Doctor Talk me Through it: A Parent's Guide to Navigating Healthcare
Ryan Hassan, MD, MPH of Neighborhood Doctor fame, takes the time to jump in for a full episode to walk us all through how complicated the healthcare system is. From the insurance side of things to decoding some of the most important 50,000 abbreviations in the healthcare system, this is a guide to best understand all that goes on when you head to the doctor's office
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Ari O’Donovan
Transcript:
Ari O'Donovan: (00:00)
Are y'all comfortable? We hope wherever you're listening to this, you're comfortable. This show is for the Bipo communities in Oregon, hosted by a black woman about the amazing work we do every day in this state. So let's build together, connect with our communities, add some laughter and humor even when it's a difficult conversation. Let's boost our voices.
Dr.Ryan Hassan: (00:25)
He's gonna cost closer to $400.
Ari O'Donovan: (00:28)
Wait a minute, wait a minute. Wait a minute. Wait a minute. , wait a minute. You said $400 per vaccine that a parent would have to pay.
Dr.Ryan Hassan: (00:37)
A parent wouldn't have to pay for this because one of the things with V F C is it is not. It makes it so that it is not allowable for anyone to charge a parent or insurance for A V F C vaccine or immunotherapy.
Ari O'Donovan: (00:53)
Welcome back y'all to a brand new episode of boosting our Voices. As always, I'm your host, IRA o' Donovan, and Boost Oregon's Diversity Program Director. I am here with Boost Oregon's medical director, Dr. Ryan Hassan. Well,
Dr.Ryan Hassan: (01:08)
Hi everyone. I'm um, Dr. Ryan Hassan. I'm a pediatrician practicing and Clackamas and Medical director for Boost Oregon since January, 2022. And part of my job, which we'll be focusing on today is that I also try to stay appraised of the most current changes in the world of vaccines and some of the constraints and barriers to vaccination besides vaccine hesitancy and anti-vaccine propaganda, which is a huge problem. But as we'll talk about today, there are other logistical barriers that are a problem as well that need to be addressed.
Ari O'Donovan: (01:40)
Tell me where you wanna get started with this conversation, Ryan, and, and I don't know as much as you, so I'm gonna have questions and I know that you'll be able to give me some kind of information to enlighten.
Dr.Ryan Hassan: (01:52)
Enlighten me. Sure. So the bottom line is that in Oregon there are a lot of parents who want to vaccinate their children and cannot. And I wanna talk about why that is. Usually we talk about, or I talk about, you know, people who have hesitancy and concerns and reasons for those. But today I'm talking about people who want their kids vaccinated, who understand and have faith in the, the science of vaccines and know that they're the safest and most effective way to protect their kids from unnecessary illness, but for one reason or another are unable to get it for their kids. And there's a few reasons for it. The first thing that we should say is that I don't know how many people can't get vaccines who want vaccines. And that's part of the problem. I know that there are people who can't get them.
Dr.Ryan Hassan: (02:36)
The extent of this problem is hard to know because we just don't have the data. We know that, you know, depending on this vaccine, 70 to 90% of kids are, you know, vaccinated in the state. Um, you know, in some areas there's lower and higher rates. And we know generally that trend has gone down a little in the last few years since the pandemic. But what we don't know is which of those unvaccinated kids are unvaccinated because their parents chose not to vaccin them versus which of them are unvaccinated because they couldn't get the vaccine. And that is just because we don't have a good public health system that is funded well enough to collect that data. That's a first part of the problem is that we don't know how big of a problem it is. But I do know there are people I've spoken to and patients and people I've worked with in the organization, immunization program, O I P, which is part of Oregon's statewide public health organization, Oregon Health Authority o h a, that have told me, you know, this is a problem for many of the people they work with.
Ari O'Donovan: (03:35)
How do we not have that information that that is really not right?
Dr.Ryan Hassan: (03:42)
O I p, which again is the Organ immunization Program, they have commissioned a study to, to try and survey parents who have not vaccinated their children to find out how many have made that choice because they didn't want the vaccines versus how many made that choice because they couldn't get the vaccines. So hopefully we will have a little bit clearer idea of, you know, how big the problem is going forward. But right now we just don't have, I'm in the process of trying to find it with working some of my colleagues, but I just don't have it. But in terms of why it is that people can't get vaccines for their kids, there's a lot of barriers and with all aspects of healthcare, you know, I mean at the end of the day, the people who have more money and who have more means are gonna be more well able to vaccinate their kiddos. Um, but with vaccines there's some more nuance. And I think the best place to start is the Vaccine for Children Program. It's called V F C. Tell me what you know about V F C. Are you familiar with it at all?
Ari O'Donovan: (04:39)
Yeah, I know a little bit about V F C. I feel like that allows kids to get vaccinated for things, regular childhood vaccines, c Ovid 19 who may not be able to afford it. It makes it so that kids can have access to these vaccines. Their parents have to consent to that of course, but it allows them access.
Dr.Ryan Hassan: (04:59)
That's exactly right. Essentially it was designed so that, as you said, any kid in the country, it's a federal program should be able to get vaccines for free. The V F C program provides vaccines for children who are on Medicaid. Uh, it also provides it for American Indian and Alaskan native children and for uninsured children. So the way the program works is that a clinic or hospital or other vaccinating organization has to enroll in the V F C program and when they enroll, they will get vaccines for free from the federal government and then they can give those vaccines to eligible patients for free. So essentially they don't have to pay to get the vaccine from the pharmaceutical company and then they don't charge for them when they administer them to patients. Essentially the contrast is, you know, if you have private insurance or if you're not on B F C, you would, the, A clinic would have to like buy the vaccine from the pharmaceutical industry who makes it and then they administer it to the patient and then they charge the patient or their insurance for the vaccine people on V F C, they get charged an administration fee for like, you know, the logistical cost of having and administering the vaccine.
Dr.Ryan Hassan: (06:09)
The MA drying it up, putting your arms storing in a fridge in the meantime. But they don't have to charge pay for the actual syringe, the vial. Does that make sense?
Ari O'Donovan: (06:17)
Yeah, that sounds like a good deal for kids, really.
Dr.Ryan Hassan: (06:19)
It's cost saving for sure. And then it means that even if you can't, you know, afford the vaccine, you're gonna be able to get this for no charge and then the administration fee usually is gonna be covered by the insurance. So that's the way it works. But unfortunately in recent years and in Oregon in particular, it's become a bit of a barrier to vaccines because there are requirements that prohibit who can participate in the program, which clinics can participate. So my clinic for example, can participate in V F C because we've enrolled in the program, but in order to do so, we have to have two stocks of vaccine. So we have vaccine we get from the government through the V F C program that we get for free and that we administer for free. But we also are required to have a separate stock of those same vaccines that we buy from the pharmaceutical companies and that we administer to privately insured patients. So basically we need two stocks of vaccine. There's one that we give to V F C kids and there's the other that we give to non V F C kids,
Ari O'Donovan: (07:18)
But it's the same vaccine though.
Dr.Ryan Hassan: (07:20)
It's the exact same vaccine. So we have, you know, V F C M M R vaccines and we have non V F C M M R vaccines, V ffc, flu and non V F C flu. It's the same thing. It's just that different funding paid for it. One came from the federal government, we didn't pay for it. The other came from the pharmaceutical company directly and we did pay for it. And the reason for that is because as with many things in the government and on any kind of welfare adjacent program, uh, there is a heightened concern in hysteria I would say, and panic about preventing fraud. And the V F C program, the government does not want people to be fraudulently giving V F C vaccines these free gov vaccines from the government to people who aren't eligible. In other words, people who are privately insured.
Dr.Ryan Hassan: (08:05)
If you have private insurance, then your insurance should be paying for those vaccines. So to try to ensure that that's not happening, they require you to stock the double supply. What that means is you have to be able to purchase and and store all of that vaccine in order to participate in the V F C program. And if you can't do that, then you can't participate. And the reason that's a problem is because vaccines can be very expensive and it can actually cost 10, 20, $30,000 to have a whole stock of vaccine that a clinic would buy from the pharmaceutical company directly. And plus the cost of storing it in the fridge, they have to be at the right temperatures. And the other problem is you have to pay for it upfront. Generally you pay the pharmaceutical company and then they send you the vaccines, but then the clinic isn't gonna be reimbursed for those vaccines until months later because they have to then administer the vaccine to the patient, which, you know, they're not gonna administer 'em all right away. They administer 'em over the next several months as patients come to the clinic. And then after that they have to bill the insurance. And anyone who's worked, you know, around healthcare and insurance should know that that usually takes quite a while. Sometimes months even before the insurance will, you know, choose to pay us back. And with vaccines, you know, they will pay us back, but sometimes they don't even, sometimes they refuse to pay, which is another whole nother problem. Okay.
Ari O'Donovan: (09:22)
Ryan, I'm gonna stop you right there. So you mean to tell me that if you have your own like private practice clinic, you wanna help kids, you wanna do good by patients in the community, it will literally cost you $30,000 just by itself to make sure you have a double stock of vaccines so you can administer them and then you'll get your money back. But it could take upwards of a year, maybe,
Dr.Ryan Hassan: (09:55)
I don't know about a year. A lot of this is new to me, so I'm mostly a pediatrician and like I talk about like vaccine safety and science and things like that. So a lot of this is new to me. So the exact numbers I, I would not be a hundred percent on. I think it'd probably not be quite a year, but certainly several months and potentially up to 30,000. Yeah. And and maybe more, maybe less for other clinics. It depends on, you know, different factors and also like, you know, how much you end up having to pay because there's negotiations the clinics have to do with the pharmaceutical company to get the best price for the vaccine as well. 'cause again, it's all a for-profit system. We can't just get, you know, however much vaccine we want for free. We have to pay for them, which is why patients also have to pay for it.
Ari O'Donovan: (10:36)
And you're spending more time with like paperwork and negotiating prices than you are with working with patients and administering these vaccines to the kids who need them.
Dr.Ryan Hassan: (10:48)
It's a pretty big problem that I wasn't even aware of until I was speaking with people at O I P who told me, you know, there's are a lot of clinics who just can't participate because of this. My understanding is, you know, smaller clinics and I, I know some of them who just, they can't afford it. There are, and you know, family practice clinics who might not be, you know, exclusively working with kids might not have, it might not be as cost sufficient for them to participate. But, you know, I know of at least one clinic with a provider I know personally who, who doesn't participate in V F C because of these barriers. And O I P has created some other programs, one called like the Vaccine Access Project and another, the Vaccine Replacement project that try to kind of bridge the gap for those clinics and provide vaccine directly to them.
Dr.Ryan Hassan: (11:34)
And then they just pay back the state directly and for doses they've used. And that has been helpful as kind of a stop gap measure, but there's not enough funding for that program that funding is drying up and, and they don't have a lot of capacity to expand that. So at the end of the day there's still a lot of people who, you know, can't really participate. And there's other barriers to V F C, but for me, I think that one is the big one that sticks out to me. 'cause that's the one I see every time in my clinic. I'll have a patient and you know, they're ready for example to get their flu shot, but I'll hear, oh, well we actually can't give it to them because we only have V F C vaccine left. We don't have private insurance or we only have private, we don't have V F C and you can't give one or the other. And it, so we have that vaccine that would work just well for them. But because it, it came from a different funding source, you know, we can't give it to a patient. Um, so it's just one extra bureaucratic hurdle in the name of fraud prevention.
Ari O'Donovan: (12:25)
Is fraud prevention more important though, than keeping children healthy and safe ?
Dr.Ryan Hassan: (12:32)
Yeah, I mean personally I, I would rather pay for everyone to get vaccinated on the federal government's dime because one, it's just the humane thing to do. And two, it is more cost effective than having a bunch of unvaccinated people putting it at risk for, you know, a preventable outbreak of measles, for example. I mean, it's not cost savings by any mean, and it it, but beyond that it's, you know, I think it stems from this, you know, racist notion essentially that people on welfare or people who participate in programs like V F C I mean are, are, or people in general are just trying to scam and get things for free and are lazy and not working for what they, what they take. And that, I think that is pervades uh, a lot of the thinking behind these kind of, you know, anti-fraud measures. I think of it the same way I think of it as, as I think of voting fraud, you know, it's, it's not a real thing. There's no widespread voting fraud. It's a buzzword used to try and, you know, disenfranchise people. And I think some of these anti-fraud prevention measures in V F C have the same kind of thinking behind them. And there's no reason that I think anyone should suspect that we would see mass fraud of people intentionally giving wrong vaccines. It's just, it seems like a ludicrous and unnecessary barrier.
Ari O'Donovan: (13:47)
Ryan, I agree with you. You really gotta, and you just didn't get to the root or one of the major parts of the problem. It really is rooted in racism, the way that we view people that are receiving, um, you know, help from the government in any kind of way. People think they're lazy, they think that they don't work for things, they think that they're always reaching for a handout. And it's like there are people that are on government assistance that work two or three jobs. What about those people who are just trying to live a better life, provide for their families, keep their families healthy and safe? I, what are we doing?
Dr.Ryan Hassan: (14:27)
I agree. We could talk for a while on that too. So one thing that's kind of the, a very basic overview of my understanding of V F C and some of the challenges with it, and again, I've talked with different providers about this and, and most of them tell me the same thing, which is like, you know, how much is this is a problem really, like I have this as a problem in my clinic. I don't know personally people where this is an issue. And my answer is, I don't know because as I said, I don't have the data and that's part of the problem. We don't have enough funding and organization and structure within our public health system to get the data that we need. But there's, this is kind of the, the background, but the issue that, that is coming forward now is that, so another requirement of V VFC is that if you wanna participate, you have to, you have to provide all the vaccines that for on V F C, all V F C vaccines that um, are your patients that you serve are eligible for.
Dr.Ryan Hassan: (15:23)
Meaning if you, if you're, you know, a pediatric clinic like mine, then you have to provide, if you want to be on V F C, you have to provide every vaccine on the C D C schedule. Uh, that is a V F C vaccine. You can't just, you know, pick and choose which ones you want. Uh, and like the idea behind it is good, but in general, like yeah, we should be giving all of the vaccines we shouldn't have seen. Well I only want give him MR but I don't want to give flu, I don't want to get detoxed or whatever. But the challenge is that it means that it's a whole nother cost you have to add on of like buying all of those vaccines. 'cause you have to pay for the separate supply of all of them. So you can't just do what might be affordable.
Dr.Ryan Hassan: (16:02)
And one consequence of that is now this coming fall in the next couple of months, next month actually the R S V immunization or seima is gonna come on the market and that it, it's not technically a vaccine, it's a monoclonal antibodies. So it provides passive immunity. So this is kind of the same way that like maternal antibodies allow babies to be immune to, uh, diseases for the first six months of life. So it does the same thing, but it is on V F C, it reduces the risk of infants getting R S V infections by like 70 to 75%. How familiar are you with R S V? Like what you're That's
Ari O'Donovan: (16:39)
What I was just about to say. I don't know a whole lot about R S V so maybe you could tell me what is it and, and what is the concern with it. Sure,
Dr.Ryan Hassan: (16:47)
Yeah, so R S V stands for respiratory syncytial virus. A lot of people, a lot of parents of newborns, most parents of newborns are familiar with it. But a lot became familiar with it last year because last winter we had a really huge spike in R S V. It was a a lot worse season than usual. It was an earlier season than usual and there were a lot more cases and a lot of people were calling it the triple demic 'cause we had that as well as covid spikes and flu spikes. And so it made for a very challenging winter for a lot of families. Even for kids who didn't end up hospitalized. There were kids who were, you know, sick at home and missing school for for weeks, recurrent illnesses, back to back illnesses.
Ari O'Donovan: (17:25)
Was there a vaccine then?
Dr.Ryan Hassan: (17:27)
It was available and it still is, but it uh, is only recommended for really high risk kiddos because it's much more expensive and it doesn't work as well. That immunization immunotherapy you have to give once a month for the whole five months of the R S V season. So it just wasn't practical to give everyone. But if you are at high risk like you, you really premature have congenital heart or lung disease, then you would be getting that. But umab, the new R S V antibody is much more effective, much cheaper and it protects 70 to 75% with just one single dose and you get a full five months or more of protection. So that's the advantage. And the reason this is important is again, because R S V, you know, it was bad last year but every year R S V is the leading cause of hospitalization in infants. That's the number one reason that babies under a year will be hospitalized. Uh, or like yeah, will be hospitalized.
Ari O'Donovan: (18:19)
Wow, I gotta stop you right there, Ryan. I did not know that. I actually thought it might've been flu . That's just not the case.
Dr.Ryan Hassan: (18:27)
So 68% of babies have R RSS V in the first year. And another thing I think is important is a lot of times, you know, when I'm talking to families about the R S V prevention and just infectious disease precautions, generally a lot of people say, well, you know, my kiddo's full term, they're healthy. There's, you know, they're strong and like they're, they're not that high at risk. Everyone's at risk for R S V, 72% of the children who are hospitalized with R S V are term, they're full-term babies and they have no underlying medical conditions. Uh, of babies who are admitted in the I C U because of R C U, the intensive R C V, because of the I C U, meaning the intensive care unit, sorry I'm getting lost in my own acronyms, but I have the kids admitted to the I C U, the intensive care unit, 60% of those are healthy and full term.
Dr.Ryan Hassan: (19:13)
So most kids who are hospitalized and most kids who are admitted to the intensive care unit where they might need like a ventilator, most of them are full term and they don't have any medical risk factors. So it's something that everyone is at risk for and it's something that everyone suffers from. Most babies will get R S V at some point in the first few years of life. So very significant illness and very much worthwhile trying to prevent. And that's why this new medicine efab is such a, such a breakthrough in our capacity to potentially, you know, uh, reduce the risk for kids getting this.
Ari O'Donovan: (19:47)
I never knew that it was such a, a problem. And you could have a, a healthy infant that ends up in the I C U and is on a ventilator, a ventilator for a a child that's not even a month old over R SS V.
Dr.Ryan Hassan: (20:00)
And now it is I think important to know, you know, most R S V cases are still gonna be minor. Most kids who get it will have a minor cold. But um, which is important to know because a lot of families will, you know, their kid might get a cold and then, you know, maybe they'll get a test and it says R S V and it doesn't mean you should freak out because if your baby seems okay, which you should confer with your provider for 'cause as a parent, your baby will never seem okay when they're sick and like sneezing and coughing and not sleeping, having fevers. But if the doctor feels like they look okay and they're not having trouble breathing or things, then that's a real good sign you probably don't have much to worry about. You just watch their symptoms. So just because your kid has RS V doesn't mean you need to freak out and assume everything will be horrible. But it's important to know that this is one of the diseases that more commonly will cause the more serious illnesses.
Ari O'Donovan: (20:44)
Wow. Good to know. Good to know for parents out there because if you can get that baby to one year old and it's alive and it's healthy and it's healthy, that first birthday is really not even for the child, it's a celebration for you . Uh,
Dr.Ryan Hassan: (20:59)
Yeah and that that, and that's a point where you usually start to get a little more sleep. That was the biggest thing for us. Our baby fortunately didn't have any major illnesses but um, the sleep deprivation was killer. So that's umab, you know, great new medicine. The recommendation is that kids should get this immunotherapy, this monoclonal antibody at the beginning of R S V season around October, November during a regular well visit, kids under eight months are eligible. Some kids who are higher risk, like the ones who are really premature have congenital heart or lung disease. They might be recommended to get it in their second R S V season too. But all kids are recommended to get it starting this October and November. And if kids are born during R S V season, they're recommended to get it in the hospital. You know, just like the hepatitis B vaccine.
Dr.Ryan Hassan: (21:42)
And this is where another one of these barrier issues comes in because there's only one hospital in Oregon that's enrolled in the V F C program and R S V immunotherapy UMAB is on V F C. So that means that by default, unless the hospital is enrolled in the V F C program, they cannot give the NEV the R S V antibody to babies who are born there. Um, unless they pay for it themselves. The baby ends up being a V F C baby, meaning they're on Medicaid or they're American Indian or Alaskan native or they're uninsured, then the cost of that medicine will not be reimbursed to the hospital and they can't charge them for the medicine. And so they would have to buy it and give it for free to those kiddos. Now they already do this with the hepatitis B vaccine because you know they have the same issue there.
Dr.Ryan Hassan: (22:36)
They give hepatitis B vaccine to every baby in the hospital. 'cause that's the recommendation. It's the best way to make sure everyone's protected and reduce their risk for hepatitis B. And when kids have V F C, they just don't get paid for it and they just have to eat the cost of the vaccine. With Hep B, that's not a huge issue because the Hep B vaccine costs about $15. You know, it's a little variable, but that's the average price about $15. So it's not too much. But nab, the R S V antibody is gonna cost closer to $400.
Ari O'Donovan: (23:07)
Wait a minute, wait a minute, wait a minute, wait a minute. , wait a minute. You said $400 per vaccine that a parent would have to pay,
Dr.Ryan Hassan: (23:17)
A parent wouldn't have to pay for this because one of the things with V F C is it is not, it makes it so that it is not allowable for anyone to charge a parent or insurance for A V F C vaccine or immunotherapy that um, that they should be up eligible to get from the V F C program. So the hospital, if they gave this um, this medicine to uh, a baby who had V F C, then they wouldn't be able to charge the parents and say, Hey, we had to pay $400 for this vaccine. So you know, now you have to get it. So they can't do that. But that also means they have no way to get reimbursed for it. Which means if they were to do this without being in the V F C program, then for every child who is V F C eligible, which is be a lot of kids, all the kids on Medicaid, then they would be having to eat the cost of about $400 for the NEV shot that they give in in the hospital.
Dr.Ryan Hassan: (24:12)
And that would add up very quickly and it would just be an untenable cost. So for that reason it has been um, a very big struggle for people at O I P and the pharmaceutical industries, AstraZeneca, Sanofi who are, you know, manufacturing, distributing, distributing the NAB medicine to try and figure out how they're gonna get the vaccine in hospitals. And as of now there's not, as the time of this recording August 31st, there's not a solution. Now I have heard just a couple days ago that O I P is working on a solution. They might actually have a way to work around this and I don't know the details of what that will look like, but if that works out, then hopefully we'll have at least for this season, a way for hospitals to provide uh, nev to babies who need it in the hospital. Um, and if so, that would be fantastic because if that doesn't happen, what it would mean is all of the babies born in October this year would not be able to get the medicine in the hospital as is recommended by the C D C and would have to get it after they're discharged from their primary care provider.
Dr.Ryan Hassan: (25:16)
Okay, so back from a short break, had to um, say hi to my baby. She just got it from NAP .
Ari O'Donovan: (25:23)
We've talked about what V F C is assorted barriers to getting vaccines. Clinics are prevented from enrollment. You have to provide all the vaccines. We talked about what R S V is, why it's important that kids get vaccinated, how dangerous it actually really is. And now we're talking about the cost for hospitals and other providers and why that's going to become a real serious problem.
Dr.Ryan Hassan: (25:51)
The point is that the whole system wasn't designed to say let's make sure kids get the vaccine or the the medicine, the antibody when they need it. It was designed around like, well we need this to save kiddos and also like it's a for-profit health system so like let's make sure we're, you know, everyone can make, get paid for it. And I think that's the problem. It's not that anyone did anything wrong. I don't wanna, you know, cast blame on you know, the the hospitals or the clinicians or the pharmaceutical company or the insurers. Uh, but I think it reflects the fact that we have a system that starts with a baseline of if you don't get paid then you don't live. So everything has to start with us making money, which means that money is a barrier to people who don't have it. I think the next thing to talk about is the fact that the R S V antibody EFAB is going to be added to V ffc.
Dr.Ryan Hassan: (26:40)
Again that adds to the cost of participating in V F C, which means that clinics who participate in it will now have that additional cost to bear, will have to buy all this private stock of NEV and of course bear the logistical burden of trying to get every newborn baby, you know, given that medicine immunized in the next R S V season the next few months. And if they're not able to get it in the hospital, that's a lot more burden on those clinics and that is gonna mean that it's gonna be very hard for a lot of these clinics potentially to keep participating in V F C. And people I've talked with at O I P or in an immunization program have said that they worry that there might be a lot more clinics who are no longer able to participate in V F C.
Dr.Ryan Hassan: (27:23)
And in a similar vein, the COVID vaccine is now also added to V F C and it's been commercialized, right? It's been privatized. So you know, we talked about before I, in the medical emergency episode when it was ending that the vaccine would now be privatized as is Paxil I the insurance treatment for uh, COVID. And that means the government's no longer paying for it automatically and giving it to people for free. Which means that clinics have to find a way to do that. And that means that you know, now that it's gonna be on V F C, that clinics will have to add this whole private supply of Covid vaccine to their stock in order to participate in V F C. That poses a whole nother set of challenges because the code vaccine is also gonna be pretty expensive. We don't know the exact cost, it only costs a few bucks to make, but it was sold to the government for a lot more than that and Pfizer has previously indicated they're gonna raise the prices even more at the commercial prices.
Dr.Ryan Hassan: (28:21)
So it's gonna be more expensive. And I don't know what that cost is. Pfizer c e o was coded saying something along the lines of, it's okay because the insurance will pay for it. Which I thought was a very ridiculous thing to say because insurance paying for anything more just means that, you know, we still pay for it, we pay for our insurance costs, it's just paid reflected in our premium prices really all into insurance. But it, I think it was a pretty obtuse thing to say in my opinion, but that cost is gonna be reflected in a higher cost for clinics to participate in B F C, which means another reason why there might be more clinics who can't participate going forward or who at least have a lot more administrative burden doing so. And I recently spoke with a provider who told me that there's actually a number of clinics he's spoken with where they've actually started thinking more and more about the fact that an alternative to this current system with V F C might actually be better even though it might even make things more expensive for us, it might be better for making it logistically simpler to just get all the patients vaccinated because it's such a barrier sometimes.
Dr.Ryan Hassan: (29:23)
'cause you have to manage the two supplies and manage these changes every time they happen. This is like the best I can explain it after spending the last three, four months learning about it on top of, you know, my whole medical background and I may not be a hundred percent on all of the exact details. Details and again, I don't know all the right numbers and a lot of this information is gonna change in the coming days and weeks. You know, prices haven't been finalized and we don't, I don't even know exactly when you know I'm gonna have NEV and new COVID vaccine available in my clinic. So it's hard to really forecast with too much certainty and that's another challenge because of everything happening so quickly recently we have these recommendations for making sure people get their COVID vaccine and their R S V antibody this fall, but we don't have those medicines available yet and we don't even have exact prices on them and we don't have a logistical, you know, layout for how it's gonna be given.
Dr.Ryan Hassan: (30:17)
Those are I think some of the big challenges I've been trying to kind of work through and navigate in my work with O I P recently and some of the reasons why I'm a little worried about the way that this current system works. And again, for me it all comes down to again the fact that this is, everything starts with the for-profit healthcare system. We have these medicines that work, we have ways to keep people from getting sick but there's these bureaucratic barriers that are keeping us from being able to optimally give them to everyone who needs them when we need to. It's, it's unfortunate.
Ari O'Donovan: (30:50)
Yeah, you can be healthy and well and protect your family and new children for the right price. That's the way things go in this country and it's disturbing. It just is really, it worries me because it's like we said with the last conversation about c Ovid 19 and ending the emergency order, now you've got two really important vaccines that are gonna cost quite a bit of money. Even if we don't know a price right now they're, it's probably gonna be more than $15. So then where does that leave parents with new babies or young kids who decided they want to vaccinate their kids who just had a child that they want to vaccinate. It can lead you to feel helpless as a parent when you can't do anything because your hospital or your provider is not participating in V F C 'cause it's too much of a burden for them. And it's not like you can just change your insurance when you want to. Like you have to go where the insurance that you get from working a job allows you to go
Dr.Ryan Hassan: (31:57)
Another ludicrous part of our system that I don't think we talk about enough. But the whole concept that your insurance should be provided by your employer is just nonsensical. It makes everything more expensive and less useful and less uh, less navigable and accessible. Why would that be the way that, uh, we set things up And I remember learning a little about the history of how it came to be a while ago and I don't remember it well enough to speak on today, but it certainly does not make any more sense if you learn about why it is that way. If anything it makes a lot less sense.
Ari O'Donovan: (32:33)
Barbaric , that's a strong word but I'm gonna use it. It's just barbaric
Dr.Ryan Hassan: (32:39)
The
Ari O'Donovan: (32:39)
Way that we do that today. And
Dr.Ryan Hassan: (32:42)
The,
Ari O'Donovan: (32:42)
These are all conversations, Ryan, that we can get into another time 'cause they're gonna be whole episodes by themselves.
Dr.Ryan Hassan: (32:49)
Yeah, that would be a good one. We should talk one time about why we getting in health insurance through our job. That would be interesting to explore that. Yeah.
Ari O'Donovan: (32:55)
'cause I don't know that and listeners probably don't. That is something we can talk about later on.
Dr.Ryan Hassan: (33:01)
For me. I like to talk about and share this 'cause I think it's important that people are aware of some of what goes on behind the scenes here and some of the barriers that we have and know that there are people trying to their best to, you know, work within the system. And those are, you know, all the people I've worked with, people within the government, the the state government at O H A and O I P and people within the pharmaceutical industry with Sanofi who've, who've met with me and met with with O I P and with the hospitals and and clinics trying to make sure that they are able to ensure that every kid who needs this medicine can get it. Everyone I think is working their, their hardest to try and find a way to work around this. But you know, at the end of the day, Sanofi is a corporate entity.
Dr.Ryan Hassan: (33:41)
It has to make a profit to exist. So is my clinic. My clinic has to make a profit to exist. I have to have a salary to be able to pay my bills. And I think, you know, it's just kind of this, this dirty little secret that's not really dirty and not really a secret that we all have to make money to be able to survive in this system we've created for ourselves. And that healthcare is part of that system and we, I mean I think it's often not really thought about in this context. We talked to a lot of providers who don't really feel comfortable talking about the fact that, well yeah, we make some money when we vaccinate patients. And it's like, well yeah, we should, like we are providing a service and we should be paid for our services. That money shouldn't have to come from people who are having a hard time paying it.
Dr.Ryan Hassan: (34:27)
Like I think also everyone should be able to get their vaccines for free, but we don't have a system that is able to meet both of those needs right now. And that is, I think, a fundamental problem because we start from the basis of a for-profit healthcare system. And you know, the other thing that, the other reason all of this is concerning to me is because it does undermine some of the trust in our institutions. You know, the fact that what we have a medicine that could save kiddos lives and we're facing all these barriers to getting it to kids. You know, it reinforces this very common message from anti-vaccine propaganda that, well people just don't care about you. You know, healthcare doesn't care about you, pharmaceutical doesn't care about you, government doesn't care about you. And in a sense that's true. Those are institutions they don't care about anything about except their, you know, they, their interested is in their self-preservation.
Dr.Ryan Hassan: (35:09)
But there are people in those institutions like myself and the people I work with and the scientists and vaccinologist at the pharmaceutical industry, the very underpaid public health servants and civil servants in O I P and the government who are doing their best to try and create ways for us to navigate the system. But there are barriers that are bigger than that that we, you know, just can't really dismantle on our own. And at the end of the day, to be honest, I mean it takes people being aware and voting for policies that prioritize funding for healthcare and prioritize ensuring that people can have access to the medicines they need and that we can all make sure that we provide what is most important, which is a safe and healthy environment. Healthcare and food and housing and, and education. To be quite frank, for everyone who lives in this country
Ari O'Donovan: (35:57)
Really though, that is your best bet. I know so many people that only vote for the president and it's like you really gotta start voting for more things that affect you directly in your state because that's just the tip of the iceberg.
Dr.Ryan Hassan: (36:12)
I totally agree with you. Maybe by the time this recording airs, there will be a solution and we'll make sure that NEV is provided for. But even if that does happen, there's still a lot of barriers to the V F C program that we have outlined and those aren't going away unless we make some fundamental changes to the way we provide vaccines in the state. And that's also something I'm hoping to, to work on going forward. But you know, that's a bigger undertaking and know where that might lead us.
Ari O'Donovan: (36:37)
Yeah, I really hope to see some change. I appreciate all the work that you do, Ryan, and shout out to O I P too. My time at Boost Oregon started there as an intern and I've never seen a group of more caring and interested people in the health and wellbeing of the community than them. They really actually do try, even though they're limited in what they're able to do. Because like you said, it's a big problem. It's gonna take statewide change, national change, but they still try and I appreciate that.
Dr.Ryan Hassan: (37:13)
They certainly, you know, they pretty sure they make a lot less money than me and I think they work longer hours too. It's very inspiring working with, you know, Mimi Luther and Kelly McDonald over at ip. They're doing such important work and it's so under-recognized. They are so limited in what they can do. And I can see that frustration working when I work with them that that what it is like to have to work in that, in that type of setting. But, you know, hopefully by talking about it and maybe trying to share my own perspective and bring some light to it to a broader audience, maybe one of our listeners will, you know, have some way to kind of work with us and, and get involved and, you know, have suggestions for, you know, ways to move forward. I think the solution to this and every problem we face is people working together is deconstructing the silos that keep us apart and reaching out to the community and, you know, getting everyone's involvement and getting other people's lived experience to help us figure out, you know, what can we do to address this need.
Ari O'Donovan: (38:10)
So true. And that's the whole purpose of this podcast. We wanna get people talking, give people organizing. We wanna hear from the community, bring information to the community that they wanna know about, stuff that they don't even know that they need to know about necessarily, but for them to be more educated about a topic. And I think that's what we did today.
Dr.Ryan Hassan: (38:31)
Yeah, I certainly hope so. I hope it was, uh, I hope people were able to follow it. It it was, I know it took me a long time to be able to understand all this. Uh, and I I would still say I don't fully understand all the processes, but
Ari O'Donovan: (38:42)
You distilled it down well though, Ryan, I like 80% of that. I really did not know.
Dr.Ryan Hassan: (38:49)
Glad that it was helpful. Yeah, well it was fun or thanks for having me on again. It's a good time. Looking forward to doing it another time.
Ari O'Donovan: (38:56)
Yes, definitely. We gotta have more conversations. Thank you for being here, Dr. Ryan Assan, it's always great to talk to you. I learned a lot today. I know that other people will learn something really good too, and that's where you start is with education. So thanks you very much. Thanks for listening to this episode. Can bring the community info without the community. Appreciate you showing up. If you wanna reach out, hit us up on ig at boosting our voices or at our website, boost oregon.org. Keep doing great things, keep uplifting one another and we'll do the same. See you next time.