Health Care Reform

[keokie]

Sprink,

Great drugs are developed and marketed in the U.S., because it can be extremely profitable to do so. If our government changes that, the drugs (and other medical advances) simply will not happen. Do you really think Pharma companies will spend billions on R&D and marketing with a guarantee of poor return? If you do, take a look at Canada where it is virtually impossible to profit from the development of a new drug. They have only 2 drug patents for the last 25 years.

The truth is, the U.S. market is the driving force for medical and pharmaceutical advancement. If we change that. The quality of healthcare worldwide will suffer.

I'll take my healthcare good and expensive, rather than cheap and crappy.

 

[Blueone]

Very well stated in your last 2 posts Gary. Im proud of you :smt001

Ya I am with you seems lately Gary really is coming out of his shell and learning to speak his mind

 

[sprink56]

"If I'm a company, I have the right to sell anything I develop for any price I want in any country. In software, we used to charge double in Europe... why? Because it's what the market would bear. Why is that wrong? Maybe they did a market analysis and determined what price points had to be where to maximize sales. Is that wrong? Why?! It's their intellectual property. No one has right to claim products and determine what price points should be other than the people that developed them. If I wanted to sell my software in Canada for $1 and here in the US for $1000, that's my right. Don't like it? Don't buy it."

Good thoughts and well said. It is also the right of the consumer to choose which products are purchased therefore creating competition among purveyors of any particular product...be it software, pleasure boats, or pharmaceuticals. What we don't want to end up with is a "controlled" environment that provides any form of "protectionism" for any particular group of products.

A good example of this is what Nucor Steel is up against in selling steel even in the United States. China is subsidizing it's steel manufacturers allowing them a cost advantage in the world market. that subsidy is a form of "protectionism" for their steel industry that we don't afford ours....yet we allow Chinese steel companies to dump their products in this country at an unfair price advantage.

There appears to be some artificial pricing in the US relative to pharmaceuticals and tax payers are being forced to pay the tab. The best example of this is that when buyers of medicines for the Veterans Administration go shopping they are allowed to negotiate the best possible price with the pharmaceutical companies. Yet when buyers of drugs for Medicare/Medicaid/Senior Drug plans buy the same products as purchased for the VA, we pay a substantially higher pre set price for the same drug!

At the end of the day the money is coming out of the same general fund that you and I are paying for. Why are we getting screwed on this deal? It's happening because lobbiest bought legislative favors which have artificially influenced the pricing of these drugs. Don't you wish you could get that same deal selling your software?

I am not advocating more governmental intrusion...but less. I advocate removing all governmental intrusion and let the market sort out the prices...in all industries.:thumbsup:

 

[Turtlesboat]

Here's what a lot of "kids" young adults, whatever you want to call them, refer to A LOT. It's a viral movie that pretty much every one under say 28 has seen, and they think it's complete fact. this is the addendum version with a "solution" called the venus project. I work with a lot of young people and when politics gets a flyin and conspiracy theories start flowing, they always refer to this video. If you've got a spare 2 hours to get through it, watch it.

[youtube]1gKX9TWRyfs[/youtube]

 

[Southpaw II]

Price (of anything) has nothing to do with cost. Price is determined by demand. Hasn't anybody learned anything by buying gas or diesel over the last year? The same is true with drugs....legal or illegal....or tobacco...or cars...or groceries.

 

[fc3]

What Gary said.

Patents are not a form of protectionism. The founding fathers included patent protection because they spur innovation and creativity. No one is going to spend time, money, and resources to innovate anything if someone else can reverse engineer a cheap copy. That goes for everything from iphones to pharmaceuticals. Only an idiot would spend years and a fortune to invent something that anyone else can copy without cost and without compensating the inventor for his efforts.

Biopharmaceutical oncology drugs are amount the most expensive on the market. Take the profit out of these life saving drugs so that everyone can afford them and the pharm companies won't invest in discovering, testing, and manufacturing them. Instead of oncology drugs they'll invest in lifestyle drugs to prevent baldness or anything else they can think of that's a luxury that would not fall under government price controls.

The main reason why cheaper drugs are available in canada than in the U.S. is because American's are subsidizing the development and trial cost for those cheapskates. The products only earn a profit on the manufacturing costs, not on the entire cost of the product.

 

[VTSeaRay]

Price (of anything) has nothing to do with cost. Price is determined by demand. Hasn't anybody learned anything by buying gas or diesel ove the last year? The same is true with drugs....legal or illegal....or tobacco...or cars...or groceries.

Actually, last summer's fuel increase (and this summer's) are primarily from oil speculation, and aren't dependent in entirety on supply and demand.

- but the other items you talk about are.

 

[Southpaw II]

Actually, last summer's fuel increase (and this summer's) are primarily from oil speculation, and aren't dependent in entirety on supply and demand.

- but the other items you talk about are.

That's what the pundits said on TV. Prices at the pump fell because demand lessened.

 

[Four Suns]

Here's what a lot of "kids" young adults, whatever you want to call them, refer to A LOT. It's a viral movie that pretty much every one under say 28 has seen, and they think it's complete fact. this is the addendum version with a "solution" called the venus project. I work with a lot of young people and when politics gets a flyin and conspiracy theories start flowing, they always refer to this video. If you've got a spare 2 hours to get through it, watch it.

[youtube]1gKX9TWRyfs[/youtube]

OK. I watched it. That thing is so full of horsesh!t on so many levels it's almost funny.

"Money is created out of thin air"... No sh!t?! Wow... I was told aliens brought it here. Money is like points on a scoreboard at a football game. When a touchdown happens... BOOM... the points are created out of thin air!! amazing! I was always taught that money was a method to keep track of one's production and contribution to society... "points" if you will... I write a book.. if people buy it... I get points... I can use my points for consumables and hopefully I don't consume more than I produce... Hell.. I've been misled!

That Venus project is laughable... it's like the movie Terminator meets Barney (I love you, you love me, we're a great big fam-i-ly...)

Maybe I'll write a book/paper on what CRAP that video is... It'll make me famous.

 

[fc3]

You're a more patient man than I. Ten minutes was all I could stand. If that stupid thing was a book, no one would pay attention to it. But stupid people watch TV, you tube, etc. So this is just the thing for them. Just enough fact to make it plausible.

 

[Four Suns]

I think they were all smoking dope.

 

[Turtlesboat]

I call it the Church of Scientology reasoning. You take a little fact, mix it with a little fiction, add in a touch of poo. You have a whole new "religion".

there is so much false info mixed in with fact, that you can't tell which is which by the end of the video.

but my point is that THIS is becoming the new movement. Believe it or not, the stupid people take this as the truth.

 

[dpvandy01]

You don't know what you're talking about. If a company modifies and improves an existing drug, which then gets patent protection, the original product is still available as a generic. One does not have to take the latest and greatest.

I work for a biopharm. It costs us at about a half billion to develop one new promising drug. Meanwhile hundreds end up with no therapeutic value. Then once you do find something that might work, it costs 800 million to get it though clinical trials so that it can be approved. Then you need to satisfy the approval agencies in every different country. Finally, with the patent half gone, you get to sell it and hope that you recover your investment.

Yes, biopharmaceutical are very expensive. But they are grown, not manufactured. The process is very expensive.

Lastly generic makers don't do any clinical trials. They just live off the trials done by the big R&D pharma companies. It's easy to be cheap when you just copy someone else's work, have someone else do the research and let them take the risks.

and after all of that investment, scrutiny, patent processing and finally FDA approval, 5 years later your drug interacts with one that wasn't even on the market when you were in phase one let alone phase three clinical trials, the pharmaceutical company's ass is on the line for millions.... and the agency that cost them billions to prove the safety and efficacy of the drug is insulated and immune from litigation........

 

[comsnark]

Well. . .something is wacked in the current system.

Here is my story:
I had an issue (non-life threatening). I got the best doctor I could.
He gave me a cost estimate. It was high. . but not out of my affordability.
Then we talked about my insurance.

With my insurance, the cost dropped substantially using the "approved rates". . . more than 50%. Still, my insurance did NOT cover the full cost. They covered part. . I covered the rest of the reduced cost. The difference between the cost with insurance and without insurance was SUBSTANTIAL. Now I am not talking about the difference in what I paid. . I am talking about the difference in what the DOCTOR got.

Holy cow. . .I learned a vital lesson. The value of the insurance wasn't what they pay. .(frankly that was chump change). . the value was the rate the doctor billed was changed. And he doesn't starve. He has a nice office. His office is well equipped. He drives a NICE car. I bet he has a nice boat as well.

If I didn't have insurance. . I would have been charged a HUGE bill (several boat units) If I was POOR without insurance. . I would have been totally hosed.

That is whacked. Why shouldn't everyone be paying the same cost for the same service? Is it really a question of how much your insurance can negotiate costs? Huh. Capitalism really produces crazy results sometimes.

 

[Four Suns]

Well. . .something is wacked in the current system.

Here is my story:
I had an issue (non-life threatening). I got the best doctor I could.
He gave me a cost estimate. It was high. . but not out of my affordability.
Then we talked about my insurance.

With my insurance, the cost dropped substantially using the "approved rates". . . more than 50%. Still, my insurance did NOT cover the full cost. They covered part. . I covered the rest of the reduced cost. The difference between the cost with insurance and without insurance was SUBSTANTIAL. Now I am not talking about the difference in what I paid. . I am talking about the difference in what the DOCTOR got.

Holy cow. . .I learned a vital lesson. The value of the insurance wasn't what they pay. .(frankly that was chump change). . the value was the rate the doctor billed was changed. And he doesn't starve. He has a nice office. His office is well equipped. He drives a NICE car. I bet he has a nice boat as well.

If I didn't have insurance. . I would have been charged a HUGE bill (several boat units) If I was POOR without insurance. . I would have been totally hosed.

That is whacked. Why shouldn't everyone be paying the same cost for the same service? Is it really a question of how much your insurance can negotiate costs? Huh. Capitalism really produces crazy results sometimes.

Horse poop. You think that a gallon of milk should be the same price if it is bought at Sam's Club versus the corner 7-11?

 

[sprink56]

Well. . .something is wacked in the current system.

Here is my story:
I had an issue (non-life threatening). I got the best doctor I could.
He gave me a cost estimate. It was high. . but not out of my affordability.
Then we talked about my insurance.

With my insurance, the cost dropped substantially using the "approved rates". . . more than 50%. Still, my insurance did NOT cover the full cost. They covered part. . I covered the rest of the reduced cost. The difference between the cost with insurance and without insurance was SUBSTANTIAL. Now I am not talking about the difference in what I paid. . I am talking about the difference in what the DOCTOR got.

Holy cow. . .I learned a vital lesson. The value of the insurance wasn't what they pay. .(frankly that was chump change). . the value was the rate the doctor billed was changed. And he doesn't starve. He has a nice office. His office is well equipped. He drives a NICE car. I bet he has a nice boat as well.

If I didn't have insurance. . I would have been charged a HUGE bill (several boat units) If I was POOR without insurance. . I would have been totally hosed.

That is whacked. Why shouldn't everyone be paying the same cost for the same service? Is it really a question of how much your insurance can negotiate costs? Huh. Capitalism really produces crazy results sometimes.

As is said...You don't get what you deserve...you get what you negotiate.:thumbsup:

 

[Jack F]

Volume discount is given to the insurance company.

 

[comsnark]

Horse poop. You think that a gallon of milk should be the same price if it is bought at Sam's Club versus the corner 7-11?

Not at all. I just expect that if I buy at 7-11 that the guy ahead of me and the guy behind me pay the same price.

As is said...You don't get what you deserve...you get what you negotiate.:thumbsup:

No kidding. So the point I am making is that insurance is not just about coverage but also about negotiation. I think this point is simply LOST in the entire debate.

But "milk" and "major medical care" is not the same is it? When you buy a commodity, generally the buyer and seller have comparable information and comparable financial stake. But in the case of medical procedures, the provider has fundamentally more information and the consumer has far more at stake.

It's not like you one price shops ambulances while having a heart attack.

You put *insurance* into the mix, and you get the benefit of "negotiated price in advance", but it comes at the cost of putting another individual with a profit motive into the mix who does NOT actually your interests in mind (except peripherally).

When you SHOP insurance. . .do people compare deductibles, or life expectancy of members? Do people shop "max out of pocket expense" or "quality of life of members". Can you even GET that information if asked?

I suspect that this is a flaw in the free market model for medicine;too many non-insurance transactions occur in a "price is no object" manner.

- - - - - -

I am not saying I have a solution to this issue. I am not advocating anything. I am just saying things are messed up.

 

[Asureyez]

The entire healthcare services industry is in essence fleecing the public. There are at least two price structures for their services.

The negotiated rate given to third party payers, which may also vary based upon the Third Party Payer (TPP) agreements or billing groups joined by the provider.

The second price is the "normal and customary" rate which is set uniquely by the provider, with some influence by similar rates by other similar providers in the area. This rate will be 2-10X the negotiated rates.

WHY? Well occasionally a patient will be a cash payer and will elect to take the fleecing. But much more importantly, when the Provider takes case assignments of indigents by the hospitals, they get a % reimbursement from the counties or states which is almost always based upon the "Usual and Customary" rate or some % there of. This last ditch TPP for the indigent and uninsured (also w/o assets) is the local property owners or state funds which collect fees from voluntary insurance plan providers (our Group insurance plans).

The false high rate is a method to jack up fees from the other, non insurance payment systems. What can be the justification? Payment from these systems can take months if not years. Much as having to seek judgments to seize assets. Consider that if an un or under insured seeks services and can not pay, this higher rate becomes the rate the Provider seeks to collect from the patient in judgments in the courts to take their assets if necessary.

In essence, the TTP system of negotiated rates has established a NEW “usual and customary” rate for services. We the consumer are quite aghast to learn how the system is built to fleece us in these two tier pricing systems. Go figure!

I’m sure we’ll have some Providers speak up in here, but the reality is the USUAL and Customary rates are a sham that is rarely ever actually paid, other than in collection efforts or as judgments in lawsuits. Yeah to the trial lawyers!

These shoddy practices have been are built from an evolutionary response to the way medical costs have been controlled by Medicare/Medicaid, private insurers and the employers. The public is rarely given an consideration in the morality of what they are doing.

The result is going to be a cram down on medical care costs in system that will become the worst possible solution to greed and excess from this industry. We the patient consuming public will again be fleeced!:smt100

The public wants chang ein this system, the difficulty is getting a sensible change that the public can and will support.

 

[Asureyez]

About drug company charges.

Some years ago, drug companies werre allowed to write off their R&D expense against current earnings and reduce their federal tax liability from curretn earnings. The Goverment wa sin essensce subsidizing drug development through the tax system. Not a bad idea really. Well because the Pharma industry was paying low taxes on current earnings brilliant Congress chaged the rules and forcced Pharma to capitalize their development costs which caused an increase in current taxes, plus had to use real cash to develop drugs. Okay .. pay your fair share right? Well to get the developemnt costs recovered inside the patent protection period typically 7 years from time in market, they had to jam all these costs into the pill sold today. Sounds fair right?

Then as drugs became more selective and directe dto narrowly incurred health prioblems, more adverse consequences occurred resulting in an increasing level of tort claims by patients. Large awards increased costs which get jammed into the pill cost sold today. Then, management in the US keeps their job base don this quarters performance which must always increase, never ever go flat or down. So profits required to satuify shareholder demands for esclating profits gets crammed into the price per pill sold today to deed the financal communities greed.

So we stand at the end of 50 year period of temendous developemnt and improvement in the health of people from drugs. The problem is the ponzi scheme of pricing is about to bust the system. A catharsis is necessary to get an affordable drug development system and rational pricing at the Pharmacy counter.

What to do: Developement should be expensed as incurred, drug prices should be limited based upon a formula derived by annual doses vs. overhead and profits. Since the developemnt was undertaken with the citizens paying a part of the cost, the patent protection for drugs should be reduced to three years before generic mfg. can step in and competition used to control costs.

Tort claims should be limited in costs much as in airline accidents.