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Q: Then who's going to pay for medicines?

"The costs of medications are so high. Who's going to pay for people to get their meds?" This question was posed to me by someone who currently works as a nurse in a psychiatric ER.

One of the reasons medication and medical device costs are so high is because Big Pharma and Big Devices drive up the prices. We know from looking at other countries that the very same medications and technologies have huge markups here comparatively. Why is that?

It's partly because we are required to buy medications from stockpiles in America. Even though some of these medications are made in America, shipped other places, and sold in those places at a fraction of the cost, we aren't provided that financial consideration, even though they are the same medications.

Given that implementing a new health care delivery system will be hard enough, I would assert that we don't have to do anything with Big Pharma and Big Devices directly, other than permit the 50 nonprofits that will essentially run health care in each state to bid for their medications with any global company that is approved by the FDA. In other words, let the FDA and Health and Human Services vet the companies that are safe and leave the rest to the market.

One of the strengths of Adult P.S.Y.C.H. is that it truly puts the control of your health care back in your hands. So when you make health-conscious choices, you receive benefits (positive reinforcement), and when you make terrible health choices, you deal with the consequences (negative reinforcement.) Having the patient pay the full, though substantially lower, cost of medications will compel people to make wise decisions. There are a few nuances we could create in the P.S.Y.C.H. system, however.

For example, if you get medications during your preventative visit, they could potentially be covered by the general health fund since it is a "preventative" measure in that they keep one's health condition from deteriorating. For all sick visits, the patient should bear the brunt of the cost (again, the costs will be much lower), but patients can submit a claim to the general health fund for reimbursement, provided they meet criteria that would be clearly delineated.

For enrollees in Pediatric P.S.Y.C.H., Bridging P.S.Y.C.H., and Geriatric P.S.Y.C.H., claims for reimbursement from the general health fund would be more lenient. Yes, everyone should pay some part of their medication costs as this makes you invested in the treatment process. But for these specific groups, we can decrease the financial burden without eliminating all purposeful motivation.

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