I had a patient in the office today who doesn't have insurance.  He told me that a recent prescription he got was too expensive.  This is not surprising, as many of the brand name, and even some of the generic medications are quite expensive.  What surprised me was the fact that the expensive medication was for hemorrhoids, and it cost over $100.  I certainly would never recommend anything but good care for that part of your body; and the symptoms of hemorrhoids can definitely have a big effect on your social life.  But come on, $100?? This medication had all of the usual components that most hemorrhoid creams have.  The real difference was the delivery system: it's a foam.  There is no generic substitute for this, apparently.  As I spoke with this man, it became clear to me that this is a central issue in the crisis in healthcare.

What?  Hemorrhoid foam is the cause of the healthcare crisis?

No, that is not what I am saying.  The significance of this encounter is that the $100 medication is one that I prescribe frequently, and that insurance companies have never rejected.  The insurance companies are paying $100 for hemorrhoid medication.  True, they probably have wrangled some sort of discount, but the reason the company who makes this magic medicine can charge $100 is that somebody pays $100 for it.  I don't think there are enough constipated millionaires to explain this phenomenon.

The main problem in healthcare is the total lack of value.  We pay a lot for care and don't get a lot in return.  Costs are going up but we are not seeing an increase in quality along with those rising costs.  Why is this happening?  $100 dollar hemorrhoids show us what's going on.  The medications contained in this concoction are not anything expensive - mainly cortisone.  The delivery system isn't space-age.  The company spends very little money on marketing (I don't think I've ever seen a drug rep for this hemorrhoid foam).  The R&D budget was probably spent on researching a way to get someone to pay $100 for hemorrhoid foam.

While in Vegas last week Dr. Wes told us about a patient he put in for 23 hour observation with a heart problem who racked up a $180,000 bill.  Insurance got a discounted rate but still covered $120,000.  How can they justify this?  How come there isn't someone at the insurance company who says: "Hey, that's an awful lot to spend on a 23 hour visit," or "Wait a minute, why the heck are we paying $100 for hemorrhoid medication?"  The answer is at the root of our system's problem: they pass on the cost to us.

If I was in the hemorrhoid foam business (my kids wouldn't tell their friends, I am sure), I would accept the $100 check for each can of foam.  I'd even start singing "God Bless America."  But I am not in that business (my kids are relieved), and instead I have people with insurance rates so high that they have to drop it.

Something is wrong with this picture.  $100 is more than I get paid for most of my visits, and congress is now arguing about whether they are going to cut my pay; yet nobody seems to be bothered by $100 for hemorrhoids?

Will I get paid better if I claim to shrink swelling and relieve itching?  Will it help if I deliver my care as a foam?

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