Observation from the hospital:
(Note before, this is a bitch about something that recently happened with a patient being treated for a pulmonary embolism, which is a clot in their lungs. There's two approved treatments here, the first is to hospitalize the patient, overlap lovenox and coumadin until their coumadin levels become therapeutic, which can 4-7 days depending, and then discharge the patient home on coumadin with him getting his INR checked every week (then every 2 weeks, etc, depending on the stability of the drug level). Coumadin is a dirt cheap, $4 drug, but requires a longer hospital stay (our hospital is a minimum of >$4000/day), and requires outpatient monitoring of their INR which means the weekly lab draws, office visits, etc.
--- The second treatment is when you diagnose them with the PE, you start them on lovenox in the hospital, watch them overnight to make sure it doesn't worsen, and then start them on Xarelto and send them home. Xarelto is about $250/month, but you take 5 or so days off the hospital stay which saves you at least $20,000. And you don't have to perform any outpatient monitoring of the drug, you just take your dose daily and that's it. [There are risks/benefits of each drug but that's beyond my rustled jimmies.]) So obviously Xarelto is the preferred choice because you get the patient out of the hospital quicker and there's less room to fuck things up outpatient. [The longer you stay in a hospital the more likely you are to get a healthcare acquired infection, etc.])
Person A is a piece of shit alcoholic and drug user. Has diabetes, is given tax-payer funded health care, but does not actually take his diabetes medications. Loses both legs as complications, etc. Person is a huge drain on society, has never contributed even a dollar in tax funds, and costs us hundreds of thousands of dollars per year on ridiculous things you wouldn't believe. He develops a pulmonary embolism, is hospitalized, and needs medication for his embolism. We (waste) about 3 days getting him therapeutic on coumadin until we find out that he qualifies for some magical health card that can get him the $250 Xarelto for $4. You and I are funding this magical card, it's taxpayer money. So it's good on one hand because it saves money for the hospitalization, but you and I are still paying for his $250/month Xarelto for the next 6 months.
Person B is from the exact same background as Person A. He works his ass off 60-70 hours per week, drives dump trucks or something similar, but he elected to pay ~$280/month for blue cross blue shield insurance, which is a significant fraction of his hard earned income. Person B also develops a pulmonary embolism in the hospital, and the exact same treatments apply to him. However, his private insurance, that he pays $280/month for, does not approve Xarelto (because they would only approve a dose of it which does not exist), so this patient has to stay in the hospital for ~4 extra days trying to get him therapeutic on coumadin so that we can safely discharge him home. So here's a person who works hard, pays for their insurance, pays their taxes, and they can't even get the same good drugs that the piece of shit who has never contributed anything gets. And it's not just that. This prolonged hospitalization forces this unfortunate guy to miss 4 extra days of work, which he isn't getting paid for, which will give him less money to pay for his insurance with! And not only that, he's going to have to miss hours/days to get his INR blood draws to make sure he's therapeutic, etc.
The situation drives me insane. The whole system is a complete clusterfuck, and I'm not blaming the government, or insurance companies (well I'm blaming both actually), but just the fact that a hard working person gets fucked over while the piece of shit who has never done anything gets everything really, really, really fucking rustles my jimmies.
