One of the selling points to us hopeful 2008 dupes was that that the ACA (now better known as A Crappy Arrangement) would increase the number of people covered. This indeed happened. But BooHoO signed away the power which he briefly held, to regulate insurance companies in the most effective manner (Public option) in order to appease the Dreaded Republicans (DRs), who at that time were the minority party in both Chambers. I don't believe he ever intended to effectively block Insurance Companies at all. How many DRs supported A Crappy Arrangement despite his abject surrender? Naught, nill, nada, zilch, Bubkis and also none.

But what about the other head of the Medical Care Monster (of course I am simplifying this greatly)? Swallow hard--yes, Big Pharma! In the same spirit of "rolling over" (or, more truthfully, selling out), BooHoO did not allow the ACA to bargain with big Pharma.

Now with millions of metabolisms (as one might suspect patients are regarded by the mucky-mucks in Big Pharma) in their private feeding grounds, the Drug Sharks have been placed in the enviable position to "thin the herd" while siphoning off monetary reward. (I won't mention sustainability issues with approach). Of course the first of the herd to be finished off are the poor, but WTF did Pharma need them for?

I wish to point out two, of the very numerous, examples of this heartless price gouging.

1. A cure--not just palliation, for Hepatitis C, an otherwise incurable, usually disabling and often fatal disorder by raising the price beyond the reach of any but the 1%. So let the sick suckers mortgage their homes, declare bankruptcy, in order to spit up enough money to pay for the overpriced biological with life-saving potency.

2. The most recent such rip-off about which I read would make Martin Shkreli proud. Due to this country's maladaptive "War on Drugs", which has seen an actual increase in illicit drug usage, an epic number of people have become opioid-addicted. The number is huge and progressively climbing. In fact a large part of this upsurge is iatrogenic--i.e., caused by physicians, some of whom prescribe opiates first and try to diagnose the problem later. Sadly, many MDs don't even attempt the diagnosis phase, they just prescribe more or different opiates. When you think of a "druggie", think not just about heroin junkies but also those coming by their addiction through legal channels. When pain, depression, and/or desperation become too intense, the sufferer (and, yes, they are sufferers) makes a desperate attempt for temporary relief--culminating in an epidemic of lethal overdoses. There is a drug which works 100% of the time, if given soon enough in adequate doses, in reversing opiate overdose. That drug is Naloxone

The quintessential fact here is that Big Pharma, knowing it has a captive audience, feels neither remorse nor restraint in jacking up drug prices, such as those for Naloxone as high as they think the market will bear.

Briefly there are several outcomes of this Greed-inspired pharmaceutical practice:
A: The predominant costs are initially borne by the ambulance and/or hospital caring for this OD'd patient.
B: Small ambulance companies often cannot afford stocking a drug, no matter how important, putting great strain on their ability to pay.
C: The smaller, mostly rural hospitals in the catchment areas for these ODs, will have to restrict the amount of Naloxone they can afford to stock. Therefor, regardless of patient insurance status, there may be insufficient inventory to satisfy demand.
D: The overwhelming proportion of victims are poor, thus many are at risk for inadequate or no treatment--goodbye to the lower class--just another sign of success in our War on Drugs.
E: Hospital reimbursement is below procurement costs in many instances. Thus who pays for the shortfall? Take a guess--the 99% do. This happens in several ways. Hospitals try to pass along the burden of underimbursement to those with insurance--but such pass-through has its limits, especially in these days of declining insurance coverage. The other main method, perfected by the Walton family, is public support, e.g., Medi-caid or Medicare funding or by emergency block grants. And We the People get saddled with higher taxes to support this corrupt, amoral pricing scheme.

I wrote a diary on GOS, before the Ides of March decree, concerning how Medicare-for-all will not fix many--perhaps not even most problems with our broken medical system. For those willing to journey back to the GOS, you might find my diary interesting. And, for those intrepid enough to undertake such a journey, you have my full permission to cross-post it here. I refuse to go back and do it.