This is just an update post on the million dollar a month case in Iowa that I noted makes the Iowa market weird.
USA Today reports a few more details:
a company executive shared more details during a recent presentation to the Des Moines Rotary Club. The patient is a teenage boy who has hemophilia, a genetic disorder that prevents the blood from clotting, Wellmark Executive Vice President Laura Jackson told more than 100 people who attended the Rotary meeting. She did not name him or give his hometown…
Michelle Rice, a vice president for the National Hemophilia Foundation, said she could imagine how aggressive treatment of a complicated case could lead to such costs. Rice said that when a patient’s immune system rejects the standard treatment, doctors sometimes try to overwhelm the body’s response. “You’re giving the patient massive amounts of factor on a daily basis. You’re basically trying to get the body used to the factor, so it no longer rejects it,” she said.
A coagulation disorder with complications is expensive. And regular risk-adjustment and reinsurance won’t even come close to covering the cost of a bad bleed.
MomSense
Word.
Major Major Major Major
It’s OK, high risk pools can fix this.
eric
get this: when you average out his costs with 1 million people that dont spend any money on health care that month (does not have to be the same people every month), the average cost is $1 per month. the only issue here is the lost $1 million a month that would be PROFIT to the insurers.
But her emails!!!
@eric: It’s one millions dollars per month in additional costs that need to be covered, regardless of the whether the insurer is a for profit or nonprofit entity. There’s also not 1 million people on that plan, nor are those who are all going without health services.
eric
@But her emails!!!: my bad….my point is that the problem is mitigated by creating the largest risk pool possible…..the risk pool of City in Iowa is too small, but the risk pool of Large North American Country between Canada and Mexico is not.
Chet Murthy
@eric: Aw, heck, no need to go to “Large North American Country”. The state of Iowa is 3.1m people. That’s plennnty big enough. Oh right, then we’d need single-payer, b/c all the employers fragment the pool. [And sure, that’s a fraught mess.] But it shows that (as you say) the real reason this is a problem, is that “money wants it to be a problem”.
eric
@Chet Murthy: And some of those folks are calvinists, and they would just be getting in the way of god’s will by going to the ER!
Ruckus
What do other healthcare systems, like the NHS or Canada or NZ do about extreme cost patients?
These systems have a much lower cost, is it a reduction in care or a reduction in costs, like the EPS (extreme profit system) that we have in this country?
David Anderson
@Major Major Major Major: Actually, this would be the case example for a well funded high cost risk pool. Carve this single individual out and the Iowa market incentives make sense and are not perverted.
The key to that analysis is “well funded”
James Powell
Every Republican and especially those in Iowa needs to answer the questions raised by this circumstance. What will your proposed plan do with this child? What should the parents tell him when they can no longer get coverage? Are you willing to appear in a documentary about this child in which you explain that his options are basically tough shit & die?
schrodingers_cat
@James Powell: R response: The child must die for the greater good, unless it is their own.
Howler Monkeys on Twitter: You should not have children if you can’t afford them, put the child up for adoption.
ETA: I have actually read response 2 in a Twitter feed about ACA. I did not make that up.
RobertB
@Ruckus: IANA Health Insurance Expert (but bump into them in my software developer role nearly every day). From what I’ve read concerning the NHS, it’s a little of both. Doctors are paid less, pharmaceuticals are cheaper, some forms of treatment might put you on a waiting list, and hospitals aren’t nearly as nice (compared to the fancy ones here in the US, anyway).
The NHS also has the notion of coming up with a quality-of-life vs. cost-of-treatment ratio. If that ratio gets below a certain number, they will not pay for it. This could be because the treatment has a high cost for a short extension of life, or because it’s a high cost/low chance of success experimental treatment. Perhaps that’s an adult conversation between the government and the citizens that we can’t/won’t have here. “We have X pounds, and to make the numbers work the Death Panel Index has to be Y. Throw more money in, and the DPI changes.”
If you spring for supplemental insurance, it bumps you to the front of the line. Fancier rooms, your knee surgery happens in 2 weeks instead of 10 months, etc.
NorthLeft12
I am a little surprised that so much information was given out about this case. Frankly, I think it is completely inappropriate and basically none of anyone else’s business how much and why this one person costs the system so much.
My wife worked at a small firm that had a large increase in the benefit coverage cost to the company, which the company decided to respond to by downgrading the overall employee group coverage to stay on budget. They justified this in meetings [this company had about four different offices with maybe fifty employees] with the employees by detailing how much one unnamed employee had cost to be covered. Of course everyone soon knew who was “responsible” for their lousier coverage. My wife knew too………the cheapskate company. I am so proud of her.
Am I off base on my concern for privacy and the opportunity for public criticism of this individual?
Snoopy
Am I the only one who is concerned that the increasing visibility of this patient will lead to personal blowback? There’s a lot of nuts out there, who wouldn’t think twice about “explaining” to this boy that he needs to take responsibility for his own health.
God forbid if Malkin finds out his family has marble countertops…
Bob Hertz
Has anyone listed the name of the drug and how much the drug costs? Sounds like the run rate is $30,000 a day.
I have said for years that price controls on the most expensive drugs would solve a lot of our health insurance problems.
P.S. The Iowa risk pool for ACA plans is abnormally small, due to over 55,000 grandfathered plans still in force.
Snoopy
@NorthLeft12: I’m too slow with my post.
Yes: first we knew it was Iowa, then that it was haemophilia, then that it was a teenage boy. Shouldn’t be too hard to figure out who it is, at this point.
We really need to leave this alone; I’m sure they have enough heart-break as it is.
mjg
Please note, too, that Wellmark has basically doxxed this individual. Hemophilia is a rare disorder – it wouldn’t be too hard for fellow Iowans to figure out who is the individual or family at issue. How do you think the family — already dealing with the stresses of a major health problem — feels about being called out in this way? I think back to an article in Slate a couple of years ago about a family similarly tagged by AOL’s CEO for the high costs of their medically-distressed newborn:
David Anderson
@Bob Hertz: coagulation factors can be that expensive. Usually they just stop being used after a few weeks/months
NorthLeft12
@Snoopy: No, thanks for posting. I am kinda glad that I am not alone on this. I have no doubt there are a lot of people who know exactly who this kid is, and how long before some media outlet or idiot blogger decides to identify him because the public has a right to know? Or else the family decides to go public to try and control [good luck with that] the coverage.
Yeah, I don’t see any good coming from this, but then I am a cynical SOB.
TenguPhule
@NorthLeft12:
Not Cynical enough.
Want to bet an R is gonna run using this patient as a “they’re stealing your healthcare!” against the Ds?
ruckus
@RobertB:
This is the VA system. They will do just about anything if the outcomes have a nominally positive effect. But a name brand that has a generic counterpart, you get generic only, even if the generic is not exactly equal. Your survival expectations after an operation are too low, it doesn’t happen.
? Martin
Yeah, I’m a bit surprised that they revealed this much info. That said, my immediate relative that was a C-level there hated Laura, that she never respected the responsibility to the public, so not completely shocked to see her name there. Not that there will be any punishment against her for this, for reasons I won’t share.
This situation begs two questions though:
1) What is the benefit to the residents of Iowa to have that cost pooled within the limited population of Iowa and not across the larger population of the US? It is inarguable that the larger the pool becomes, the better able it is to absorb these corner cases. When you can single out one individual for that kind of impact, it broadcasts that as large as Wellmarks pool is (75% of the state) it’s still not nearly large enough.
2) Not to diminish the needs of this individual in any way, but is $1M a month really a justifiable amount to charge? I say that because for that money you could build this individual a dedicated medical clinic staffed 24/7 with a physician and nurse, and still have money to burn. Do the consumables really cost that kind of coin? Yes, I understand that amortizing capital costs for drug development that affects a limited number of people necessarily leads to high drug prices, however, this seems excessive even from that perspective.
ruckus
@? Martin:
Used to have several customers who worked for a growing biotech company. They develop and mfg drugs for rare generic disorders. I can believe the costs, just from the required capital costs, let alone the regulatory costs.
Making a million pills a day, or even more is relatively cheap. Making a few hundred per month for twenty people is an entirely different ball game.
Mark Regan
Not to invade the young man’s privacy any further, but why isn’t this a job for Iowa Medicaid? Does Iowa not use the Katie Beckett option for waiving parental income and resources? If you’re thinking, Medicaid has cost limits that it would impose on the young man, the answer would be, not under EPSDT for people under 21 it wouldn’t.