In 1986, it took $100 to vaccinate a child from birth to age 18. Today, it costs $2,192. Because of this expense, insurance companies often don’t reimburse for the full price of a shot, and doctors lose money on each vaccination they give. As a result, many family doctors and primary care providers have stopped offering vaccinations to the general public, or even to longtime patients. Yet schools still require children to receive certain federally mandated vaccinations before students can matriculate. A NYT profile on rising vaccine costs shows the dilemmas this situation has created for parents:
A survey of family-practice doctors, who along with pediatricians are among the lowest-earning physicians, found that about one-third were considering giving up immunizations because of the expense. Another survey found that 40 percent do not offer at least some required childhood immunizations […]
That is why Breanna Farris, a San Antonio mother, had to call 10 pediatricians in April before she found Dr. Irvin to vaccinate her son, Traven, who is entering kindergarten this fall. The family’s usual doctors do not offer vaccinations, and referred Ms. Farris to local pharmacies (which do not vaccinate children) or the city health clinic (which would not take Traven’s insurance).
“I was like, ‘Where should I go?’ ” Ms. Farris said. “They say vaccines are covered, but that isn’t really true if doctors aren’t giving them.”
Some of the price increase represents real added value of new and better vaccines. As the piece makes clear, however, corruption, greed, and rent-seeking also factor in. Companies can game the process by which a vaccine is added to schools’ requirements, and once their product is added they can raise prices. Doctors who buy vaccines are sometimes required by the pharmaceutical companies to sign legal agreements that prevent them from disclosing how much the drugs cost. And while big pharma can reasonably claim it needs to charge a higher price for a new drug in order to recoup R&D costs, prices tend to go up, not down, as time goes on. This is especially true in the United States. Elsewhere, vaccines are sold for less but the companies make a profit on them, experts say.The U.S. heath care system is so huge and complicated that it can be hard to discern what’s driving its dysfunction. But zoom in on almost any major area of health care spending and pricing, and you see the same trends creating inflation on the micro level that are ratcheting up costs across the whole system. Insurance coverage and barriers to transparency hide costs from consumers while government mandates line the pockets of vested interests. This all combines to make it harder to access certain services. The U.S. system will never function well until would-be reformers realize how unlike a true market it is and endeavor to make it more like one.