THIS is the problem with healthcare

[sdifox]

Remember it isn't us guys. It's retarded conservatives that would rather twist themselves in knots rationalizing why the liberals are wrong and continue being fleeced instead of admitting liberals are right.

You make it sound like this is a partisan issue. It isn't. Root of the problem is unfeted political contribution. Shit like Citizen United is what allows the rich to control the country.

First iteration of Universal Heathcare was enacted on July 1, 1968 in Canada. That's half a century ago.

 

[darkswordsman17]

You make it sound like this is a partisan issue. It isn't. Root of the problem is unfeted political contribution. Shit like Citizen United is what allows the rich to control the country.

While I agree that plays a huge role, you're dismissing how that was a partisan issue.

The ignorance and refusal is partisan, but its like so many other topics, where the one side screaming about it being "political" are the ones that made it so. They're the ones dismissing all objectivity in order to keep their blinders on. Global warming, health care, gun rights, they're the ones that politicized them, or rather politicized their refusal to actually do anything about them. Governments are looking at those things because that's the fucking point of having a government, is to deal with major issues. Just because topics like those are going to be managed by governments operating in political systems, does not make them politicized topics in the sense that the idiots are trying to say they are. That happens when a political party goes "nope, not even going to discuss it" even when they'll often say it absolutely is an issue. And that's actually less than what Republicans have been doing, which is to not only refuse to discuss it, but to try and lie and intentionally coverup if not outright sabotage anything that disputes their claims about it.

I don't know if I've met a single claimed Republican who doesn't say that "money needs to be out of politics", yet they're supporting a party that is looking for every way they can allow unfettered money to flow into our political system. Its possibly the most absurd of all the absurd hypocrisy. I see a lot of them that say that is by far the biggest problem and doing something about it would automatically make a huge difference (for the better) on every single issue, and yet they flat out refuse to even acknowledge when their party openly pushes for the opposite of that, and has chosen to ignore all the rampant corruption the Republican party has shown for 4 decades (longer than that, but especially on the topic of financial conflict of interest corruption that they crow on about so much). They want Hilary burned at the stake, despite hundreds of millions of dollars of investigations showing she's less corrupt than the Republicans they vote in. Until they can actually accept how bullshit they are, its not going to change.

 

[yllus]

The only reason I can think of that America should refrain from going single payer is that I wonder if R & D at pharmaceutical companies would slow because the profit incentive gets significantly diminished. Does anyone have any information on that topic?

 

[sdifox]

While I agree that plays a huge role, you're dismissing how that was a partisan issue.

The ignorance and refusal is partisan, but its like so many other topics, where the one side screaming about it being "political" are the ones that made it so. They're the ones dismissing all objectivity in order to keep their blinders on. Global warming, health care, gun rights, they're the ones that politicized them, or rather politicized their refusal to actually do anything about them. Governments are looking at those things because that's the fucking point of having a government, is to deal with major issues. Just because topics like those are going to be managed by governments operating in political systems, does not make them politicized topics in the sense that the idiots are trying to say they are. That happens when a political party goes "nope, not even going to discuss it" even when they'll often say it absolutely is an issue. And that's actually less than what Republicans have been doing, which is to not only refuse to discuss it, but to try and lie and intentionally coverup if not outright sabotage anything that disputes their claims about it.

I don't know if I've met a single claimed Republican who doesn't say that "money needs to be out of politics", yet they're supporting a party that is looking for every way they can allow unfettered money to flow into our political system. Its possibly the most absurd of all the absurd hypocrisy. I see a lot of them that say that is by far the biggest problem and doing something about it would automatically make a huge difference (for the better) on every single issue, and yet they flat out refuse to even acknowledge when their party openly pushes for the opposite of that, and has chosen to ignore all the rampant corruption the Republican party has shown for 4 decades (longer than that, but especially on the topic of financial conflict of interest corruption that they crow on about so much). They want Hilary burned at the stake, despite hundreds of millions of dollars of investigations showing she's less corrupt than the Republicans they vote in. Until they can actually accept how bullshit they are, its not going to change.

Democracy can only work with a population capable of critical thinking. This has not been a strong suit of the Americans. There has been a few Democrat majority government in the last half century, yet the best you managed was ACA, which is an half assed measure. So while Republicans have done the most damage, it is the people that keep electing them the problem. Until you fix the people, nothing will change.

Not that Canadians are saints, we vote against our own interest once in a while as well. Ontario just elected a premier that used to be a hasish dealer during his youth. Didn't even bother to put out a costed platform yet got majority.

 

[ivwshane]

Since I've addressed this topic before, I'll simply quote myself:

We could lower our health care costs if we do what every country does...implement price controls. Unless we do that it really doesn't matter what system we use, our costs will continue to still be high.

Here's why that won't happen: Representatives are forced to spend a lot of their time fund raising and rely on big donors for support. Those donors typically prefer policies that enrich them through favorable legislation for their businesses.
Because of changes newt gingrich implemented for Congress, house representatives no longer have adequate resources to craft good, smart, complicated legislation and now pretty much rely on industry lobbyist to write their legislation.

Of course this was brought to you by the, party before country, Republican party, most specifically newt gingrich. No single man has wrecked this country as much as that man did when he was speaker of the house.

I will also add that if we really want to cure diseases, we should have a government agency in the same way we have NASA to explore space. Like NASA, it would publish its data for all to use and its findings would be public domain.

There isn't any reason to still not subsidize some research but because there would now be a competitor in the market, drug companies would now be forced to find cures instead of drugs that mask the symptoms in order to monopolize the market.

 

[soundforbjt]

What you should be asking is why do drug companies spend so much more on advertising than they do on research? I’m talking about all those commercials telling you to hound your doctors for specific medications instead of letting them do their jobs based on what is in the patients best interest.

Imagine the impact dropping that would have in the price of drugs.

Why do you think the US consumes 80% of the drugs produced, advertising works.

 

[Brainonska511]

I’m talking about all those commercials telling you to hound your doctors for specific medications instead of letting them do their jobs based on what is in the patients best interest.

As I've heard from top physicians, those adverts don't just target consumers: doctors are people too and watch TV. Many community physicians may not be as well versed in the latest clinical trials, so those advertisements work to build both disease and brand awareness.

 

[soundforbjt]

As I've heard from top physicians, those adverts don't just target consumers: doctors are people too and watch TV. Many community physicians may not be as well versed in the latest clinical trials, so those advertisements work to build both disease and brand awareness.

Yep, they need to be up to date on drugs that make your eyelass's grow.

 

[Ausm]

The Healthcare costs will never go down until the Politicians quit getting their collective palms greased by Big Pharma.

 

[MomentsofSanity]

As I've heard from top physicians, those adverts don't just target consumers: doctors are people too and watch TV. Many community physicians may not be as well versed in the latest clinical trials, so those advertisements work to build both disease and brand awareness.

So you think ads are the best method for physicians to keep current on treatment options? I’d agree if we were talking medical journals. Not every damn channel on your television. That’s aimed at the consumer only. It’s created something called disease mongering to try and grow their market where no morbidity benefit exists.

 

[Sunburn74]

Why do you think the US consumes 80% of the drugs produced, advertising works.

I don't think its advertising at all actually.
Its mostly wealth, access, and cultural. We are the wealthiest nation with the worst lifestyle patterns and arrangements, with decent access to medications, and have a culture of taking medicines for things treatable with lifestyle changes.

Take this for example. Not getting boners with the old lady? You could lose weight and thus reverse obesity related pituitary suppression of testosterone, get your diabetes under control with said weight loss and improve penile neurovascular signaling with better blood sugar control, and with exercise re-train your vascular system to respond appropriately and briskly to both exercise and sexual stimuli. You could do that... or you could take viagra and get testosterone shots (the latter not even proven to work in some clinical trials despite being a 3 billion dollar industry annually in the US). I don't think its really advertising because the majority of people don't want to take pills but take them when they look at the alternative (which is generally lifestyle changes).

 

[Brainonska511]

So you think ads are the best method for physicians to keep current on treatment options? I’d agree if we were talking medical journals. Not every damn channel on your television. That’s aimed at the consumer only. It’s created something called disease mongering to try and grow their market where no morbidity benefit exists.

I don't think the ads are necessarily the best method to reach physicians, but it is one way to reach them. As I said, not all physicians are as steeped in the literature as the top people in the field. And yes, some of it is aimed at consumers - with the changing nature of medicine and treatments available, sometimes its important to build disease awareness to let people (consumers and physicians) know that something is actually a medical condition and could be treatable. And with the changing nature of content delivery for journals, I doubt an ad in a printed journal would be as effective as it would be 10-15 years ago.

Now, should payers be picking up the cost of every single medication? Probably not. The payers need to do the analyses to see if a drug actually has a good cost/benefit compared to existing standard of care options or other treatments. And in the event of a single payer system, we need to have people that will do the unpopular thing and deny coverage of certain medications [negotiating drug price rests on the ability of a payer to say "no"]

 

[Sunburn74]

I don't think the ads are necessarily the best method to reach physicians, but it is one way to reach them. As I said, not all physicians are as steeped in the literature as the top people in the field. And yes, some of it is aimed at consumers - with the changing nature of medicine and treatments available, sometimes its important to build disease awareness to let people (consumers and physicians) know that something is actually a medical condition and could be treatable. And with the changing nature of content delivery for journals, I doubt an ad in a printed journal would be as effective as it would be 10-15 years ago.

Now, should payers be picking up the cost of every single medication? Probably not. The payers need to do the analyses to see if a drug actually has a good cost/benefit compared to existing standard of care options or other treatments. And in the event of a single payer system, we need to have people that will do the unpopular thing and deny coverage of certain medications [negotiating drug price rests on the ability of a payer to say "no"]

I don't think ads are reaching doctors. What mostly reaches them are marketing talks and reps that come out to where the doc works (pharma reps, device reps). Once they get a doc hooked, generally he's hooked for life.

Most payers do have some form of cost analysis where expensive drugs are rejected/not covered. What's wrong is that expensive drugs that do work and have clear tangible benefits over replacement often are also rejected simply because they are priced at astronomical costs. Look at the current pricing problems with CAR-T cell therapy, PCSK-9 inhibitors, a few specific chemotherapy drugs, etc etc Heck even things like replacement factor VIII for hemophiliacs (which clearly works and has almost no alternative in some cases) often will be rejected based on its astronomical cost. The problem is not that bad drugs have disproportionately high costs but that almost all drugs these days have disproportionately high costs and nothing seems to be slowing the trend.

I remember a very prominent healthcare economist quirp that if Jonas Salk had invented the polio vaccine today, we'd still have widespread polio (because it'd be like $7000 a shot)

 

[MrSquished]

woman gets injured in Boston, is more worried about not getting an ambulance ride due to the cost - this is our America

https://www.nbcconnecticut.com/news...orm-at-Mass-Ave-Station-Boston-487178921.html

 

[GagHalfrunt]

Drug prices are the most direct example of what protectionist policies will do the cost of a product. If our politicians had any balls and morals they would open up our market and watch as the price of most drugs plummets because drug makers do not have a captive audience. Now they are competing with factories in China, India, or anywhere else to sell their products.

I have to give you credit. That could be the single dumbest thing ever said in P&N and the mind just boggles at the prospect.

Latest estimate is that it takes $2.6 BILLION to get a drug developed, tested and successfully to the marketplace. Any drug that fails is money wasted and the majority of drugs do in fact fail somewhere along the line. Pharmaceutical companies pour hundreds of billions into unsuccessful products to come up with a few that work and they have to be able to recoup R&D on their failures. Without that, drug development STOPS COMPLETELY. ZERO. ZIP. ZILCH. Not another new drug ever gets developed and the factories in China, India and the rest of the world have nothing to copy.

 

[MrSquished]

I have to give you credit. That could be the single dumbest thing ever said in P&N and the mind just boggles at the prospect.

Latest estimate is that it takes $2.6 BILLION to get a drug developed, tested and successfully to the marketplace. Any drug that fails is money wasted and the majority of drugs do in fact fail somewhere along the line. Pharmaceutical companies pour hundreds of billions into unsuccessful products to come up with a few that work and they have to be able to recoup R&D on their failures. Without that, drug development STOPS COMPLETELY. ZERO. ZIP. ZILCH. Not another new drug ever gets developed and the factories in China, India and the rest of the world have nothing to copy.

Do you have a source for your numbers. You know, breaking it down how every drug takes 2.6 billion bucks to get to market?

 

[MomentsofSanity]

Do you have a source for your numbers. You know, breaking it down how every drug takes 2.6 billion bucks to get to market?

Tufts put out a study a couple years ago that quoted this number but it was grossly inflated by theoretical costs. Not out of pocket actual. Things like “time costs” of $1.6B. Basically it’s expected returns investors forego while a drug is in development. Things like that heavily inflated the actual out of pocket costs.

 

[Chapbass]

Tufts put out a study a couple years ago that quoted this number but it was grossly inflated by theoretical costs. Not out of pocket actual. Things like “time costs” of $1.6B. Basically it’s expected returns investors forego while a drug is in development. Things like that heavily inflated the actual out of pocket costs.

Heres a link to an article. I haven't read it, so I'm not giving my opinion. Just the first one I saw.

https://www.scientificamerican.com/article/cost-to-develop-new-pharmaceutical-drug-now-exceeds-2-5b/

 

[MomentsofSanity]

Heres a link to an article. I haven't read it, so I'm not giving my opinion. Just the first one I saw.

https://www.scientificamerican.com/article/cost-to-develop-new-pharmaceutical-drug-now-exceeds-2-5b/

Yeah that’s the Tufts one I saw. It’s badly inflated.

This article explains a lot of why.

https://www.ft.com/content/6a57fcd4-bdcd-11e4-8cf3-00144feab7de

 

[uclaLabrat]

Clinical trials are hugely expensive. Phase I is $10-50M or so. Ph II can be $25-100M. Ph III can be $50-100M or so, and you might need 2-3. That doesn't include original pre-clinical research or manufacturing outlays to build capacity necessarily.

Nor does it take into account attrition rates, which the DiMasi work attempts to include. Expect your drugs to fail at a rate of roughly 50% in phase I, 60% in ph II, and 40-50% in ph III. Total attrition rates from pre-clinical to launch are in the range of 9-11% success, meaning one in ten drugs that go into humans will actually become a marketed drug.

For all the billions of dollars that pharma companies spend on R&D, only a approx. 20-45 new drugs are approved each year.

 

[whm1974]

I used to be against "Socialized Medicine" myself when I was younger, especially when after I started reading Ayn Rand for a short period. I but I started to "grow up" as I got older.

 

[senseamp]

Marketing dwarfs R&D for big pharma.

 

[fskimospy]

Marketing dwarfs R&D for big pharma.

Yes, the argument that prices need to be this high because research is expensive falls apart when you realize that drug companies spend between 50% and about 90% more money on advertisements than they do on developing drugs.

 

[WackyDan]

I don't know if I've met a single claimed Republican who doesn't say that "money needs to be out of politics", yet they're supporting a party that is looking for every way they can allow unfettered money to flow into our political system. Its possibly the most absurd of all the absurd hypocrisy. I see a lot of them that say that is by far the biggest problem and doing something about it would automatically make a huge difference (for the better) on every single issue, and yet they flat out refuse to even acknowledge when their party openly pushes for the opposite of that, and has chosen to ignore all the rampant corruption the Republican party has shown for 4 decades (longer than that, but especially on the topic of financial conflict of interest corruption that they crow on about so much). They want Hilary burned at the stake, despite hundreds of millions of dollars of investigations showing she's less corrupt than the Republicans they vote in. Until they can actually accept how bullshit they are, its not going to change.

To be fair, we've seen presidents come and go. House and Senate controlled by either GOP or DNC come and go. We still have money in politics. There is no difference in the level of greed for corporate monies between parties. You apparently buy into the rhetoric that the dems are for changing it... They aren't.

As long as congress both writes and approves campaign finance law we are never going to get big money out of politics.

That said, as long as campaign finance remains an issue, we won't have meaningful reform of healthcare, gun control, immigration etc. Campaign finance should be our number one priority on the path to managing our other issues.

 

[WackyDan]

MY daughter had a visit to the ER about 3 weeks back... Short story is she accidentally ingested a wood chip from the school's playground which caused irritation to her throat and they wanted to be sure the chip wasn't lodged.

Total billing is unknown as of yet, but I see a clue that prior to insurance for part of it the hospital wanted $2800 for a total time of two hours in the ER (mostly waiting) and maybe ten minutes of exam and two x-rays.

The real fun begins probably this coming week when I will probably receive four to five bills from four to five different providers even though our daughter was at a single place of business receiving medical services.

They could not and would not provide an estimate or what the total billing would be even after the services we consumed were complete. Yes, we have insurance and I can see where they might not be able to estimate cost post coverage but they couldn't even give us pre-insurance dollar figures.

This is what is wrong with healthcare. We are supposed to be informed consumers but there is nothing informative about consuming healthcare services. The only time I've ever seen to the penny quotes for healthcare was when the services were elective.

All I ask is that I can receive a projected billing that is within a certain % of accuracy and that I get only one fucking bill from the whole nonsense. Not a bill from the hospital. Not another bill from radiology. Not another bill from the doctor in the ER. Not another bill from some other aspect of facilities. That is the shit that drives me nuts.... as weeks go by and bills just keep coming and you never know when it is going to end.