What is your background in this subject?
Dr. David Wilcox is a Doctorate prepared nurse who also holds a Masters’s in Health Administration and is Board Certified in Nursing Informatics. Dr. David Wilcox has 28 years of healthcare experience in which he worked as a bedside nurse, hospital administrator, and in healthcare information technology which has helped him to develop his unique perspective on the American Healthcare System. Dr. David Wilcox is the author of the book “How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival (2021)” available atHow To Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival: Wilcox, Dr. David: 9780578878362: Amazon.com: Books
Why is this subject important in the world?
With the passing of the Inflation Reduction Act, healthcare for Americans on Medicare and privately insured will change. The pharmaceutical companies will offset the Medicare savings covered in this act by raising prices elsewhere as they are a business and must answer to their stockholders. Unfortunately, people with insurance will bear the additional costs of medications. Included in the bill was a cap on insulin for all insured Americans, but the pharmaceutical companies waged a seven-figure campaign against this bill, and in the end, the politicians removed the $35 cap on insulin for all insured Americans. The real winners are those who are on Medicare or Medicare Advantage programs. The losers of this bill are average Americans with or without insurance.
What is the pressing issue, right, and how are you addressing it?
The pressing issue is the changes to Medicare that will be brought on by this Act.
Prescription drug costs are consistently one of voters’ top health care concerns. The average price of brand-name drugs in Medicare Part D, which covers medications at the pharmacy counter, more than tripled between 2009 and 2018. A new West Health and Gallup survey recently found that nearly 40% of American adults say they have skipped or delayed health care treatment or cut another spending in the last six months because of high health care costs.
Right now, Medicare beneficiaries often have fixed incomes and have no out-of-pocket maximum for drug costs. Once they reach $7,050 in a year, they pay 5% of subsequent costs. Paying 5% of drug costs might not sound like a lot, but paying for expensive drugs can add up quickly. Under the new bill, they will not pay any costs for medications once they reach $2,000 in a year.
The reform is a stunning defeat for the pharmaceutical industry, which has invested a staggering amount of money in getting its way in Washington and launched a seven-figure campaign last month to try to stop this effort. Implementing Medicare’s new negotiating power will be a contentious experiment. Drugmakers have tremendous resources to deploy and three years before any of the provisions would take effect — time they can use to try to bend the regulatory process to their will. It doesn’t affect every voter, as the reforms are mostly limited to adults over 65. The package is also a win for patient advocates who were dramatically outspent by drugmakers and watched one reform bill after another die for years. The bill doesn’t do as much as progressives had hoped, particularly for uninsured patients, but they ultimately decided that something was better than nothing.
Here are the changes the Inflation Reduction Act will bring:
- Medicare will begin to negotiate prescription drug prices.
- 10 drugs can be negotiated to start in 2026
- 15 drugs can be negotiated to start in 2027
- 20 drugs can be negotiated every year beginning in 2029
- Out-of-pocket medication costs are capped for Medicare part D, and Medicare Advantage plans to $2000 a year beginning in 2025, with the option to break that amount into monthly payments
- Only insulin will be capped for Medicare recipients at a $35 out-of-pocket cost. Politicians successfully stripped a provision that would have extended the cap to private plans as well
- The legislation would also extend enhanced ACA federal health insurance subsidies for another three years. The boosted subsidies helped fuel a record 14.5 million signups for the ACA exchanges this year. The extension will prevent an estimated 3.4 million Americans from losing health coverage. The extension lasts until 2025.
- Drug companies will be required to rebate back price differences to Medicare if they raise prices higher than the inflation rate, coined an “inflation rebate.” The Part B inflation rebate goes into effect in Q1 2023. The Part D inflation rebate goes into effect annually, starting with the one-year period beginning on October 1, 2022
- The legislation makes all vaccines covered under Medicare Part D free to beneficiaries with no deductibles, co-insurance, or cost-sharing, starting in 2023.
Tell me about your book
The American Healthcare System is complex. That is not an accident. It’s made complex by the healthcare entities vying for your healthcare dollars. In my book, How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival I break those complexities down into laypersons terms to proactively educate the average American on how to stay safe when accessing the healthcare system. How do you stay safe in a hospital, what do you do when your insurance company denies your claim, and how do you lower high-priced prescription drug costs? It’s all covered in the book. Everyone will need healthcare at some point in their lives. The healthcare consumer who is proactively educated stands a better chance of being safe in the healthcare environment.
What is something that most people don’t know about you?
I used to play guitar in bands semiprofessionally and even wrote a song that won an international song contest.
What are your passions outside of your career?
I love my three dogs, and my wife and I love to travel to new places. We are very adventurous. This year we did two weeks on the road where we went to London, Chicago, and New York City.
Are there any social causes that you believe in and support?
I give regularly to my local food bank. I believe that in this country, no one should have to go hungry. We are blessed with so much and need to look out for our struggling neighbors.
What is next for you?- While I have some ideas for another book after I obtained my doctorate and wrote this book, my wife told me I am not even allowed to take a Facebook quiz. So, I will be negotiating that at a later date.
Where can people buy the book?
Here is the link to my book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival which can be purchased on Amazon. https://lnkd.in/diZKYC2
My website offers a free healthcare resource guide for people who sign up. It is one-click access to see how well your doctor and hospital are rated and a price transparency guide to help you price out your healthcare. There are also one-click links to GoodRx and Mark Cubans online generic pharmacy. You can find it here: https://drdavidhelps.com/