that the Ins. companies can pay the exorbitant fees and still make a reasonable profit. If they couldn't pay, these prices would tumble because obviously most of us could not pay even if we were willing to. Like the above mentioned $25,000 PER MONTH for an extra no doubt miserable extra 4 months of life. only a very few of us could or would pay that. But you can count on it that services would still be available if prices dropped. For example, a surgeon might charge from $4000 to $20000 for an RP, and do several in a day. Do you think there would still not be plenty of surgeons if the max they could get was $3000? For those fast surgeons that would still work out to over $2000/hr, and does not count all of their vast non OR related fees. Just as their are plenty willing to take care of MCare and especially MCaid. Most medical/surgical services are available, but reduced in price sometime 90%. Every one I knew *****ed endlessly about
these low ball prices, but most still accepted it. In fact, I know some who even make a good living with nothing but Mcaid or MCare only.
For example, the last couple of years before I retired I would travel to a little hospital that did a large amount of what is called Full Mouth Restoration or Dental Rehab. On children from age 2 years to 18, or even since Obama care up to 26 I think but still on their childhood Mcaide, I would put them to sleep, put a nasal ET tube through their nose down into their trachea, and give them gas while the dental surgeon pulled all their teeth and gave them some shiny new metal ones. The patients and parents called it "getting a rack". Some days we would do most of a family on the same day!
Now if you or I had to have this done for ourselves or our kids, the cost would be into the many thousands. ( Purgatory, didn't you just have something similar done, related to your PC treatments? Can you tell us the cost?) What with going into the OR getting general anesthesia, the dental rehab, recovery room, etc, big bucks. And most likely we would have to pay cash because probably most of us don't have insurance that will pay if we let out teeth rot out, which is all most of this was. (dental trauma or teeth pulled for cancer treatment would be different for insurance purposes)
But 100% of these patients were MCaid. Never once did I see one of these patients have private insurance or be self pay. Like I said, private insurance is usually not going to pay for careless dental hygiene which is what these were. The hospital would pay me $100 per hour, and then bill MCaid something above that. Probably if you had this done just the dentist fee would be astronomical. For example, there is this: www.yourdentistryguide.com/fmr/
"The approximate cost (at a minimum) could be about
$800 to $1,500 per tooth. That figure does not include any charges for oral surgery, crown lengthening, periodontal treatments, etc. It is not unreasonable to expect a full mouth reconstruction to cost approximately $30,000 to $45,000 or more.". Yep! It's good work if you can get it! Probably $500-1000+ just for the anesthesia.
But MCaid would pay for us to do from 5 to 15 a day of these, on average. MCaid patients do not have deductibles or pay for the insurance or pay into the insurance fund for a lifetime like many of us have done for MCare. (anyone here on MCaid correct me if I'm wrong please) We simply take what MCaid will pay and that's the end of it. And they pay a greatly reduced price. For example, looking at the above charges, you can guess that the dental surgeons fee would be a good hunk of that total cost, right? So at least thousands of dollars per case. But the dental surgeon told me MCaid paid him a straight fee of $400 per case. He would drive up from 2+ hours away. We might average 1/2 hour a case. So maybe we would do 10 by noon. He has a guaranteed $4000 for 4 or 5 hours work, or maybe $6000 if we did 15. He would do this most days. Lets say only 3 days a week and only 10 per day. So a guaranteed $4000 a day X 3 days a week x 50 weeks a year = $600,000 a year. More($900,000) if you are doing 15 per day. And a measly $300,000 if you are only doing 5 a day for 2.5 hours work per day.
Would you work hard 4 or 5 hours a day, 3 days a week, plus a few hours driving thrown in, for $600,000 a year? So maybe you see my point. Mcaid is paying $400 for the Dental surgeon plus maybe $100 for me and who knows what for the hospital, so maybe $1000 or $2000 total for what is priced above at $30-45,000! If insurance was not there to pay these outrageous fees, or people did not have the money to pay it themselves, there would still be plenty of people to do at least a lot of the work. Unless folks won't lower themselves to pull teeth for hundreds of thousands of $ per year. ( I know none of that is PCa, but the principle is universal in med/surg)
Post Edited (BillyBob@388) : 10/24/2014 9:39:24 PM (GMT-6)