We do not want an American-style healthcare system in the UK. It would be catastrophic for millions of patients...

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I found myself tumbling down an internet rabbit hole the other day; the sort that compels you to keep looking, keep clicking, keep reading, immersing yourself fully in a topic that feels urgent and important and necessary.

This tumble was triggered by a short video I’d seen on TikTok, filmed by a young American woman sitting in her car who could not afford the medication she needed. She had filmed the video after leaving a pharmacy empty-handed. She’d been shocked by the costs, caught unawares, and hadn’t been offered any alternative or support. “Sorry”, the system seemed to be telling her “too bad”. “If you can’t pay, you can’t pay”. Her treatment wasn’t for a minor ailment, or a short-term condition. It was for diabetes, and if she couldn’t access treatment, she faced becoming very sick, very quickly. Unsure of what to do, she’d turned to the internet, tearful and distraught. She’s not alone in her desperation, in fact there are now millions of Americans struggling with medication costs, and the situation is getting worse. As CBS reported in July:

“Americans spend more money on health care on a per capita basis than people in any other developed nation, yet almost half say they've struggled recently to pay for medical treatment or prescription drugs, according to a new study from Gallup and West Health … About 45% of those polled by the organizations said they'd recently had to skip treatment or medicine either because of cost or lack of easy access.”

It’s horrifying to contemplate that patients are having to engineer their own drug regimes, ones that presumably deviate from those prescribed by healthcare professionals. And it’s even more horrifying to contemplate the scale of this problem. The article goes on to say:

“While 55% of Americans are ‘cost secure’, meaning they can afford care and medicine, that's a decline from 61% who fell into that category in 2022, the study found.”

Numbers and statistics aren’t always very emotive, even when they’re as stark as these, but when you start reading about the experiences of patients who are being impacted by this situation, it brings the reality of the situation into sharp focus. Time magazine wrote a really powerful article recently explaining the situation and featured this example of a patient facing impossibly high medication costs:

“After Jackie Trapp was diagnosed with multiple myeloma, an incurable blood cancer, in 2015, she thought her biggest health shock was behind her. Then came the bills for Revlimid, a powerful cancer drug that her doctor said was her best hope for controlling the disease. The first month’s supply cost $11,148; the second, $12,040—and her insurer denied coverage. ‘I’d need to take the drug every month, for years’, says Trapp, 59, a former high school teacher and realtor from Muskego, Wis. ‘My husband and I had done well in our careers, we’d been frugal and we’d saved, but there was no way paying $120,000 a year or more was sustainable’.

While The New York Times wrote about the experiences of another patient last year:

“April Crawford never thought she’d be begging for help on GoFundMe, but she has run out of options. She has multiple sclerosis, and Mavenclad, the drug that could slow her decline, has a list price of $194,000 a year. Her Medicare insurance will pay for most of it, but she has a co-pay of $10,000 … Ms. Crawford, 47, doesn’t have $10,000 and has no way to get it.”

The piece by Time magazine goes on to suggest strategies for patients in this position; courses of action and places to turn. But as I read through the piece I wasn’t struck by a robust architecture of support mechanisms available to patients. There was no clear and reassuring “how to” guide, with easy steps for people to follow. Instead, the article was a series of “maybes” and “if you’re lucky”s, which serve to highlight how fragile the situation is, how random, and how insecure many peoples’ access to medication really is right now. At one point in the article, it was suggested that free samples of medication might be available from healthcare providers, at another point, coupons were mentioned. Let’s be clear - no-one requiring medication should be relying on free samples or coupons.

But what struck me most was the normalisation of this horrifying situation. There are scores of examples highlighting cases where patients with cancer or epilepsy or mental health conditions or diabetes are simply shut out, let down, and left out in the cold by the American system; a system which in many ways puts profit above patients and shareholders above all…