Is the price of your prescription drugs making you sick?

Dr. Eddie Patton examines pharmaceutical costs in the U.S. healthcare system. Today, we explore the surge in prescription drug spending from 1960 to 2020.

Dr. Patton discusses the distribution network's impact on pricing transparency, focusing on the role of wholesalers and Pharmacy Benefit Managers (PBMs). Topics include drug pricing, financial toxicity, healthcare policy, and patient access to medications. He highlights the need for legislative changes and increased transparency in the pharmaceutical industry, and he provides insights on navigating the complex world of prescription drug costs.

Your Health, Your Wealth aims to help listeners understand the economics of healthcare and make informed decisions. For more information, visit eddiepattonmd.com.

Five Conceptual Takeaways

1. The significant issue of high drug costs impacts overall healthcare spending and affects patient access to necessary medications.

2. Pharmaceutical companies, as for-profit entities, need to recover the costs associated with research and development.

3. The pharmaceutical market in the United States is controlled by a few major wholesalers, which limits competition and can lead to pricing issues.

4. PBMs play a critical role in negotiating rebates and discounts with drug manufacturers.

5. There is a necessity for legislative changes and early discussions regarding the economic impact of medications on patients when choosing health plans.

Timestamped Overview

00:00 Doctor Eddie Patton discusses healthcare system complexities.

04:00 Rising prescription drug costs require urgent action.

08:28 Complexity of pharmaceutical drug pricing and flow.

11:44 Consolidation of wholesalers affects drug pricing, formularies.

17:59 New SMA medications improve kids' lives significantly.

19:15 Limited drug options lead to higher prices.

23:17 Cost of medications impact patient's health.

25:54 High drug costs lead to financial burden.

29:30 Addressing healthcare issues at micro and macro levels.

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How did Medicare and Medicaid come into existence?

Dr. Patton dives into the origins of Medicare and Medicaid, created through the Social Securities Amendment of 1965 during President Lyndon B. Johnson's administration. These programs aimed to provide government-funded healthcare for vulnerable populations.

Dr. Patton traces the evolution from Baylor Hospital's early health insurance plan to the establishment of Blue Cross Blue Shield. And he covers the rise of HMOs and PPOs in the 1980s and the resulting impact on the American healthcare landscape.

Learn more at eddiepattonmd.com.

Five Conceptual Takeaways

1. Understanding the historical context, from President Lyndon B. Johnson’s Social Security Amendments creating Medicare and Medicaid to the emergence of self-insured employer plans, HMOs, and PPOs, helps us grasp the development and complexities of the modern American healthcare system.

2. The rising costs of healthcare significantly impact individuals and families, with hospitals, insurance companies, and the pharmaceutical industry being major contributing factors. Patient autonomy, choice, and accessibility remain critical in mitigating these impacts.

3. When selecting a health insurance plan, it is essential to understand co-pays, deductibles, reimbursements, coverage for preferred doctors and facilities, and prescription drug policies. Quality customer service and additional perks like gym memberships or wellness programs can also influence the decision.

4. Both vertical and horizontal consolidation within the healthcare industry reduce competition and patient choice while enabling insurers and providers to control costs by owning more of the healthcare process. This consolidation can affect pricing and accessibility of care for patients.

5. HSAs provide important benefits like pre-tax contributions, reduction in taxable income, and flexibility in spending on healthcare-related expenses. However, understanding the limitations, such as use-it-or-lose-it policies and restrictions on non-healthcare expenditures, is crucial for maximizing these benefits.

Timestamped Overview

00:00 Industrial revolution led to workers' protection laws.

05:11 Compulsory health insurance in 1916-1919 and opposition.

09:45 In 1933, New York labeled plans insurance.

13:20 Medicaid and Medicare provide health care support.

16:18 ERISA plans are federal, require federal advocacy.

19:03 Health insurance plans evolving to provide care.

23:38 Healthcare consolidation reduces patient choice, impacts insurance.

26:20 Healthcare insurance pros and cons for employees.

28:06 Employers must offer insurance to full-time employees.

33:51 Health providers need timely insurance reimbursements.

35:03 Challenges in basic services and insurance plans.

37:48 Inquire about insurance coverage for emergencies.

42:20 Telemedicine offers convenient health insurance options.

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How does the U.S. healthcare system impact your wallet?

Dr. Eddie Patton explores healthcare costs in the United States. Factors driving expenses include administrative costs, insurance networks, and pharmaceutical pricing. He compares U.S. healthcare expenditures to European Union countries. Dr. Patton discusses the patient-physician relationship's role in the system. Topics include health insurance, medical billing, prescription drug costs, and healthcare policy.

Your Health, Your Wealth aims to help listeners understand the complexities of healthcare economics. Dr. Patton provides insights on navigating the system as a patient and consumer. For more information on Dr. Patton's work, visit eddiepattonmd.com.

Five Conceptual Takeaways

1. The United States spends significantly more on healthcare compared to other countries, with administrative costs being a substantial contributor to this high expenditure.

2. The U.S. healthcare system is fragmented and complex, incorporating elements from various international healthcare models (e.g., UK's national healthcare, Germany's regulated non-profit insurers, Canada's government-financed private care).

3. A considerable portion of healthcare spending in the U.S. goes towards administrative tasks rather than direct patient care.

4. The cost of medications in the U.S. is influenced by a complex interplay of factors involving pharmaceutical companies, wholesalers, pharmacies, and pharmacy benefit managers (PBMs).

5. Investing in preventative care offers a potential solution for lowering healthcare expenditures while enhancing the quality of care.

Timestamped Overview

00:00 Enhancing healthcare accessibility for patients is crucial.

06:27 US healthcare spending needs better patient outcomes.

10:13 Healthcare costs tied to fragmentation, patient-physician relationship key.

14:13 Physician practice costs rise, pay decreases. Healthcare inflation.

18:02 8% of Americans lack health insurance, affecting care.

19:42 Healthcare cost dynamics, pharmaceutical industry drivers, explained.

25:11 Healthcare relationship key; administrative oversight complex issue.

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In Your Health, Your Wealth, renowned neurologist Dr. Eddie Patton exposes the hidden forces driving up medical costs for millions of Americans. From the fragmented healthcare infrastructure to hospital billing practices and pharmaceutical pricing, Dr. Patton provides an exhaustive examination of why the U.S. spends significantly more on healthcare than other nations.

"The US healthcare system emphasizes autonomy and choice for patients,” said Dr. Patton during episode one. "Accessibility is a key term that will be important in healthcare as we move forward."

Dr. Eddie Patton is a recipient of Texas Monthly Magazine's SuperDoctors®, Houstonia Magazine's Top Doctors awards, and was appointed by Texas Governor Greg Abbott to the Texas Council on Alzheimer's Disease and Related Disorders. These accolades, along with his decades of experience, make him the ideal host for a podcast like this.

The podcast is a must-listen for anyone grappling with skyrocketing premiums, outrageous medical bills, or lack of access to quality care. Dr. Patton encourages listeners to "Increase your mindset, health set, and heart set as it pertains to your health and the healthcare system.”

Learn more about Dr. Patton HERE.

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