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PaperclipPerfector  3d ago (text post)   2248 thread views

Small-Scale Question Sunday for January 5, 2025

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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I do not use a healthshare plan, but it remains a possibility for the future. I have many friends who do.

  • Doctors do not hassle about the use of the plan, but you do have to pay for many things which would be covered by an insurance plan. This would include checkups, vaccines, etc. It does not cover birth control and this is explained to me as intentional. These plans are most popular among very conservative Christians who object to paying for prep on moral as well as financial reasons, as well as a few hippies, and this demographic oddity is reflected by the leadership.
  • You will get a bill after care and have to submit it to healthshare for reimbursement/payment yourself. I'm not sure whether they give you the money and you pay the bill, or they pay the bill for you. They definitely expect you to negotiate the bill down and price shop but I don't know how much enforcement there is. Either way, this is significantly more navigating paperwork than a conventional insurance plan.
  • Not covering the obese, drug addicts, alcoholics and heavy smokers, homosexuals, etc is probably a large part of the cost saving, but members in these plans tend to really believe in the mission and I believe that they save money by price shopping a lot as well, or by expecting members to pay for certain things themselves. Prescription coverage in particular is very bad and you should see this as similar to a high deductible plan, but with no network requirements.
  • A lot of the people using these plans have hippy-ish attitudes and the doctors most used to these are the ones that are willing to see antivaxxers, or who have unusual views on nutrition, or whatever.

For context for those not in the know, prep is a drug that allows for participation in gay orgies without contracting HIV. Your US insurance is legally required to provide it at no cost (thanks Congress). It is not especially cheap to your insurer, and those costs are covered by elevated prices for users in general.

I don’t believe the orgy is required.

You know what else isn’t cheap to your insurer? Anything on this list. Those drugs reach about 30x as many people as Prep (circa 2021), and most of them cost more per month.

If you’d like to complain about healthcare spending, there are plenty of better targets that don’t rely on baiting a disgust reaction.

I too am very smart and can't think of any difference between a drug that treats blood cancer and one that treats a lifestyle choice.

The comparison between the drugs that treat type 2 diabetes/cardiac issues and those in question is left for the reader.

I don’t believe the orgy is required.

I haven't run the numbers, but I've been friends with a decent amount of gay men in my life, and my impression is that this particular virus would have no chance to spread among the non-drug-addict population, if gay men had about the same amount of sexual partners as straight men.

Eh, sodomy is just much much riskier than having sex the proper way.

I don’t believe the orgy is required.

Sure, it doesn't have to be orgies, but doing a lot of sleeping around with partners you don't know well is the main use case. Rates of HIV transmission for PIV sex are less than one per 1000 instances of sleeping with an infected partner. Even the highest risk forms of sex are about 1 in 72 chance, though I get that that's certainly high enough that you wouldn't want to cavort with a person known to be infected without prophylaxis. Meanwhile, drugs to suppress viral load in an infected individual, which should be done anyway to prevent the deleterious health effects, also prevent HIV transmission, so if this is with someone you know has HIV, it isn't needed, provided they just use that. The chief use case, then, is if you're often sleeping with people (especially men with men) whom you don't trust or don't know whether they have it.

That said, I agree that in general, it should be possible to buy insurance with fewer mandated things, especially along hydroacetylene's take-responsibility-for-yourself lines.

If you’d like to complain about healthcare spending, there are plenty of better targets that don’t rely on baiting a disgust reaction.

I have no issue with baiting a disgust reaction here. Taxpayer money to enable behavior that I find reprehensible is more distasteful than taxpayer money wasted.

I mean, a health insurance plan with an ‘on your own head be it’ provision so it doesn’t cover type-2 diabetes or HIV treatment is a major market blind spot which healthshare partly exists to solve.

I believe the generic drugs (now available in the US) are much cheaper:

https://pmc.ncbi.nlm.nih.gov/articles/PMC9341201/

The list price of PrEP medication and its impact on the ability to scale up use to have public health benefit was described in research literature as early as 2008, four years before the drug was approved. A study published that year assessed the cost effectiveness of implementing a PrEP program targeting men who have sex with men in New York City. The model to determine cost-effectiveness used the 2007 wholesale list price of TDF/FTC, which the authors note was $31USD per pill, making the monthly supply $930USD.

On May 16, 2019, Gilead Sciences CEO Daniel O’ Day testified in front of Congress on the pharmaceutical company’s reasoning for keeping the price of TDF/FTC at approximately $1800 for a 30-day supply. O’Day offered that despite the high cost of the medication, it did not impede access, stating, “We offer a wide range of programs to help ensure that people have access to Truvada when they need it. For example, 98% of people who use our copay Assistance Program have no out-of-pocket costs.

Luckily, several structural changes recently have helped turn the tide on some of these upstream structural barriers to PrEP access. The U.S. Services and Preventative Task Force A grade rating for PrEP in 201911 helped reduce or eliminate cost sharing for PrEP. In 2021 as generic TDF/FTC became more widely manufactured and reduced the price of a 30-day supply from $1800 for brand name PrEP down to $40 for a generic, many of these restrictive payer and clinical guideline policies have been removed.

Mentioned this a few weeks ago, iirc it's $20,000 a year. Something like 10x my entire lifetime of medical expenses, but I end up paying for it anyway.

@self_made_human’s source suggests that it’s dropped to $40/month, better than most of these Medicare prescriptions. Probably fewer users, too.

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