How expensive is treatment for RLS in the U.S.?

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QyX
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Location: Berlin / Germany

How expensive is treatment for RLS in the U.S.?

Postby QyX » Fri Jun 30, 2017 9:06 pm

Since Donald Trump got elected I follow closely the news from the U.S. I got a subscription for the Washington Post, read the top Articles at the NY Times and watch the top stories from CNN, FOX, MSNBC, etc. and independent media on YouTube. Just to get a sense of whats going on in the U.S. because I think these are historic times.

So health care in Germany works like this: we have a private sector for people with high income (>4.800 EUR / month in 2017), people who own their own business (also they can be insured in the statutory health insurance, something like MEDICARE while this kind of insurance is open for everybody). People who for work for the state like Police Officers are 80% insured by the state and need to cover the other 20% with an additional private insurance which makes health insurance very cheep with excellent coverage.

From the 81 Million people in Germany, around 71 Million has the statutory health insurance (Gesetzliche Krankenversicherung). Premiums are 14,6% of your income but no more then 14,6% of 4.800 EUR (approx. 700 EUR). So even if you yearn 20.000 EUR / month you won't pay more then 700 EUR per month as long as you are in the statutory health system. Premiums can be higher in the private sector. Especially when you are old and have pre existing conditions or had high health care bills in the past. The private sector in Germany is normally for the rich or people who are employed by the state / government. I just want to speak about the statutory system because it applies for the most people.

The statutory system doesn't have deductibles except for dental costs. Everything that is really necessary is covered 100%. When you are older then 18 you have to start paying a small extra fee for prescriptions in the pharmacy. The co-payment is 10% of the drug but at least 5 EUR and no more then 10 EUR per drug.

We have many cheap and old drugs for Diabetes, high blood pressure, antidepressents, sleeping pills etc. Let's say one package costs 19,95 EUR then you pay 5 EUR. If one package is 76,65 EUR, then you pay 7,67 EUR when you maybe get some expensive opioid painkillers were one package is about 400 EUR, then you pay 10 EUR. Co-payment is limited to 2% of your yearly income when you have chronic disorders. So people with low income and chronic disorders don't end up paying so much for health care. Also people who are unemployed and receive social support from the state are 100% insured by the state and don't need to pay extra 14,6% for insurance. In Germany everybody is covered. Only in extraordinary circumstances you are not covered. This may happen when you are in the private sector and can't afford your premiums anymore. You are only allowed to go back into statutory system when you are completely broke. So especially old people can end up paying high premiums in the private sector when they have a lot of pre-existing conditions and stopped earning as much money as before.

But in the end, when you completely messed your life up, have no money etc. you can always go back in the statutory health system which really covers a lot. When you have to be admitted to a hospital, you pay 10 EUR per day as co-payment but for no more then 30 days. Also the system will cover all these expensive cancer and immunesystem drugs who have been introduced in the past years.

Regarding this new Hepatitis C drug: the insurance will cover it but doctors are reluctant in prescribing it. The system has its ways to force the doctors to use cheaper and older drugs. Doctors have a certain budget per month and if they prescribe too much or too expensive drugs they get into trouble with the insurances companies. They have to really justify what they do and if the insurance company finds a hole in the argumentation the doctor has to pay for the drugs out of his own pocket. Off-Label use is possible but there really needs to be good justification. Of course the doctor can always write a private prescription.

For example short acting Ritalin / Methylphenidate for adults with ADHD is not covered by insurance. Only the long acting versions are. So when you have ADHD, are a student and only short acting Ritalin works for you you can end up paying 150 EUR just for drugs every month. Also there are some ways to make the insurance pay for it but these may take a lot of time, maybe you need so switch doctors or your insurance company.

So the system is not perfect but it seems to be way better then in the U.S.

Right now I pay 150 EUR / month for health care insurance because I am still a student. My co-payment for drugs is around 80 EUR / month. This includes all my RLS and ADHD medication. I get way more out of the system then I am paying monthly.

Hard for me to understand why the U.S. can't have a similar system. There is nothing socialist or communist behind our system. If you want additional benefits or a faster appointment, there are lots of doctors who exclusively treat patients with a private insurance or simply as a private patient.

After all health care is really affordable and the coverage in the private system isn't really better. It often happens that they perform way more procedures on you then necessary, just to have a reason to bill the insurance company.

If I would earn a lot of money I still would stay in the statutory system. After all I am quite happy with what I am getting. Just today I got

30 mg Morphin x 100
60 mg Morphin x 100
8 mg Hydromorphon x 100
400 mg Carbamazepin x 400

for just 37 EUR.

The regular price would be something like 500 EUR ....

ViewsAskew
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Re: How expensive is treatment for RLS in the U.S.?

Postby ViewsAskew » Sat Jul 01, 2017 4:29 am

Culture is so influential on us. I highly recommend the work of Gerte Hofstede - https://geert-hofstede.com/countries.html - about the cultural characteristics of the world's countries. Highest characteristic in the US? Individualism - people are to look after themselves and their family, no one else. That means that I shouldn't help you because you are supposed to do it yourself. The US is a very young country in its current incarnation - unlike Europe or Asia, there are no 1000 year old buildings or signs of the collective history. There is not much experience of coming together for anything. It also is a very large space - US folks do not have to work together or care about each other as those in many other countries might have to. The history, the Bill of Rights, the Constitution, the size of it and other factors have lead to a narrative that most citizens learn as young children - personal responsibility and a limitation of Federal powers. Adding to that, there is a deep and long standing distrust of government with many feeling it is already overreaching, so letting it do more or have more power would be terrible.

Culture makes it very hard for many people in the US to come around to this argument, even if it makes more economical sense.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

badnights
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Re: How expensive is treatment for RLS in the U.S.?

Postby badnights » Sat Jul 01, 2017 10:52 am

Canada has pretty much the same scores as the US on that site. We're also a young country in a big space. But our health care system is very different. There are plenty of factors that contribute to that and other cultural differences, but I can't speak knowledgeably about any of it.

Everyone in Canada can apply for insurance, which is cheap though the actual cost varies by province (it's free where I live). Providers of health care, like doctors, are generally private. They bill the province, never the patient directly, at some set rate that is periodically re-negotiated between doctors associations of some kind and the relevant provincial government.

The insurance covers many things - 100% of doctors visits and I think of hospitalization, limited bits of other stuff (dental, physiotherapy, vision, etc) which varies by province, but unfortunately 0% of prescriptions, except in a hospital setting or - in some provinces - part or all is covered for old folks. Most employers provide insurance that covers 80% of prescriptions. So as long as I keep working til I'm old (er) I'll be fine....
Beth - Wishing you all restful sleep tonight
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ViewsAskew
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Re: How expensive is treatment for RLS in the U.S.?

Postby ViewsAskew » Sat Jul 01, 2017 6:36 pm

Beth - maybe Canada has more of a connection to its parents - France and the UK. I just know that as a US resident, when I talk to people, it is all about personal responsibility. They do NOT want to be responsible for others and they feel strongly that others are deficient if they cannot provide for themselves. I haven't stayed in Canada long enough to have those discussions with others.

Canada's system started in the 40s - and I think that was the time in our history with the best chance of success. It did not happen then and politically, Slowly, but after the 60's/70's, very clearly, we have been moving right since. Policies that a republican would have supported in the 50's though 80's are not even supported by some corporate dems today.

I have always thought that it makes no sense to me that fiscal conservatives and corporatists do not want it. It saves money as well as it helps business to have healthier employees (the cost to companies of uninsured workers is quite high).
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

leggo_my_legs
Posts: 257
Joined: Sun Oct 16, 2016 12:29 am

Re: How expensive is treatment for RLS in the U.S.?

Postby leggo_my_legs » Wed Oct 04, 2017 5:22 am

ViewsAskew wrote:Culture is so influential on us...
Culture makes it very hard for many people in the US to come around to this argument, even if it makes more economical sense.


All well said. Don't forget the billiinaires and propagandists continuing to push the cultural roots now though. Most Americans support healthcare change but big dark money, corruption, and rich special interest groups are interfering with a true democratic process.

sleepdancer2
Posts: 160
Joined: Sun Jun 29, 2014 7:46 am

Re: How expensive is treatment for RLS in the U.S.?

Postby sleepdancer2 » Wed Oct 04, 2017 10:44 am

As an American, it seems to me our views are widely varied and many of our views regarding the role of government fall along a spectrum. I personally came from a background strong on self reliance and responsibilty, but with a heart for sacrificing to help those less fortunate. I really don't think the mindset of "I got mine - you get yours" is in the majority here, but is certainly a sentiment we hear voiced more than I am comfortable with. In my last place of employment with a staff of maybe 50, management had to decide on insurance coverage. They asked the employees for input. The insurances rated a company based on its employees' health history and gave it a relative cost to provide insurance. We could adopt a plan that each employee's contribution was based on their own health status and resultant cost for insurance. Or we could average the cost and everybody take a bit of a higher cost so as not to overburden those already dealing with poor health. To a person, it was decided to share the cost.

The link and discussion about cultural roots is so on point. I do hope our country evolves to a better place regarding health care for all. How that will look, who knows.
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