The epidemic of wealthy psychosis demonstrated by their drug use in graph number three illuminates the mysteries of our current executive administration .
My congratulations and gratitude to the New York Times for it's informational reporting.
-I just thought he was drunk .
Kevin Quealy and Margot Sanger-Katz
The New York Times
New York, NY
Dear Mr. Quealy and Ms. Sanger-Katz
The article on The Prescription Drugs that Rich People Buy in the New York Times on February 7, 2019 did not mentioned here is the difference of medical care between low and high income, and how that drives different outcomes in prescription.
I am still very upset that EpiPens ® are extremely expensive. This is a lifesaving medication for people with severe allergies which could kill them in a matter of minutes if this drug is not administered. The high cost of EpiPens® alone may explain some of the differences in usage. Current guidance is for patients to stock several of the devices, used to treat life-threatening allergic reactions, and replace them often. But their high cost may lead some poorer patients to make do with fewer or older ones, while those with more disposable income might stock extras.
Epi-Pens® can also help to open up air passages and make breathing easier for people with various lung problems such as severe asthma. It also treats severe allergic reactions and certain heart problems. This medicine is sometimes added to certain types of anesthesia to make them last longer.
Sincerely,
Tiffany Gerrity MSN, RN
3
I work for Nutrition Services in a public school district. I have noticed that the affluent children are the children with diet restrictions including the common conditions: celiac, gluten sensitivity, lactose intolerance, nuts/tree nuts. Every year the incidence of diet restrictions increases but it is all the "paid" students.
Is the explanation that the affluent households get diagnosed and the low income families do not (so children are essentially sick at school all day long having a profound impact on their learning) or is it that the affluent children imagine that they have these illnesses or is it that these sensitivities/illnesses are more prevalent in affluent households, or "other" explanation. The concern for me is that it may be lack of diagnosis in our low-income families of extreme need.
4
@Bonnie Christensen
Obviously such things as allergy testing are easier for the wealthy to afford. Doh!
Would have been great to have a few more specifics. For example, were the mental illness medications antidepressants, antipsychotics, or some other therapeutic category?
6
When my child needed counseling I was shocked at how difficult it was to get counseling or care, even with good healthcare insurance Most of the psychiatrists and psychologists had to be paid out of pocket and if you were lucky enough to get some reimbursement, well good for you. What family of moderate or even average means can afford $350 or $175 out of pocket for an appointment with a psychiatrist or psychologist, especially if it is recurring on a weekly or biweekly basis? The only place I could find near me that actually accepted insurance was Stanford, but they had a six month wait. If you can't afford the doctor, you aren't going to get the prescription, no surprise there. I can't imagine the pain of a parent with a severely depressed teen who cannot afford mental health care for a suffering child.
15
I remember my mom postponing doctors visits until we had enough income to be able to pay for the doctors visits and then the medicine required. The medicine would only be purchase if it was chronic enough.
3
Prescriptions and income don't track well overall because higher level of income often means higher level of medical and scientific literacy.
Well educated people, such as doctors, understand that the side-effects of many drugs outweigh the benefits. So many of them take only essential drugs for very serious conditions. (And, no, I do not mean Botox or other image enhancers.)
It is not that wealthier people are more intelligent than poorer folk. But they do often have more education and are more likely to understand medical studies, statistics, and the like. They are less likely to be convinced by pharmacological marketing.
This is why I wish ALL people had access to great educations, staring with pre-school... Knowledge is power.
16
What a surprise, rich people can buy what ever health care they need.
13
Not too long ago, I asked my Doctor what do rich people die of? He kind of looked-off for a moment and said heart disease, cancer, broken-heartedness...(he had recently lost his wife.)
7
Life in the USA is a grind wether rich or poor. For the affluent it is the desire to keep up with the perfect life and having the disposable income to get it. Well, at least try to get it. Earth to Americans your neighbors are not as rich, happy, sexed, etc. as you think. They are broke, and busy doing things that don’t make sense.
I don’t have a Doctor. I may die young but I had a great ride.
5
Anyone really watching all this who still believes in the America of “
amber waves of grain “
and “ purple mountain majesty “ deserves to be fleeced .
5
Upper-middle class professionals working stressful jobs to get that 6 figure salary and send their kids to the right school district are popping Adderrals and anti-depressants (mental health category) at a high rate.
15
Adderall is the drug of 20 years ago...
1
Whatever. You know what was intended.
2
"When people say it's not about the money, it's about the money."
--- H.L. Mencken
When is the last time your doctor looked in your ears and cleaned out the earwax?
When is the last time your doctor poked his finger up your behind to examine your prostate?
Prescription drugs and medical care are about the money, just like
everything else.
13
Even if we had national health insurance, these expensive drugs would not be covered.
2
I work in government and all employees have the same health insurance and are all paid within middle class status. I can tell you that most people are just lazy and do not utilize healthcare and prescription drugs that are relatively inexpensive due to laziness.
I know diabetics that do not take their medication because they believe its a waste until they fall ill with a glucose level of 400. Therefore, trying to blame socioeconomics on the use...or lack of use of drugs is somewhat misleading.
I believe it's intelect not wealth that leads to the proper use of medications in an equal economic environment.
7
Birth control pills are given out free at most clinics and offices as are the other products. Just ask for samples.
2
@Jan: under Obamacare, since 2010 (it went into effect early), all birth control is now free -- every possible method. 100% free. It cannot be cheaper than that!
It was always 100% free to poor women on Medicaid -- totally free. It cannot be cheaper than that.
2
@Concerned Citizen. "Poor women on Medicaid---". Yes. But ONLY if your Medicaid is NOT administered by a CATHOLIC based system such as Fidelis. Before you pick a local Medicaid plan, women should make SURE all possibly needs are covered.
4
It is getting so only the rich can get pain medication like oxy. The rest have to go slumming. Or resort to heroin or morphine on the street.
7
Someone must have studied this, but why do physicians prescribe fewer pain medications for blacks than whites? Do they think blacks don't feel pain as much? Or that they're more inclined to become addicted? Or both? Or is it because blacks ask for pain medication less frequently, out of their own fears, or mistrust of doctors, or because they believe they won't get pain meds even if they ask? Or something else I'm not thinking of?
Do black doctors prescribe fewer pain medications for black patients than for white patients, or is this mainly about white doctors who prescribe for black patients? Do blacks report asking for, but not receiving, pain medication at a greater rate than whites? Do these findings hold when controlling for income level, medical specialty? I have questions ...
14
Poor people in America have totally free Obamacare. Totally free drugs, totally free everything. How much more free do progressives want to make healthcare for the poor? free is free. I realize that facts get in the way when a point is being made about identity politics but honestly this piece is pure baloney.
4
@Asher You are really mistaken about the "free" part of health care for low income people. In my state, North Carolina, where Medicaid has not been expanded, poor people don't qualify for Medicaid unless they extremely low income (well under poverty level) and have minor children or they are disabled under social security's strict rules. They don't have free health care. That may what you're hearing on conservative media, but it's not accurate. It would be a good idea for you to examine the facts. You would find that this is much more nuanced. Even Medicaid usually requires copays, some states require premiums. Community Health Centers operate on sliding scale basis. They don't have free drugs.
32
@Asher
Please define poor? Working poor? No income poor? 150 percent or 250% of poverty poor?
Please understand not every poor person receives free everything including prescription drugs. If you cannot afford the co-pay, no pharmacy will say oh? Are you poor ?Its free. From outside of the bubble.
3
"But longtime holes in the health care system mean that richer patients are more likely to have private insurance or extra money to pay for psychiatric care that is not covered by insurance."
I suffered from severe emotional and mental abuse from my mother and learned this through the therapy that I received TWICE a week for five years when I was in my 50's. I was treated by a nun who had a clinical degree and charged me $15 a session but upped it to $25 when I got a pay raise from my job as an elementary music teacher who was also a single parent. The going rate at that time was $150 a session. I didn't have insurance to pay and certainly couldn't have afforded more.
I do not know what would have happened to me if I hadn't received this help.
I had experienced strong unalleviated situational depression for 10 years and had reached the point where I COULDN'T stand it any more. Fortunately, at that point I received help.
It is an extreme malfunction of the health services/private insurance companies in this country to not recognize the necessity of providing psychiatric care for as long as is needed for a rate that people can afford. If it is needed and used by the wealthy it certainly is essential for the middle class and the poor whose lives are probably, in many cases, more stressful.
21
All of the figures are misleading because they need to start at zero to accurately reflect the size of the relationship. This is not a matter of journalistic or stylistic choice.
3
I wonder if the higher number of HIV related prescriptions in poor neighborhoods is a function of local efforts to reduce transmission by making them available for prophylactic use. Lower income uninsured and/or Medicaid recipients might qualify for such meds at no cost that the middle classes would otherwise pay for.
It also seems like psychiatric medication, and mental health treatment, should be at least as ubiquitous as antibiotics - especially among low income persons. Mental illness can have a negative impact on the ability of sufferers to enjoy gainful employment.
3
@Gary F.S.
My thoughts exactly! Government doesn't want HIV/HepC to spread in the population so it is freely available but the other drugs (from antibiotics to Ambien) aren't used because they are unaffordable by many people in the lower income percentiles. It says nothing about the base causes or needs for these prescriptions.
4
A few caveats.
Many people get their prescription drugs by mail especially for chronic or long-term conditions. How does mail prescriptions vary with income? This service requires an online account with the health provider, which means access to a computer and internet. Are clinics less able or likely to offer this service in low-income neighborhoods?
Many, especially younger women, are encouraged to obtain long-term birth control that doesn't require a prescription. Do clinics in low-income neighborhoods (especially free clinics such as PP) promote long-term birth control as it's more reliable and doesn't require the woman to remember to take a pill or have money to buy pills?
These two factors would skew the data quite a bit. PP might keep statistics on the type of birth control used by demographic. Clinics may keep statistics on long-term birth control. Health providers and insurance companies may track prescriptions by mail vs those picked up at a pharmacy. Note that controlled substances, often associated with pain, behavioral, or psychiatric conditions, have to be picked up in person.
3
@Anne
Re: mail prescriptions. I have all my on-going prescriptions sent by mail, as this is the way our insurance has requested it be done. While I have used the website of the mail order company, I generally refill using the phone. Mail order does require a fixed address, which may indicate a certain level of wealth. Also, since many employer's insurance requires mail order, this indicates a job and benefits and, again, possibly a certain level of income.
Also, is Planned Parenthood free? I used them in college for exams and birth control. They were not free, but were very affordable compared to the doctors at the local medical center.
3
Many excellent comments. Thanks all.
I’d suggest that the physician visit rate varies by income due to shadow out-of-pocket costs. Lower income folks more often get paid hourly, higher income get salaries. This increases the doctor visit cost to include a couple hours of lost income leading to lower income folks having fewer doctor visits / capita / year.
Fewer physicians visits = less opportunity to discuss medical complaints and get prescriptions.
Plus, of course, the deductible shadow cost is higher for lower income folks due to their lower levels of discretionary income.
5
I think two complementary arguments to this discussion are:
1) Some of the same factors contributing to the disproportionately low rates of birth control purchases by lower income individuals would probably also contribute to the increased rates of infant mortality and maternal death rates among the poor.
2) As the article explains: "... for some types of medications, income is a pretty strong predictor of how often someone is picking up a drug to treat an ailment." And, for many of these medications, where [Prescription Fills = f(Income)], to argue that these prescription purchases are discretionary purchases that a consumer can prioritize, budget for, and if necessary, simply skip, is just plain in error. The more medical purchases labelled discretionary overall, one argument goes, simply means that higher deductibles and skimpier medical insurance coverage should apply to lower income individuals, because they should be able to budget for and plan ahead for such expenditures., no matter how large. It is as if most medical purchases by the poor are discretionary and focused on "lifestyle drugs" as significant health care options.
[JJL 02/08/2019 F 12:23pm Greenville NC]
2
@John Joseph Laffiteau MS in Econ
You do realize that there are 3- and 4-bedroom apartments available in housing projects? The more babies you have, the more money you get, and the bigger the apartment.
A stereotype, admittedly, but certainly a reality. I understand that lower-income girls are beginning to use birth control in order to avoid the fates of their mothers and grandmothers, who took the ridiculous 1980s idea that birth control=genocide to heart and produced generations of those who couldn't compete either in school or in the job market, and who dragged down everyone around them.
It was noted in error that prescriptions for Botox are “picked up”. Botox is injected in a clinic; it isn’t filled as a prescription.
11
Very interesting! It seems that prescriptions medications are just like Gucci and Dolce Gabbana bags. You buy them because you can. They pamper rich people's ego, usually without any real additional benefit over generics.
Physicians that do not consider cost are un willful accomplices of big pharma. A good example is acne treatment. Acne treatment requires long term use of topical medications. Studies show that 50% of people that receive Dermatologists prescription for their acne, cannot afford to buy them. One way to provide better more affordable healthcare is to democratize healthcare with direct to consumer, AI-based physician-free treatment services such as MDacne for acne as Nurx for birth control. With this type of services, healthcare spends would be significantly reduced providing better and more affordable medical services, irrespective of personal wealth.
7
I used to hand out samples to mostly poor patients in my clinic. And many clinics in low-income have associated pharmacies that have subsidized county or state programs. State-covered family planning programs. And then there is Kaiser! They don’t use Good Rx. There is a missing data problem with the lowest percentiles which likely explains the steep slope in that range.
14
Studies of this type often miss that richer neighborhoods tend to skew older—it takes time for most people to accumulate wealth or move up the income ladder.
So certain types of prescriptions should correlate at least slightly with income, as it picks up the age effect.
And, of course, some afflictions tend to skew poor, not because poverty is a cause but because the disease or affliction often leads to poverty (some forms of neurological disorders, for instance). Causality goes both ways with poverty.
But the notion that income and wealth buy more inclusive medical treatment generally, and particularly for discretionary therapies (e.g. baldness treatment), isn’t surprising.
16
Is there any data on a possible correlation between wealth and use of mail order pharmacies? If so, the methodology would be vitiated.
10
So this comes as a surprise that rich people have fewer illnesses? If one had access to healthier foods, a peaceful safe environment, and good preventive care sure we'd all be less sick. Wait! That sounds like good health care for all would save money! Don't tell Congress or the President they might get the idea.
65
@Honeybee "If a person has access to unhealthy foods, they have access to healthier choices. " Uh... no. Have you heard of "food deserts"? I live in one, although I'm fortunate enough to have ready transportation to travel to better neighborhoods with supermarkets. My poorer neighbors rely on convenience stores that carry 72 varieties of pork rinds, sports drinks, beer, alcohol, candy, snacks, some canned and frozen foods and virtually no milk or bread and literally no fresh produce.
24
@Honeybee You are revealing significant ignorance about "the poor." There is such a thing as food deserts, also, fresh food is more expensive than unhealthy food. And while working multiple jobs, it's hard to do long term planning, etc...
9
@Honeybee
I doubt you have been to grocery stores in very low income neighborhoods. I have and the quality of the fruits and vegetables is decidedly lower. The produce is often wilted and bruised and would have been long removed from the cases in well-off neighborhoods.
Whose "right" is it to eat just shy of spoiled produce?
And of course, the healthier organic produce is never available, because we all know that it is priced too high for most people let alone low income folks.
FYI - Your statement that it is impossible to prevent cancer and heart disease with healthy nutrition flies in the face of both common sense and modern medical scientific studies And you are a teacher?
1
I'm still looking for the list of specific drugs, instead of graphs of drug classes. I didn't find it. Not very illuminating.
30
@Delawarian You can find the list of drugs via the link to GoodRx; the full list and methodology is in the full white paper (downloadable PDF).
1
Good God. Another rich-person article telling what isn't news to anyone who has ever given the matter a moment's thought.
Yes, rich women use Botox.
They also are treated for cancer, Parkinson's, and other diseases that afflict all of us.
Stop dehumanizing people who have a modicum of money earned or inherited, and saved. And not everyone on the UES is wealthy.
23
Only the poor are ‘insane.’ The rich who display similar behaviors are merely ‘eccentric.’
95
@chambolle
Absolutely. Simply monitor "Twitter" or the last two "State of the Union Address".
15
@chambolle this comment trivializes mental illness by reducing it to euphemism. My family has plenty of money and I do not consider my suicidal depressions over the last few years to be "eccentric."
This is a fairly interesting story attempting to interpret data in a study. The graphics, however, are misleading because the charts have such different scales along the y axis. It's simply not possible to compare the charts at a glance. I'd like to see a compound graphs with multiple results on the same graph for purposes of comparison. Or a matrix that shows all the graphs at the same scale so I could visually compare the relative usage of different types of prescriptions. Thanks! (Sorry to duplicate if others have made this comment; I do not have the time to review all the comments.)
9
Having a Primary Care Physician and receiving a yearly physical is premised on having a job with health insurance (or being retired or poor). As long as we insist that most Americans have to get their healthcare from their employer, we will continue to have people that fall off of health care. And don't receive the prescrptions that clearly wealthier people are receiving.
Citizen = Healthcare
Not
Company = Healthcare
47
@JK. Being stuck in a job that's sucking the very life out of you because you are beholden to them for access to healthcare is just another form of slavery. Much of this country was built off the backs of slaves and indentured servants and we still hang onto that mentality. In comparison to the other industrialized nations we are the slow kid in the class in terms of quality of everyday life for all citizens.
6
I have eczema, and the most effective drug for years was Elidel, but not covered by my insurance. So I would pay the $85-$200 per tube, and make it last. A few years before her death, my then 85 year old mother developed extremely thinning skin, and began with a constant itching. Again her doctor proscribed Elidel and the cost was $277 a tube. I skrimped and put together the $$ for the cream so that she could have a few hours respite from the constant itching. I am glad there are other drugs out there, but the cost just seems cruel considering that eczema is the worst for the youngest and oldest of us all...
55
I would like to ask this article’s writer why every graph shows that the use of each drug takes a sharp U-turn at the 90th percentile of income. This is true whether the use of the drug overall shows an increase or decrease in relation to income. Can you explain this please?
9
@Kathy
This data comes from those who use goodRx or another form of insurance...perhaps the top 10% just pay out of pocket to avoid detection.
10
@Kathy The other anomaly is the smooth curve to zero or from a high point to lower in all 0 to 25th percentile. The data has shape in the other percentiles, until that last U turn. Seems like artifact of some sort at both ends.
1
I'm from the UK so the cost of prescriptions isn't an issue but I wouldn't be surprised if the link between wealth and drugs for serious mental illness held here too. It takes a remarkable amount of effort and organisation to stay on a psychiatrist's list, call for help when you're ill, go to appointments, get side effects dealt with, monitor your medication and actually do something about getting more when they run out. It's much easier just to stop taking them when life gets chaotic and then not start again. People with more money tend to have better support, more stable environments and fewer crises, so a better chance to keep to a long term drug regime.
69
@LH this is so true, and makes my heart ache for those who do not have the support
11
This, and insured people treat their mental health issues with doctors and prescription drugs, whereas poorer or uninsured people self-medicate with alcohol, marijuana and street drugs. For just the reasons you cite. It’s easier, and cheaper.
11
@Kay
And doesn't involve potentially shaming and traumatizing encounters with clueless healthcare providers.
5
From the link to GoodRx:
"We defined mental health medications as prescription drugs typically used to treat ADHD, alcohol addiction, anxiety, bipolar disorder, depression, eating disorders, fatigue, obsessive-compulsive disorder, and panic disorder."
Doesn't this list help explain why these drugs are prescribed more in higher income areas?
9
@Jim No, I don't see how this list of drugs explains why they are prescribed more in higher income areas. It's just a list of drugs.
9
Loads of psychiatrists don’t accept insurance- its a bother. They take cash, so treat people people with lots of cash.
3
@Jim - yes, it absolutely does. We know that some of these cover drugs that are considered lifestyle drugs and others address incontrovertibly serious conditions. Why is schizophrenia not on that list? And how is “fatigue” a mental health condition?
There are many good comments on this thread pointing out how flawed this data is in terms of being the basis for the NYT’s broad conclusions. I really don’t understand why they have allowed the quality of the publication to deteriorate so dramatically. I wrote an author a year or so ago to point out that they had made a false statement regarding a women’s health issue in an article. The male author wrote back to tell me he knew what he wrote was inaccurate but that they decided that it was better for people to believe it was true because it supported what he felt was a public health goal. It was incredibly bizarre and obviously, not journalism.
Why is this "surprising"?. People with more money can afford the medication they need. This is a byproduct of our lousy medical and drug system.
55
Running is my drug... and I it has been available to me whether I was rich or poor, it has kept my vitals and mental health in check and outside of shoes and some clothing it is free. Yes I have to figure out the time to fit it into my schedule but it is the perfect free drug.
18
@Amy
Running is much easier to do for people in higher income brackets. Neighborhoods are safer for pedestrians, more sidewalks, parks, lighting etc. And then there is the clothes, and running shoes that help prevent injuries etc.
53
@Amanda Guyler I live in a rural area and run on county roads. I miss the well maintained paths of Minneapolis where I grew up but make due with the area I live in and running shoes are cheaper than prescriptions. I will concede right now I have a flexible schedule but I have been running since the age of 22 and I am now 46.. it is not about income and by the way I am a democrat.
6
Thanks for your insight, your insight however shows you live in a neighborhood and in a climate that allow for safe running.
Try running in Atlanta. The fewer pubic pedestrian paths they build, the happier some certain Atlantans seem to be. Just to rule out those people who don’t have cars! Just to rule out those people who don’t live in gated communities!
Try to do this anytime between March to October. I will try to stop for you when I see heat has taken over you...
10
How many of us are happier with the care we get now over what we received in the '70s, regardless of what we pay?
I have been paying for medical services for a number of almost exotic complaints since the 70's. When I started, everything except hospitalization was out of pocket. When my insurance started covering drugs and physician costs, the price increases did not affect me— my employer paid the insurance companies to skim off the top of everything, much like organized crime does to garbage collection in New York. If it were up to me I would get insurance out of pharmaceuticals and physician visists and let the market control it. It is obscene to pay for insurance where the company's executives get millions every year to so nothing but make me waste my time on the phone and argue with them while they skim 35% of my medical expenses.
31
@Stuart Wilder. You are quite right. Since health insurance has started covering everything the cost of just seeing a doctor has skyrocketed. Doctors have much higher overhead now trying to keep up with the myriad insurance policies and waiting to get paid. Medicare has administrative costs around 3% and people who say Medicare for all would bankrupt the country are either ignorant or lying.
1
@Stuart Wilder
Well, for heaven's sake, in the 70s I was young and hardly ever went to a doctor. I probably had health insurance via college but didn't use it, and when I began working I had health insurance but probably didn't use it. Blue Cross-Blue Shield, I'm sure, but was it worth filling out the paperwork when I hardly went to a doctor and never went beyond the deductible?
It's apples and oranges.
That's why people are so stupid about "Obamacare" (which, admittedly, has its faults).
Those young people who don't want to pay for their elders' Medicare anymore aren't looking ahead to when they'll need it.
1
My first reaction to this story was, "duh"! I am always amazed at the disconnect from the reality displayed by individuals (icluding researchers) with good health insurance. I have a chronic condition that requires regular medication. My co-pay is $30 per month but the receipt tells me that my insurance saved me $1,269.00. That is per month. Absent an excellent health insurance policy, I could never afford that medication. The same medication is available for purchase as a generic in Canada for $200 per month. In the U.S. it is only available as a name brand drug. Everyone deserves good health insurance and Big Pharma should not be allowed to fleece the public for the sake of the rich executives (a.k.a. pirates) that operate them.
123
@M.Downey
It has always amazed (stunned, actually) me that a Congress that has excellent health insurance refuses to extend the same to the population that supports that same coverage.
21
@M.Downey
Good news! DJT has repeatedly said that CDN medicine has been subsidized by USA taxpayers, and it is time for CDN to pay its fair share, and USA less.
MAGA that, Canada!
3
@Bang Ding Ow "DJT" lies.
5
There are plenty of data showing that being raised in a highly sterile environment predisposes to allergy, whereas being raised on, for example, a farm is associated with a low incidence of allergy.
So maybe the increased use of EpiPens among the wealthy is also due to rich kids being raised in environments that are thoroughly sterilized by hovering parents? Or being raised in urban/suburban environments with reduced childhood exposure to allergens?
7
@John People with asthma also use EpiPens, and poor people, especially children, and especially minorities, are many times more likely to have asthma than higher-income people. The are more likely to live in environments that are bad for asthma. Inadequate and inefficient heating, cooling, and ventilation in homes, schools, and work places, are culprits in frequency of asthma attacks. Low income people have to contend with this much more than higher income people.....yet they can buy fewer EpiPens.
9
I hate reading generalizations like this. I ate peanut butter all through my uneventful pregnancy, had a clean house, but avoided chemical cleaners and antibacterial soaps. I breastfed and delayed vaccinations. We had cats and a dog and spent time outside in our garden. And at 1.5 years my son displayed an anaphylactic response to peanut butter. Second son, same household, no allergies at all. Luck of the draw is all.
8
Very bad for asthma: industrial northwest Indiana, some south side Chicago neighborhoods, other coal plant/coal firing areas, petroleum refineries, giant piles of coke( the black powder) steel plants, etc. Tends to be very low income people who live beside industrial polluters.
4
Why do the very rich buy less prescription drugs? If I had the time and the means to always get freshly made balanced meals with organic ingredients, a personal trainer to design a program to keep me in shape considering my personal limitations and needs (and the time to do that daily), if I could take a week off when I'm very stressed, and all kinds of special treatments and supplements as needed. If I could get all kinds of tests that are not covered by the average insurance, so any problem would be identified early, and not wait for years to get the right diagnosis when you have something out of the ordinary, I'm sure I would need less prescription drugs too. And I cannot complain, after all, I have a decent insurance from my employer and a comfortable economic situation, but my family depends on me for health insurance.
I cannot imagine what people without insurance or a decent salary are going through.
87
@MR
I think you're talking about the ultra-wealthy here and not people with higher incomes?
I'm in the top percent of income and I don't have anyone feeding me freshly made balanced meals and I sure can't take a week off just because I'm feeling stressed.
And I'm self-employed, so I'm on Obamacare--so my insurance is almost certainly far worse than yours.
16
@MR The article states that higher income people buy MORE prescription drugs than low-income people.
3
No, they buy more lifestyle drugs (think Viagra and Prozac) but less overall. Health vs wealth is a well-discussed chicken and egg problem. Does wealth lead to health? Better access to treatment, better food, less stress, etc. Or does health lead to wealth? Ability to learn and work. It probably runs both ways.
6
This is no mystery for any practicing physician, particularly in family medicine. People who aren’t able to secure time from work to see a doctor, afford good insurance, live in areas that make it difficult to access quality clinics or hospitals, or tend to be disorganized or lack structure in their lives are most commonly the ones with the poorest health. Income is a solid correlate, but it’s not an explanatory variable. There are a lot of other predictive correlates based on income, such as access to quality education, involvement with crime, access to nutritious food, and on and on. The lower income bracket will require a disproportionate amount of government aid and oversight. I think if we move towards a universal Medicare system offload the healthcare costs from business and align it with income and sales taxes, then businesses would be more willing to allow their workers to get treatment. And I think if we can make it easier for people to be healthier, a lot of other issues that negatively affect overall worker productivity will be removed from the equation. We also need to further expand on technologies that allow easier access to medicine, such a telemedicine, more rural clinics and hospitals, universal electronic medical records, producing more nurses and doctors, and artificial intelligence to assist nurses and doctors would make a huge difference in our overall quality of life. We need a “Manhattan Project” effort towards healthcare. It’s insane that we don’t.
137
@AG Uhhhh... No we don't need a "Manhattan Project".. We need a "you need to take care of yourself and quit depending on Uncle Sam to take care of you".
11
@Ruben Sounds great, but all that money I paid in as a journeyman lineman and now that I am disabled and need help I have been strung along by the state for almost a year with no care or help. I worked storms all over the us since 2002 helping to restore power and I get diagnosed with chronic pancreatitis in 2017. They had me jump through hoops until my savings and healthcare expired and I am loosing everything I have with no healthcare or help.
17
@Ruben
How did my 29 year old granddaughter who has psoriatic arthritis and needs very expensive injections in order to be able to walk (and work) not “take care of herself”? Note: She never did drugs, or anything irresponsible. S--t happens Ruben.
How is paying taxes for a single payer system (such as Medicare) “depending on Uncle Sam to take care of you”? I would call it me and others continuing to pay our share so that she gets those injections even when she is working in a gig economy that doesn’t always include insurance.
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Those with mental health issues are discriminated against. Many insurers place limits on the number of therapy sessions a person may attend a year or lifetime, as if this were negligible care. It's not. Talk therapy can be the treatment between life and death. In terms of anti-depressants. one either needs to have a general practitioner or a psychiatrist's prescription, and some physicians require monthly visits. For those with high deductibles or low income, access to live-saving anti-depressants can be beyond reach.
It really is time for insurers, and society, to stop taking advantage of the stigma for mental illness. Mental illness does not denote a character flaw, and psychotropic medication shouldn't be any more difficult to obtain than any other medications
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@Regina Valdez one of the reasons health insurers limit mental health care is poor results. When mental health can start delivering on its promises people will demand such care and the health insurance markets will be forced to respond. Until then mental health care will have exhibit significantly greater investment returns.
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@Mark Singleton
I'd bet Mark Singleton works in the health insurance industry...this is exactly the kind of argument that they use to justify not paying for service. It's the MBA mentality applied to health care. That's capitalism.
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@Mark Singleton
Continuing my prior comment. This is a typical line of the insurance industry. They already have their goal in line - not to pay - so then they look for reasons to do so. They have already made the decision based on economics and are looking to justify it.
Although Mark Singleton makes it sound like the industry doesn't pay because outcomes are poor, it's the converse statement that is more true.
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Income is a factor in the purchase of just about everything. Unfortunately it also is a factor, in a negative way, in the percentage of out-of-wedlock births, which is a major factor in generating and perpetuating poverty. Prevention and discouragement of such practice via the work of Planned Parenthood clinics could be a great help. Religious fanatics will disagree.
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I meant to say "income"...not age, accounted for less than 10% of the variance in my comment. (Age also accounted for less than 10% of variance.)
1
I don’t think low income women realize that with effort they can change the course of their lifes or just how much family planning could change their lives/how much having children costs. I think the message society sends is birth control is against god, you’re stuck being poor, so having children just makes them marginally more stuck. Sex ed is focused on health and birth control, we need to teach parenting and budgeting. Getting treated for something before it mushrooms into a problem is another issue. People with money understand and can afford proper preventive maintenance. These LIFE skills are NOT in our WORKforce readiness curriculums-why not?
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@Sw, YES! But men need this education as well. And we stronger laws re child support by all fathers, not just divorced, current or long tern partners, but also one night stands. Children born of short term relations cost as much to raise as those of long term relationships.
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@Sw
"Sex ed is focused on health and birth control". Lucky you, in my state there are just "abstinence only" programs. My daughter is about to graduate high school and she only has heard about condoms from us.
Also, in addition to lack of education, there are also psychological factors that lead teenage girls to get pregnant and/or keep the baby. Disenfranchised individuals that suffer discrimination, poverty and/or don't have a stable home are more likely to become parents.
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I am a senior with Medicare who pays out of pocket from a savings account because I cannot live in dry, warm shelter and eat and afford insurance company charges for supplemental insurance.
Doctors, hospitals and Big Pharma are not interested in good care for senior Americans unless they are rich - they all join insurance companies in their only interest: the bottom line of $$$ profits- not patients!
Why should any of us trust the care we get when that care is based on money?
My local hospital sends forms to fill out to give them power of attorney (regular POA, not healthcarePOA) for any future hospitalizations even tho I pay my bills in full as soon as I receive them! Why would anyone give a hospital power of attorney of any kind!?
Health care is a basic human need - not a commodity! Why should the rich be the only ones who "deserve" it? Money. It does not take a study to prove this - talk to your grandparents - unless they are rich!
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@SouthernLiberal -
"My local hospital sends forms to fill out to give them power of attorney (regular POA, not healthcarePOA) for any future hospitalizations even tho I pay my bills in full as soon as I receive them!"
This is outrageous. If you can do so without endangering your privacy, consider sharing with the New York Times the name of the hospital and what they asked of you. They should be shamed into abandoning trying to get patients to give them POA's.
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@SouthernLiberal
Well, yes, the costs of illegal drug abuse are roughly 50% of the PPACA. Why doesn't Bernie Sanders, say something about that, about funds that could help you?
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@SouthernLiberal "Regular POA..." My jaw dropped. That cuts to the chase that American sickcare wants to take away our assets first and foremost.
4
Does this prove anything other than the rich have more money to spend?
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@David
Yes, it provides evidence --if you haven't been to Walmart lately--that low income people of all ages and ethnicities suffer from morbid obesity that will greatly undermine their happiness and greatly increase US health care costs. How to educate the poor to care about what they eat, how much they exercise? We are losing this battle. And young people are increasingly affected by diabetes, colon and pancreatic cancer. We have to reach young people, and their obese parents, interrupt this vicious cycle.
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@David absolutely not. It’s a correlation, not an explanation... but it serves as something interesting to raise awareness on an important issue.
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Ms Sanger-Katz keeps dancing around the real issue: that Americans should have national health insurance as a right, that it shouldn't matter at all what income one's family receives when it comes to mental health or physical health, or what medicines one can afford or not.
It appears to be the one issue that The Upshot writers refuse to take up: national health care for all.
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@Sean
Why would the USA repeat the medical-care failures of countries like the UK and its NHS?
https://www.nytimes.com/2018/01/03/world/europe/uk-national-health-service.html
Anyone who wants to repeat NHS failures, go ahead. Others refuse to accept incompetence, waste, and long lines.
1
Of what earthly value was this study?
Who asked for it? Who paid for it?
Why????
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@Mimi Did you read the article?
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@Jim Bach
I did. It was a waste of my time. There was no point at all to the study or the article.
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It would be interesting to do this analysis for OxyContin.
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Clearly there is health inequalities. Anyone with more than $1M should be inoculated with HIV and billionaires should be given cancer. That will equal things up.
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@JoeGiul the relationship between $1,000,000 and $1,000,000,000 is the same as the relationship between $1,000 and $1,000,000
Don't confuse millionaires with billionaires
2
Who was it that said "Your money or your life" ?
The vulture capitalist, naturally.
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@Getreal
Ha! A book of that title written by J. Dominguez and V. Robin. It's a guide to help you establish a balance between your time living as you please and your time working for money, relying heavily on the application of thrift and modest investing at an early age.
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@Matt
Actually, without NIH, CDC, FDA, and numerous research institutions, these drugs never would have been created.
It's just the evil capitalists that exploit the system which is there for the greater good of all.
5
And you thought Good RX was a real benefit! Now at least you know they are tracking you, and your prescription purchases! I knew that commercial with their leader Hirsch claiming they don't need any personal information is and was hiding something! Buyer beware!!!
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So much for medical privacy. If someone pays cash, how are they even included in a demographic? We live in Big Brother times.
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@Andy
I think they simply mean that the record shows that the transaction was “cash” not “card”. How is that ominous?
This is a useful article. But I think there is little justification for starting the y axis at a number other than zero. The trends would still be easily discernible if the y axis started at zero, but the effects would not be exaggerated.
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@Michael
You have a point, though starting the y-axis at 0 would compress the details of the yearly variations considerably. I am having a hard time understanding what the "fills per 100k residents means. For example, does 1,000 fills of antibiotics per 100k residents mean that 1% of people get a single prescription filled in a year? Does 360 fills per 100k residents of birth control mean that 0.7% of women (assuming females are half the population) are using birth control. These numbers seem low.
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@David
1,000 fills of antibiotics per 100k residents
could be 1000 individuals filling 1 prescription each, 1 person filling 1000 prescriptions, or anywhere in between.
1
I conduct market research and analytics in the prescription insurance space. GoodRx, like other discount card services, get their transaction data through one of the PBMs (think CVS Caremark, Express Scripts, etc.)...i think it's Medimpact in the case of GoodRx. Cash cards are used by people who otherwise don't have prescription drug insurance, or for those who do have drug insurance but where the copayment might be even less through a cash card. So one of the challenges with this analysis is that it's focused only on that population of people who use the GoodRx discount card service, and thus it's difficult to generalize to the overall population. The other reason people use these cards is when they are purchasing drugs with some stigma associated with them, which they don't want showing up in their employer-provided insurance data, so they purchase with a discount card instead. Some of the conditions cited in the article fit the bill in that sense. In some analyses I've done using a broader data set, age only explained a modest amount of variation in prescription drug expenditures and the presence of conditions (<10%), although that was among people who were all using prescription drugs of some stripe, so the relationship might be stronger if the most healthy people not using drugs were added into the analysis.
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Thomas Goetz, from GoodRx research team here. To clarify, this data is NOT just from GoodRx users. This analysis is based on a large sample of claims (from many sources) from insured population, so it is representative of overall US fills. I hope that helps clarify.
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As someone who works in the personal privacy/data privacy industry, I'm very curious how these data sets were acquired: what personal data was used; how was it acquired; what permissions were given; critically, how was it anonymized if at all; how was data & source info stored, protected and, again critically, how was it destroyed.
These are all very important questions; I'm not saying this study misused data, but am certainly questioning how they conducted the entire data collection process. There is a definite "high-handedness" surrounding the often almost criminal use, and certainly unethical use, of personal data. And it's getting worse - consumers are careless or uninformed, & data brokers are for the most part completely without restraint...which borders on criminal, and should be.
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Thomas Goetz from GoodRx research team here. I want to clarify what data was used in this analysis. We used an aggregated and de-identified sample of overall US pharmacy claims; no personal data was used. The income status is inferred from US census data, based on which pharmacy a prescription was filled at. In other words, we assume that people live near the pharmacy they use, and we then applied US Census income status. We take data privacy very seriously.
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@Thomas Goetz
"We take data privacy very seriously"
Does anyone actually believe that??
The moral of this story - GoodRx is yet another company turning people's spending habits into data to make a profit-
So stay away from GoodRx!!!
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@Thomas Goetz
"We take data privacy very seriously"
GoodRx - yet another company collecting data on us and seeking to turn a profit on it.
Avoid GoodRx!!
1
The data could be analyzed and fit by using a 3-parameter (wealth, culture, & race) linear analysis to determine the percentage of each contribution. But just based on the graphs, I would say the wealth alone is the dominant factor. Another reason is that money doesn't see the boundaries between different races or different culture. For that matter, money flows through the national borders. My guess is that similar pattern should exist in many other developed countries.
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The more interesting analysis would be to compare these results with data from civilized countries where access to health care is not so dependent on your income.
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@Pat I’m every step of the process there’s so much bias in who is believed, diagnosed, and treated. I wonder how much the data changes when cost isn’t a factor.
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@Megan cost is always a factor. Utopia may not have economics but the real world will always be faced with accountability.
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@Pat
Well, yes, NHS is a financial mess, and if you have cancer in the UK, you hope to fly to the USA --
https://www.nytimes.com/2018/01/03/world/europe/uk-national-health-service.html
And you do realize that Japan is 99% Japanese, and Germany is 87% white?
They are nothing like the USA. It would be like company a Porsche to triple-trailer/semi-truck. Obtuse, disjointed, and easily-skewed for bias.
1
One thing not mentioned here is the difference of medical care between low and high income, and how that drives different outcomes in prescription. Go to a waiting room for low income patients: the patients wait a long time in dingy, basement type places, and are ushered in among a busy line of patients. I have this image in my mind of a psychiatrist whose office played some sort of musical chairs. First you waited on a chair in the waiting room, then you were moved to a chair in the hallway, then a chair closer to the door, then you finally got to go inside and wait for the doctor.
Then the doctor doesn't have much time to understand the situation or get you to say what you are really for. It takes a lot of confidence to ask for specific medications to treat embarrassing issues. If you can't relax, you probably won't have that talk describing your needs.
It must be so much more so when it comes to more difficult-to-get medications, ie controlled substances. I always ask myself: what happens when laws put limits on these substances? The wealthy have doctors who continue to write prescriptions while the poor are told by nervous doctors that they can't prescribe any more.
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