Insurers pass back a significant amount of rebates back to their payers. It’s going to be a never ending argument over what is or isn’t happening. I totally understand your perspective. Maybe to say it bluntly, I agree with you that a single payer system could provide a tremendous opportunity to take a huge amount of revenues out of the healthcare system. From a tax payer perspective and someone who considers themselves conservative from a financial sense this is very clear to me. Again however my question remains that as a pharmacist do you really understand the impact of single payer on your business and business model. It’s not wrong to think that the pros of single payer outweigh the cons that come of a change of massive magnitude to our healthcare system. With a significant GDP and job exposure to our curry fragmented healthcare system, the impact of changing to single payer would be much much much broader than just being happy that “the man” who has constantly been pinching pennies from us now has what’s been coming to them. Going back to my first question it seems as a profession as whole there hasn’t been a “right” answer to the question of what’s best for the profession. “Better Reimbursement” is often quoted but even with your rationale, better reimbursement (via govt payers like Medicaid) comes at the cost of the taxpayer who is also us. I fully agree with you that it’s a big shuffle of revenue with non-transparent costs and reimbursements and rebates in today’s system. While every stakeholder is making claim to trying to serve the altruistic purpose of better patient outcomes at lower payer costs with as high of patient access as possible... many, if not all, stakeholders have a benefit when in favorable arrangements where there are worse patient outcomes, higher payer costs or limited patient access. Pharmacists and dispensing pharmacy businesses are not immune to that. The sicker the patient, the more meds they are on, the more revenue they are bringing into your business. A higher margin for pharmacy means the payer is spending even more than it has to when it comes to true net cost of medication and dispensing (true acquisition + operating cost). By your same logic of the taxpayer taking on the cost of Medicaid, it’s hard to not realize if we took less of a salary and got comfortable making less profit, the cost to Medicaid could decrease and our liability as a taxpayer could also decrease. It’s ok to say single payer is a better system but then we should also be comfortable making less profit as a business and in turn less salary as a pharmacist.
