This is the type of thing I'm talking about

[Truth OT]

The CDC found that black women and low income people in general have worse cancer outcomes for the same cancer, partly because they go for treatment much later.

Low income folks have myriad of problems that often center around the fact that ignorance is more prevailent in their communities than in the communities of the more affluent. Education as well as a desire for knowledge and cultural change are the best hopes of changing the generational health problems of the poorer groups. 

People who have little experience with being low income say, "Just go to the public clinic or emergency room and have that lump checked." Yes. You take the bus there. And wait several hours sitting on a plastic chair, maybe with your kids, surrounded by other really sick, bleeding, hacking, coughing, drunk, vomiting people, to be seen for five-ten minutes? 

And you many not even be seen that day--the clinic closes, the doctor leaves, and they tell you to come back tomorrow. If you get there when it opens, you may get seen, as long as there is nobody sicker who they have to take first. And there always is somebody sicker if all you have is a lump or mole to be checked. Who has time to take off from work for that? You have to be awfully paranoid about that mole or lump.

Again, I think this overstates the problem. The facts are that there is currently no federal requirement that states provide health coverage to adults without dependent children and these adults qualify for Medicaid coverage only if they have a disability or are age 65 or older. However, about half of states provide some coverage through federal waivers or state-funded programs for non-disabled adults who have limited incomes but do not otherwise qualify for Medicaid. This group is the only group that currently can be considered to have no coverage and generally this demographic falls in the 18 to 25 age and happen to be the most healthy age demographic, so the need for coverage is minute among this group.

Of course it is not the occasional $80 payment that puts a person into bankruptcy. (But that can still be too much to pay for a doctor visit if the wage earners are making 10 bucks an hour. That is an entire day's pay: two bags of groceries or new shoes for the kids or the month's electric bill.) It is the diagnosis of a serious illness, like cancer, or the out-of-pocket costs of treating a chronic illness like diabetes that leads to bankruptcy.

I was being snarky when I said you had no experience with strep. I apologize for that comment. But I was not working when I got strep. I waited for over a week, suffering and getting worse every day. I did not have $80. My sister, who I was staying with, did not have $80. We had to put the doctor visit and drugs on her credit card.

Incidentally, people in Japan are like hypochondriacs compared to Americans. They go to the doctor for every little lump and bump. They generally get same day or next day appointments. And everyone has insurance coverage. Their health outcomes are very good. And they pay far less then we do for health care.

So let's say it's back in the late 90's and I'm a 21 year old person with no kids and a job as a customer service rep paying about $10/hr. I need a place to live, I need food, and I need transportation. Additionally if I get sick I'd like affordable healthcare, but it ain't on my priority list as a major concern. The job offers coverage, but I make $10/hr, so I ain't paying for that, I figure if something comes up, I'll just go to the Dr. and handle it cause I'm betting that nothing major will come up. Each month I bring in like $1500 after taxes. I pay my housing -$720 and my auto expenses/bus pass -$350, and then I eat -$225. That leaves me with only $225 to play with and put away for a storm. I decide to stash $85/month in a savings acct in case $hit happens and I parlay with the remaining $120 leaving me with $30 a week to drink and club with.

Let's say I get sick or break an ankle playing ball and it gets to the point where I ain't go try to keep dealing with it; so I decide to seek treatment. I go to a local MinuteClinic or what have you, pay the $65 to $95 consultation fee, then get a Rx that costs me like $30 bucks (if I don't order from Canada for $10), and pay $60 for a walking boot to stablize my ankle or for my annual well woman treatment if I'm a lady. In the end I'm out no more than $200 and I still have a small emergency stash. To keep it real, this is the most likely scenario for the overwhelming majority of this uninsured demographic if they even need medical treatment.

There is a percentage that will need more of course. We must realize that accidents happen, and this same 21 year old could get in a car wreck or get stabbed in the club and in those cases would need major medical attention for rehab after being treated in an emergency room. As a society, setting aside something for such a scenario may indeed make sense. But let's not make this seem like it's the rule as opposed to the exception.

[nogodsforme]

Okay, I give up.  There are no problems with the US health care system. Everyone in the world looks to us as the model to emulate, because we do health care so well.  Not.

All that has to happen in your young adult scenario is a diabetes diagnosis. Costs minimum $100 bucks a month out of pocket to manage the disease. Add in a thousand bucks worth of dental problems[1] and your young adult is financially finished. (Only in the US. But not in France or England or Canada or Japan where they have universal health care.)

The examples I gave you are all real. I am 52 and have had health problems. If I lose my job, I will not have health insurance. Period. At my age, the chance of me getting another job with good benefits is slim. This is a common fear among people my age-- finding ourselves out of work and uninsured.
 
I own a house, have retirement funds and savings. I am not eligible for any assistance programs until I spend down all my assets and sell my house. A cancer diagnosis could easily eat up everything I own. If I become too sick to work, I am ruined. Without family to help me, I could be homeless and destitute in a few years. And I am in the upper middle class.

We pay thousands of dollars more than any other country per person every year for health care. We have worse health outcomes than any other industrialized country. We have people losing their homes and going without needed care.

People think they have good insurance because they've been paying hundreds every month. Then they get sick and find out that their program doesn't cover the treatment they need, or the doctor they want is not a preferred provider, or the nearest hospital does not accept their insurance, or find that they have already maxed out their benefits.

Sucks to be you. Too bad you paid out all that money for nothing-- or rather for the health insurance CEO to have a private jet and a yacht.

I just got a letter saying that my insurance will no longer be accepted by the doctors at the local emergency room. A few years ago I had to leave another doctor who I liked because he no longer took my insurance. I have changed insurance twice trying to get better coverage. Private health insurance is effed up.

Health care should not be a for-profit business.

1.	not too hard to do-- a root canal and crown on one tooth cost me about a thousand with insurance; my husband's gum graft cost $1400 out of pocket, with insurance

[Truth OT]

Okay, I give up.  There are no problems with the US health care system. Everyone in the world looks to us as the model to emulate, because we do health care so well.  Not.

No one said or insinuated that the US healthcare system is problem free or the model by which the world should follow.

We pay thousands of dollars more than any other country per person every year for health care. We have worse health outcomes than any other industrialized country. We have people losing their homes and going without needed care.

People think they have good insurance because they've been paying hundreds every month. Then they get sick and find out that their program doesn't cover the treatment they need, or the doctor they want is not a preferred provider, or the nearest hospital does not accept their insurance, or find that they have already maxed out their benefits.

Sucks to be you. Too bad you paid out all that money for nothing-- or rather for the health insurance CEO to have a private jet and a yacht.

It's a common misconception that the health insurance companies are raking it in hand or fist. The fact is, that is not the case at all. Their profit margins are below 3% whereas the pharmacutical companies and the companies that sell and produce medical equipment are raking it in at a profit margin of nearly 20%.

The reasons why we pay damn near 5 times more for medical service than other nations is based on a number of factors with one of the biggest being our inability to enact price controls on the costs of medical technology and physician charges. US doctors charge more because the US per capita income is higher than other comparable nations and the physicians are taking advantage of cakering to a wealthier target market. In additions, US medical facilities pay more for technology, equipment, and staffing than do other nations. Those costs are factored into the charges passed along to the US patient.

With the cost where they are, the idea of universal coverage in the USA is frankly STUPID. The costs must be addressed and reduced before coverage can be increased. Hell, this nation (meaning our government) already spends more on healthcare than any other nation! First we attack the costs, then we address coverage, no other approach will lead us anywhere near success.

I just got a letter saying that my insurance will no longer be accepted by the doctors at the local emergency room. A few years ago I had to leave another doctor who I liked because he no longer took my insurance. I have changed insurance twice trying to get better coverage. Private health insurance is effed up.

Health care should not be a for-profit business.

Ever thought about the reasons why doctors and healthcare facilities accept certain insurance and reject others? I know a number of doctors and clinicians that absolutely hate and refuse to accept medicaid and certain HMO's. The main reason they do not accept these programs is because, according to them the government sponsored programs do pay them enough meaning they must see nearly twice as many patients to get the money they would otherwise get from patients with preferred insure or cash. Another reason is that all insurance is not the same as it relates to processing time and delivery of payment. Finally, and this is the most subjective reason, they say that the patients with government sponsored coverage are the most ignant, least compliant, and biggest headache to deal with so they'd rather not.

I wish healthcare was not a for profit industry, but it is. Hardly anything in life is free. The industry is bigger than treatment. There is R&D, recruiting, as well as the cost of humanitarianism involved. In other words, the companies doing the R&D gotta get paid, the scientists and doctors who come up with breakthroughs and administer the care gotta be incentivized for going to and paying for all those years of schooling, and the costs of selling equipment to contries that have the luxury of setting price controls must be recooped somehow, someway. Guess which nation fits nearly 80% of the bill for that?

[nogodsforme]

Much of that so-called R and D comes from universities that are tax supported. That means we are already paying for the research. The drug companies are not paying for all that research. They spend most of their money on sales, marketing, nice offices, perks for their executives and giving free samples out to docs.

Insurance companies just want to make more profit by squeezing the docs and hospitals. Of course they don't like certain insurance because it does not reimburse enough. Everyone is trying to make a buck off the sick. Or rather, make a buck by not treating the sick.

The VA is very efficient and gives good care. Completely socialized government-run medical care. Medicare is also very efficient, compared to for-profit insurance companies. Because there is no extra markup for profit. Most industrial countries do not allow for-profit health care. They still have doctors, nurses, researchers, etc.

Non-profit does not mean nobody makes money. It just means that there are limits on how much more you can charge over what it costs to do the service. And it takes the useless parasitical health insurance middleman out of the equation. That alone would free up more money to go into actual heath care. About 30% of our health care dollar goes to overhead, not to the people who actually provide the care.

I am very concerned about what would happen if there was a real epidemic in this country, like the worldwide 1918 influenza. Millions of people died. Back then, most people realized that public health was vital and worth paying for. European countries took it seriously enough to institute universal health systems, so that even low income and poor people could go to the doctor. They are proud that decent health care is a right everyone has. Except for in the US, where we want to peg everything to how much money you have.

The people handling our food in restaurants, cleaning our hotel rooms and teaching our preschoolers have to choose between paying their rent or going to the doctor when they are sick. We don't care about them having access to health care, that is clear. But don't we even care enough about ourselves to want them to have health care?

Last story and I am done. I know a family in France. The little boy got brain cancer. The dad got on web support group for parents with similar situations to discuss treatment options.

He was horrified to find out that if he had been in the US, his family would have to sell their home and move in with relatives. In the US the costs of treating that disease routinely eats up all the family's financial assets including the house. The child then qualifies for state Medicaid.

The Americans on the site said that having a child with this disease meant that nobody in the family will go to college or be able to retire. One parent must give up full-time work to care for the child and get him to treatments, further reducing the family's income. You will never get out of debt.

Middle class life was over if you wanted to save your child. They gave advice on how to apply for welfare and sell your belongings. How to run a car wash or bake sale. How to beg for money to save your child. They advised joining a wealthy church like the Mormons. Anything to save the child.
 
In France, all treatment and medication was covered. A tutor and nurse came to the house to help the family. The wife got paid leave to take care of the child, and her job was waiting for her. The family was told that if the child needed to be flown to another coutnry for treatment it would be covered. The child recovered and the family was not damaged financially.

If you had a child with a rare brain disease, would you rather be in the US or in France? In France, they don't have jars by the checkout collecting change to pay for some kid's treatment. They don't have car washes or bake sales to raise money for an operation.

So, no problems with the US health care system at all. If you have enough money, your sick kid probably won't die. Otherwise, you may have to become a Christian. And get good at begging.

[screwtape]

It's a common misconception that the health insurance companies are raking it in hand or fist. The fact is, that is not the case at all. Their profit margins are below 3%...

Bollocks.

http://www.nationaljournal.com/healthcare/report-health-insurance-profits-rise-despite-health-care-reform-20120105

In the first three quarters of 2011, the five largest publicly traded insurers reported their best three-quarter performance of the past decade, Bloomberg found. The companies' average operating margin widened to 8.65 percent in 2011, compared with 6.9 percent in the 18 months before the law was passed, surpassing Wall Street analysts’ expectations.

[Truth OT]

Bollocks.

Not so fast with the bullocks my friend.

Before you call me a liar, look at all the data and read the entire article you put up a link for so that you communicate the entire context. In 2009, the profit margin was at 2.2%, since 2010, it has increased for various reasons to as high as the 8.65% number (which was the average for the 5 largest companies only) recently published in the article you posted. The reasons for the increases you ask? Some insures that were less profitable have left the business leaving the more profitable ones to skew the numbers upward. Insurers have been pursuing other non traditional ways to make a profit by dipping into the public healthcare market (Medicare/Medicaid). Economic concerns have people hesitant to spend on medical care which of course saves the insurance companies money since fewer claims need to be filled. None of the experts believe this is the new normal, but rather a spike that is an exception to what can be expected long term. Many do not even believe the health insurance industry to have long term viability because it is tough to make consistent profits in light of the cost of healthcare in the USA.
All this points to the fact that the healthcare “crisis” in the USA is a cost crisis and laying blame and anger at the presumably “evil” health insurance companies is a product of being told and reacting to misinformation and propaganda and is counterproductive. If we want to reduce anyone’s profits, maybe we ought to focus on the pharmaceutical companies and the medical equipment and technology developers. After that, find a way to get doctors and ESPECIALLY specialists’ salaries down to a reasonable number as compared with what the world market has set. Doing this will be a task, and anyone with the knowledge, persuasive powers, and wherewithal to get this done and still have an atmosphere where the best and brightest want to be physicians as opposed to something else they feel more incentivizes their time and effort is a bad mofo!

http://www.nytimes.com/2011/05/14/business/14health.html?_r=1
http://abcnews.go.com/Business/health-insurance-profits-worth-outrage/story?id=9036632
http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s-health-care-costs-so-high/
http://www.washingtonpost.com/blogs/ezra-klein/post/why-an-mri-costs-1080-in-america-and-280-in-france/2011/08/25/gIQAVHztoR_blog.html
http://voices.washingtonpost.com/ezra-klein/2011/02/health-insurance_industry_stil.html

"The players sitting across the table from them — the health insurers — are not so profitable. In 2009, their profit margins were a mere 2.2 percent. That’s a signal that the sellers have the upper hand over the buyers."

"Insurance companies are not money trees. They got out into the market and buy health care services and resell those services at some markup at health care consumers. I would argue that markup is not that much," said Thomas Carroll, a health care analyst at Stifel Nicolaus. "This whole notion of big bad insurance companies is rather silly."

"Insurance company profits in the large picture have very little to do with the overall rising cost of health care," said health care expert Henry Aaron, a senior fellow at the Brookings Institution.

"Carroll and others pointed out that the profit margins the health insurance companies report -- often below 5 percent -- pace some industries and lag behind many others."

"From a net margin basis, it's not that much," said Steve Shubitz, an analyst at Edward Jones. "The bottom line is any business needs to make money. That's why you're in business."

"The health-care sector is absurdly profitable. The sector-wide profit margin is 21.5 percent. But the insurance industry is one of its least-profitable parts: Its profit margin is at 4.54 percent. Hospitals are also a bit strapped, with an average margin of 3.5 percent. So where's the money going? Drugs and medical technology, mainly. The major drug manufacturers have a 23 percent profit margin. The medical device makers are pulling in 12.6 percent."

[nogodsforme]

I am not really concerned with the level of profits that the poor beleaguered health insurance companies make. They should not be making ANY profit off of sick people. They are parasites. Everyone hates them. We do not need them. They stand between the patient and the medical provider. No other civilized country allows this.

Imagine if, before you could enroll your kids in school, you had to buy "school insurance". You get it through your job-- you pay half the cost and your employer pays half. And then when you went to the school the principal tells you that your child can only attend 75% of the time, because your "school insurance" does not cover the full year. If you want a full year of school you will have to come up with the rest of the money yourself.

You call the "school insurance" company and, after being on hold for 45 minutes, and being shifted from one person to another, you finally get a supervisor who tells you that in the small print on the 27th page of their website it clearly states that the policy your employer provides only permits partial attendance unless you come up with a $250 per month co-pay, and you should have known that. You feel stupid and angry and ripped off. You decide to change companies and this time really read the materials.

Every year you switch companies during the two-month open enrollment, hoping to find one that does not rip you off. And every year it is something different that is not covered. Your kid does not get PE or art on this policy. Or that one does not include field trips or science labs. And another one does not cover lunch.

You have no way to know exactly what is and is not covered because the paperwork is so confusing and there are so many components of the school services that you can't possibly be an expert in all areas. Every month there are 4 or 5 additional bills coming in from different education companies. You are always having to come up with extra money out of pocket.[1]

You have been forking over 500 bucks a month (your own 250 plus your employer's 250, which is actually part of your salary) on "school insurance" and it has been thrown away on a stupid scheme that is all about taking your money but not really giving your kid an education.

--The teachers are overworked and underpaid, because a chunk of the money you pay has to go to the "school insurance" company instead of to the school. 

--The school has to employ an entire office of folks just to process the "school insurance" paperwork.

--The principal spends a good portion of each day on the phone begging the various "school insurance" companies for payments owed and asking for services for various kids to be approved. 

If you could, you would bypass the whole "school insurance" mess and just pay for schooling, but that would cost 1000-5000 bucks a month. You would have to go into debt, or beg from your relatives, or take a second job, or it's bake sale time.

Meanwhile your kid gets a patchy education, and some other kids get worse and some get better, depending on the policy their parents have. Poor kids get a rock bottom no frills education with public "school insurance" funding provided by the state. They get a different teacher every day, the classroom is dirty, the books are old, and there are no computers, sports teams, music or art classes.  But at least their parents know where they stand. 

Rich kids get everything, plus the bells and whistles because their parents can afford to bypass the "school insurance" entirely and pay cash. The rich people's bills are padded to help cover the poor kids' expenses because the state money is not really enough. That way everyone is getting ripped off.

People in the US would riot if we ran education the way we run health care!

Imagine the same scenario with other services that we consider to be so important that everyone should get them: fire department, police protection. If you don't have enough money, your house burns down, or the cops don't come when you call. Or, you only get as much fire service or police protection as your policy provides for, and then when your alloted amount runs out, they go away. Insanity.

Can you stomach watching your neighbor's house burn down while the fire department drives away, because their policy only paid for x amount of fire service? Or watching someone's house get robbed while the police stand around, because the family did not pay their premium on time? But we watch our neighbors suffer from treatable conditions all the time and think it is normal.

Health care is life and death. But we let the house get robbed and we watch it burn down. Because some people have to make a profit off of the sick.

1.

If anyone thinks I am exaggerating, I have a stack of bills right now from having some things checked out a few months ago--not an emergency, just  "you are a 50-something female" stuff. One is for 11 bucks, another is for 98, another is 160 something and so on and on. All from different companies for the doctor, the ultrasound tech, the biopsy, the lab charges, etc. This is on top of the beaucoup bucks I pay every month for "good" health insurance. But if I did not have the insurance, I would not even be allowed in the door of the hospital.

[screwtape]

Before you call me a liar,

?  is this a rhetorical thing or what?  I neither said nor implied it.

I am sorry, I didn't read much of the rest of the wall o' text because it was a wall 'o text. 

But if I'm wrong, I'm wrong.  That is a distinct possibility. 

And in any case, would a single payer system be more or less expensive?




And ngfm, see my recent posts on analogies. 

[nogodsforme]

Before you call me a liar,

?  is this a rhetorical thing or what?  I neither said nor implied it.

I am sorry, I didn't read much of the rest of the wall o' text because it was a wall 'o text. 

But if I'm wrong, I'm wrong.  That is a distinct possibility. 

And in any case, would a single payer system be more or less expensive?




And ngfm, see my recent posts on analogies.

I looked through your posts and did not find one on analogies. Which post?

[Truth OT]

A single payer or any system where EVERYONE is covered is ideal, so hopefully all parties end goal is to have a feasible and sustainable system in place that covers everybody. With this end goal in mind we should focus our time and energy into finding ways to get there and along the path from here to there understand that we aren't there yet but are doing the best we can within the constraints we are currently facing. We MUST find ways to lower healthcare costs and reduce healthcare spending in the USA. If we cannot, sustainable quality medical coverage for the masses is an unrealistic hope. Making it seem as easy as deciding to cover everyone becoming the law of the land does anything to fix the problem is short sighted, foolish, impulsive, and not well thought out.

[nogodsforme]

I can't understand why it works everywhere else, but cannot work here. 

No matter what culture, history or medical reality, every country from Germany to Japan, from Australia to England gives everyone basic decent health coverage. You may have to pay extra for frills like cable tv in your private room, or to have your lips plumped up with fat from your a$$.

You might even have to wait your turn behind more urgent cases. You may have to travel to see a specialist. You may not get the most outrageously expensive cancer treatment possible if there is almost no chance it will work. And when you are 95, they may just put you on pain meds and let you go home to die peacefully with your family instead of hooking you up to expensive machines for the next 6 months.  But nobody has to go without needed care because of cost.

Why is that impossible here in the US of A, where we spend more money than everyone else already? Couldn't we cover everyone for the same cost as the next most expensive country? (I think it is France, but I would have to check.)

[LoriPinkAngel]

I can't understand why it works everywhere else, but cannot work here. 

No matter what culture, history or medical reality, every country from Germany to Japan, from Australia to England gives everyone basic decent health coverage. You may have to pay extra for frills like cable tv in your private room, or to have your lips plumped up with fat from your a$$.

You might even have to wait your turn behind more urgent cases. You may have to travel to see a specialist. You may not get the most outrageously expensive cancer treatment possible if there is almost no chance it will work. And when you are 95, they may just put you on pain meds and let you go home to die peacefully with your family instead of hooking you up to expensive machines for the next 6 months.  But nobody has to go without needed care because of cost.

Why is that impossible here in the US of A, where we spend more money than everyone else already? Couldn't we cover everyone for the same cost as the next most expensive country? (I think it is France, but I would have to check.)

Why??  Because the people in those other countries pay higher taxes to foot the bill for that coverage.  Here in the US of A noone wants to pay more taxes, especially if it's going to benefit people who don't work or who they think don't work as hard as they do.

[Truth OT]

I can't understand why it works everywhere else, but cannot work here. 

No matter what culture, history or medical reality, every country from Germany to Japan, from Australia to England gives everyone basic decent health coverage. You may have to pay extra for frills like cable tv in your private room, or to have your lips plumped up with fat from your a$$.

You might even have to wait your turn behind more urgent cases. You may have to travel to see a specialist. You may not get the most outrageously expensive cancer treatment possible if there is almost no chance it will work. And when you are 95, they may just put you on pain meds and let you go home to die peacefully with your family instead of hooking you up to expensive machines for the next 6 months.  But nobody has to go without needed care because of cost.

Why is that impossible here in the US of A, where we spend more money than everyone else already? Couldn't we cover everyone for the same cost as the next most expensive country? (I think it is France, but I would have to check.)

Why??  Because the people in those other countries pay higher taxes to foot the bill for that coverage.  Here in the US of A noone wants to pay more taxes, especially if it's going to benefit people who don't work or who they think don't work as hard as they do.

Our income tax rates may be lower than other nations, but our private and government speading on healthcare FAR surpasses that of other nations because we are charged more oftentimes for less benefits, and here, costs for healthcare are MUCH higher. The costs here are way more than we can afford as a nation if our goal is comprehensive, sustainable, high quality universal coverage.

If we can reduce what we're being charged SIGNIFICANTLY, then and only then will we be able to offer coverage akin to and even better than what nations with effective current single payer systems offer. So unfortunately, we CANNOT cover everyone for the same cost as the next most expensive country as our costs far exceeds theirs.

Say I develop a machine hospitals can use to effectively treat AIDS enabling patients who get the treatment to live normal, healthy lives and not even be contagious. It cost my company $10k per machine to produce and ship. The whole world needs my machine, so I sell them to hospitals worldwide. In some nations there are governmental price controls that won't allow there hospitals to pay more than $9500 for any single piece of equipment, other countries impower its nation's insurers to negotiate and in those nations I can only charge $10,500 per machine. If this was all I was facing, why would I be in the business and how could I afford to be in the business of medical device R&D being that it requires lots of time, effort, trial and error, as well as a significant personal monetary risk/investment? Fortunately the above mentioned scenario has another element that includes nations like the USA where my business and others can sell our patented devices at whatever price the market will pay. That means that in America, I'll be able to sell my device for $30,000 to some hospitals, $17k to others, and maybe $45,000 to some others willing to pay that premium. It is the profit I make in these free market nations that allow and incentivizes me to go into this business and take the risks associated with it. So guess what country's hospitals will be charging move for the SAME services offered significantly cheaper elsewhere. Take away the Americas, and there will either be less businesses like mines, or those other countries that were getting a bargain would be forced to pay a higher premium.

[nogodsforme]

Someone in India or China will make and supply the machine for less. And then the US will not let poor countries buy it from India, because it will hurt US business. It happens with AIDS drugs. Look it up.