Of course it’s not always so easy. Insurance often doesn’t function like it’s supposed to, and the terminology can get very confusing. We’re often burdened with additional “out-of-pocket” (OOP) costs. And sadly, the system doesn’t work for everybody, especially those who for one reason or another don’t have insurance at all (a report from the US Census Bureau estimates that figure at about 10% of Americans).
Unfortunately, the very system that is supposed to make our most innovative medicines affordable to people when they need them is also rife with serious issues that cost people their health and financial well-being. And since the U.S. Insurance system is so flawed for so many, those flaws sometimes unfairly hurt the reputations of doctors who treat patients and scientists who create drugs.
In this chapter, we discuss why insurance is sorely needed for innovation. We’ll help you get clear on the various and sometimes confusing terminology related to insurance, and we’ll explain how private insurers have gobbled up a lot of the supply chain between a drug company selling a medicine and the patient receiving it — and why this is problematic.
Insurance is a complex issue that needs to be discussed and debated. We aim to equip you with the foundational knowledge you need to confidently enter into the debate. We’ll also share our perspective on where we think insurance goes off the rails, and how we can get it back on track. (Hint: capping out-of-pocket costs will go a long way to fixing most of what is wrong.)