Sharon Fowler knows all about the high cost of prescription drugs. She has learned the hard way. In fact, she knows far more about the out-of-control health insurance system in general than she ever expected to.
Sharon lost her business because of last winter’s six-month-long Ralphs strike, which was all about health care costs. Even before she went under, she was unable to offer insurance to her employees, though they worked hard and deserved it. In her own life she and her husband have been knocked back on their heels by the high costs of health care.
The whole system is broken, Sharon says. Like many people hurting financially and emotionally by health care cost increases and other abuses, she is dismayed that the government and the country at large seem absorbed with other things. "The focus in America is skewed," she says. "It should be on education and on health care. We should all be horrified about the health care situation, the prescription situation."
"We have become too complacent in America," adds Sharon’s husband, Barry. "We have just quit caring."
Sharon and Barry, a real estate agent, live in San Diego. Like so many other Kaiser subscribers, they saw their premium increase to $565 in January. Corollary costs shot up as well, way up.
The out-of-pocket maximum became $5000 per family, up from $3000. Mental health and ambulance co-pay all went up. There was a new $200 a day hospital fee, up from $200 per admission. There was a $250 deductible on brand name drugs, also a new charge. Cat scans and MRIs, were $5, went to $50.
In addition to the financial strain, all these health care cost increases have made her apprehensive. Fear of the future, she says, "is always there. I think, if I’m OK till I am 65 and can get Medicare, I might muddle through." "It is going to be tough. We are freaking a little."
The increases hit all the harder because at the time, her business was struggling because of the Ralphs strike. Sharon supplied glass vases to Ralphs. In addition to her own suffering, Sharon was forced to lay off two employees in December. It was like evicting a family member from the home. They both had become key employees and Sharon had grown close to them.
"Each of them had a child," Sharon says sadly. "One was a single Mom. It was very tough on her; she cried and cried and cried."
When Sharon’s business shut down, the costs of health care became even harder to meet. She has a $10 co-pay, so long as the drug is generic. She and Barry between them take eight prescription drugs.
They would like to do better. But they feel they are locked in because, at 56 and 62, they both have pre-existing conditions. "I’m not sure I can change. I have degenerative disc disease," as well as migraines and problems related to menopause. She notes that most people as they grow older develop pre-existing conditions. "Everybody is going to get arthritis. Every woman goes through menopause."
Over the years, Sharon has become something of a self-taught expert on prescription drugs. She can tell you, for example, about the routine practice among San Diegans of getting drugs from Mexico. "Every other building in Mexico is a pharmacy," she says, and people in the Southwest, driven by high costs in their own country, regularly go south of the border for medications. They do this despite the risk of confiscation.
Among the many problems in the U.S., Sharon says, is rampant wastefulness. She tells a harrowing and astonishing tale about her migraine medication, a story that reveals grotesque and maddening waste.
The year before last, she received shots three times of Imitrex, which helps alleviate pain from migraines.
In June 2002 she had an Imitrex shot in Ventura; it cost $95. Six months later, at Thanksgiving, she was at Lake Havasu City in Arizona and needed the shot again; the medical center gave it, and billed Kaiser $1,700. On New Year’s Eve, the same Havasu clinic charged $700 for the same shot. Kaiser balked at the $95 charge, although it ultimately paid. But it forked over the $1,700 and $700 to the Arizona clinic with hardly a blink. When Sharon complained, Kaiser led her on the bureaucratic shuffle, from one department to the next. She never has received a satisfactory answer about why Kaiser is wasting money this way.
"Kaiser is inefficient, and is paying out of town bills without even checking" with patients, Sharon complains.
Both Sharon and Barry want reform in the system, and they have several ideas about where it should take place. They have clambered aboard the Rx Express to speak about these.
"We have a cost problem, " Sharon says "and I don’t think (the insurers) will fix it themselves. There ought to be a board to monitor all of this," beginning with the increases in costs and the accelerated take-always. Those all need to be justified, she says.
"We are fortunate that we can afford an HMO," Barry adds. "But that is relatively brutal, because there is no monitoring. There is no justification for cost increases; there are no guidelines. You need a state board to regulate it."
Both Sharon and Barry are also calling on state and national political leaders to provide national bulk purchasing, which would dramatically lower the cost of prescription drugs and help stabilize our health care system.
As Barry points out, the Canadian government and the U.S. Department of Veterans Affairs already negotiate 30 to 60 percent bulk discounts. But the U.S. government, deep in the pockets of Big Pharma, specifically banned bulk purchasing in the nation’s Medicare program, thus spitting in the face of the nation’s millions of seniors.
"The pharmaceutical companies will sell in bulk to other countries," Barry notes. "The drugs are made in America, but sold around the world. You can walk into a drug store in France, Greece, or most any other country, and get these drugs at a reasonable price. But not here."
There is also a political problem. The medical profession spent $4 billion lobbying last year, he adds.
In addition to getting involved politically, Sharon and Barry urge health care consumers to get active and take charge. Sharon has done a great deal of self-education, and is aggressive with health care providers and insurers.
"We spend a lot of money," she says. "I am determined, at the age of 56, not to suffer any more. I am not going to be put off. We have decided to take control of our health."