Friday, 26 July 2019

Life And Debt: Stories From Inside America’s GoFundMe Health Care System


The Creeping Privatisation of the NHS – Brighton and Hove CCG is Forcing Patients to Buy Medicines Rather than Prescribe Them


  
You may remember that line from Joni Mitchell’s Big Yellow Taxi
You don’t know what you’ve got till it’s gone.’
That applies like nothing else to the NHS.  People take for granted being able to turn up at a hospital if they have a problem or get ill.  We take it for granted being able to obtain a GP’s appointment.  We don’t know what it is like to face the agonising decision of whether we can afford to go to the doctor or afford to buy the medicines he has prescribed.  Yet that is the ‘logic’ of the free market.
With Donald Trump promising that in a US-British trade deal ‘everything is on the table’ including the NHS, then it is worth having a look at what the free market in health is like in the United States.
A comment piece I did for the Brighton and Hove Argus some years ago on Big Pharma
After all the ideology of the market is that everything has its price, everything is a commodity, health included. No one has any social responsibility or duties towards another. If you can afford it then the world is your oyster but if you can’t, then that’s tough. Everyone has the right to starve and sleep under the stars but it just happens that only the poor and homeless take advantage of these ‘freedoms’.
As RH Tawney put it ‘freedom for the pike means death to the minnow.
In the United States ‘freedom’ includes the right to die without treatment and of course the right to buy virtually any treatment you want and to jump the queue whilst doing so.
Below is a shocking article on how thousands of Americans are having to resort to crowd funding to pay for health care. Billions of dollars have been raised to pay for what we take for granted. Whole communities rally round to raise the funds necessary to pay for someone’s cancer treatment because even when someone is insured, there are ancilliary costs that are not covered.
There is a reason why every newspaper hates Corbyn - and it isn't 'antisemitism'
However those who don’t have a community to rally round them, the homeless and forgotten, are left to die unaided. And the ‘Christian’ politicians who call themselves ‘pro-life’ as they prohibit abortions, because the death of the unborn so distresses them, are unmoved by the death and suffering of those who cannot afford medical care because they cannot afford it.
When I learnt that I had Hepatitis C 7 years ago, I was fortunate in more ways than one. I was unable to cope with what was the then standard treatment of being injected with a toxic drug called Interferon.  Although it was curing the disease it was killing the patient!
I was lucky because at that very moment new experimental non-interferon treatments were coming on stream. A drug called Harvoni was being marketed by an American drug company called Gilead Sciences. I took this drug for 90 days. One pill a day after which I was cured. But without the NHS I couldn’t have afforded it because it cost about $1,000 a pill.  It cost $1 a pill to make.  An obscene level of profit.
I was lucky because I was one of the 500 sickest people with Hep C who were on a government funded programme to pay for this drug on the NHS.  I was the first person my consultant told me in Brighton and Hove.
The drug was developed primarily at Cardiff University but Gilead Sciences got the patent and they charged what they admitted ‘the market would bear’.
There is a brilliant cross-examination by Alexander Orcasio-Cortez, the socialist Congresswoman from New York who Trump particularly hates and who was recently told to ‘go back home’ despite having been born in the USA.  In the same speech Trump accused the Congresswomen of ‘anti-Semitism’.

In the video we see the hapless Gilead representative face the accusations that they are charging $2,000 for Truvada, an HIV drug, in the US whilst it costs $8 in Australia. Big Pharma has no morals.
My complaint to the Brighton & Hove CCG

I mention all this because the Brighton and Hove Clinical Commissioning Group has decided on a policy that any drug that can be purchased over the counter is no longer going to be available on prescription.  It doesn’t matter what it costs, you will not be able to get it. It would appear that it does not depend on what your ailment is either. This is in order that the CCG can ‘save’ approximately £500,000, absolute chicken feed.
The cost of drugs in the US is one of the main ‘extras’ that insurance tends not to cover so it is an important principle that if your doctor believes that you should be prescribed a drug it’s not for the faceless bureaucrats of the CCG to determine whether or not you will be ‘allowed’ it.
I have made a formal complaint and I have threatened that if necessary I will seek to apply for a judicial review of the decision.  However this is not just peculiar to Brighton and Hove but is a national policy. The NHS may be safe with us, as the Tories claim, but one thing is for sure.  Given half the chance they would like to adopt the American system of super profits for private health care companies and an insurance lottery for the rest of us whereby the insurance company will decide whether or not you need the treatment you have been prescribed and how much they will fund.
One statistic has always caught my eye.  Cuba, which has a universal health care system, has a lower child mortality rate than its wealthy neighbour because the United States prefers to spend its money on weapons systems than on the most basic needs of its citizens. And it has a President whose job it is to get the poor to fight amongst themselves, ‘making America great’ in order that the rich can get away with it.
And that is also what the attacks on Corbyn and the ‘anti-Semitism’ moral panic is about. Protecting the wealthy here from those who would like to redistribute their ill-gotten gains.
Tony Greenstein

The human body is a frail thing, and illness is a pitiless adversary. Every day, an untold number of Americans are diagnosed with a devastating illness or suffer a sudden injury that threatens to upend their lives and tear apart their families.
This misfortune often comes at a staggeringly high financial cost that can be just as cruel.
While health insurance or government programs like Medicaid and Medicare can shield against huge medical bills, massive debt and even bankruptcy, only the truly wealthy can feel secure that sickness won’t lead to financial ruin.
This is why thousands of Americans have turned to crowdfunding website GoFundMe in the last decade to help cover medical bills and related costs. HuffPost is profiling some of those people, and what their stories reveal about the shortcomings of the American health care system.
These are not feel-good stories.
That’s often how the news media cover these fundraisers ― focusing on the generosity of individuals giving rather than the systemic failures that created the need. While it’s hard not to be inspired by successful campaigns and the fortitude of those suffering through terrifying ordeals, such stories portray a chilling reality that Americans ― even those with good jobs and health insurance, can be one bad day away from financial ruin.
A serious disease can put financial strain on people even in countries with universal health care systems and strong safety nets. But the United States, which has neither of those things, leaves its residents uniquely vulnerable. 
More than 50 million donors contributed more than $5 billion to GoFundMe campaigns between 2010 and 2017, according to GoFundMe, which is based in Redwood City, California, near San Francisco.
Two years ago, one-third of all the money raised went to campaigns listed in the Medical category. GoFundMe reports that more than 250,000 medical fundraisers are added a year and raise $650 million annually.
Although the fundraising numbers offer a sense of the need behind the many campaigns, they are imprecise, according to GoFundMe. Users can choose whatever category they like, so not all medical fundraisers are actually for medical bills and related costs, and some users seek help for those things in other categories on the website. Those figures also include money raised in other countries.
Successful fundraisers can generate $100,000 or more, as neighbors and strangers alike rally around families in need, and that money can go a long way to ensuring that treatments can continue, that housing and other daily costs can be covered and that families don’t lose everything while trying to keep loved ones alive and make them healthy.
ISABELLA CARAPELLA/HUFFPOST
Americans pay more for their health care than their counterparts in other developed countries. And even though more than 90% of Americans have some form of health coverage, according to a federal survey from 2017, it’s often inadequate. Some 45% of Americans are “underinsured,” according to a report published last year by The Commonwealth Fund, a New York-based think tank. And 27% of Americans told West Health and Gallup they had skipped medical care because of the cost in the past year in survey findings published this year.
High deductibles requiring thousands of dollars of out-of-pocket expenses before the insurance covers any bills, large copayments at the point of service and costly prescription medicines are among the reasons Americans pay so much. Add to that services or medicines insurance companies won’t cover at all, experimental treatments ineligible for coverage, medical providers that aren’t in insurance networks and other uncovered costs, and medical bills can rise into the millions of dollars. For the uninsured, there is no upper limit to how much they could owe.
According to data from the Federal Reserve Board, 40% of Americans don’t have enough savings to cover an emergency expense exceeding $400. In the past year, Americans borrowed $88 billion to cover medical bills, the West Health/Gallup survey found. Among Americans who declared bankruptcy from 2013 to 2016, 59% cited medical bills as a factor, according to a survey published in the American Journal of Public Health this year.
Illness often means lost income, as the patient and family members miss time at work during treatment. Transportation and lodging costs pile up for people who must travel long distances to receive care, including those in rural areas who live far from the nearest medical facilities and those who seek medical treatment from specialists who practice at prominent institutions like the Mayo Clinic in Minnesota or the Cleveland Clinic in Ohio. These so-called indirect expenses are a reason medical fundraising is the leading category on GoFundMe worldwide.
Browsing the Medical category on GoFundMe offers a brutal reminder that illness doesn’t discriminate. People from all walks of life and at virtually every level of income, both the insured and the uninsured, turn to their communities and to strangers on the internet to solve a financial problem that would be impossible to handle on their own.
No amount of charity is enough to compensate for America’s tattered and unforgiving health care system, as GoFundMe founder and CEO Rob Solomon articulated in an interview with Kaiser Health News published in January.
“The system is terrible. It needs to be rethought and retooled. Politicians are failing us. Health care companies are failing us. Those are realities. I don’t want to mince words here. We are facing a huge potential tragedy,” Solomon said. “We provide relief for a lot of people. But there are people who are not getting relief from us or from the institutions that are supposed to be there. We shouldn’t be the solution to a complex set of systemic problems.”

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