Friday, September 18, 2009


I have a heart transplant. Yes, the cost of the transplant itself was enormous. And yes - here in America many people who need one can't get one because they simply have no way to pay for it. The Internet is full of "bake sales" and other fundraisers trying to raise enough cash to get people on the waiting list for a heart transplant. You see... you can't even get on the waiting list unless you can prove - in advance - that you can pay for the operation. The US is the only place in the civilized world where this happens.

And then, what is often neglected, hardly reported on at all in our national press, is the plight of those who actually get a new heart and later die because they cannot afford the lifesaving immunosuppressant drugs they must take daily for the rest of their lives. Yes, after paying hundreds of thousands of dollars for a heart transplant, some successful transplant patients suffer and die without the necessary maintenance drugs. I take two such drugs. They are Cellcept and Prograf. Cellcept is manufactured by Roche Pharmaceuticals, a company based in Switzerland. Prograf is made by Astellas Pharma Inc., a Japanese corporation.

A 90-day supply at my dosage level costs more than $5,400 for Cellcept and a mere ten bucks less than $7,300 for Prograf. A small price to pay for staying alive - if you have it. A $12,700 death warrant for those who don't.

In England - where they also do heart transplants and where they have socialized medicine - a 90 day supply of Cellcept costs less than $100 US or 1/54th the cost for a patient here in America. You read it correctly - less than a hundred dollars for three months. In France where they also do heart transplant operations and where they still have private doctors and hospitals but a highly regulated healthcare system, the same 90-day supply of Cellcept costs half of what the English pay - only $51 US.

So, that's $5,400 here in the US. $100 in England. Only $51 in France. Makes you want to stand up and cheer, doesn't it? USA! USA!

Prograf, the other immunosuppressant drug I take every day costs $7,291.22 in the United States for a 90-day supply. The same prescription in England costs $517.50 and in France it only costs $284.62.

Neither Roche nor Astellas refuse to sell their products in the countries where universal, highly regulated or outright socialized medicine exists. Nor do they claim to lose money there. Look closely at those dollar costs again and decide for yourself if the cost of selling these drugs in America can possibly be so much more than they are in England and France.

Numbers can be dull and boring... unless your life depends upon them. Regardless of income or assets, a citizen of France can get a heart transplant when and if they require one, and the cost of staying alve afterward is $3.72 per day. In the United States of America only those who can prove in advance they can pay for it get a heart transplant and then their cost of survival is about $141.02 per day. That's a hundred and fifty bucks yesterday, today, tomorrow and every day for the rest of their lives.*

* If there was the usual small print disclaimer here - the kind often seen in drug company print advertising - it would have to say that these prices are based on today's costs in 2009 and are not guaranteed to remain the same - because we all know drug prices never remain the same. They go up. They increase in price. They do not - ever - go down. So, who can say what it will cost to stay alive next year and the year after that, and the year after that? Every heart transplant patient in the US worries about this. Our compatriots in the Rest of the Civilized World live under no such stress.

1 comment:

ralph said...

Powerful commentary, Richard. I hope someone in a position to do something about this reads it.