Seniors lounge (over 50) come on in.

[movdqa]

“This is why Medicare for all won't work - it will bankrupt hospitals”

You mean with everyone profiting like they are now ... thinking mainly big pharma but surgery bills are obscene also.

I think the current system is bankrupting us ... so hope we figure out one that doesn’t.

I think that pharma is making profits. I think that some medical device makers are making profits. I don't think that hospitals are doing that well. Imagine that you, as a business, are required to provide services to everyone that walks in the door, regardless of their ability to pay. How would you operate the business?

We have a system that does cost-shifting. Any other system would also do cost-shifting. Just in another way.

I think that 80-90 percent of people are happy with their health insurance. The big problem is the other 10% to 20%. Do you tear down the current system which works for most for 10-20%?

These hospitals bring in a lot of overseas patients and they pay full fare. Why do you think they come to the United States for care when they can get it at no cost in their own countries?

 

[ByeByePoly]

Some percent of something is better than 0% of nothing.

I negotiated a $14,000 bill to $8,000 for a relative without insurance a few years ago. If you offer to pay on the spot, they may take off up to 50% off the bill. I'd guess that they get nothing in most cases.

Our healthcare is priced based on what the market will bare ... turns out that is more than a conscience should bare.

You know we don’t end up agreeing on this right?

 

[movdqa]

Our healthcare is priced based on what the market will bare ... turns out that is more than a conscience should bare.

You know we don’t end up agreeing on this right?

Everything ultimately comes down to markets.

People try very hard to circumvent them though. Or get someone else to pay and sometimes that works for a while. But there are disadvantages that aren't always immediately clear.

If you think that an industry is making a lot of profits, prove it. Don't just say that he, she, the man behind the tree is making a fortune. Show me the income statement and balance sheet. It's only reasonable to prove it to yourself before you try to convince someone else of something.

WASHINGTON, D.C. -- As the incoming Congress prepares to debate further changes to the U.S. healthcare system, solid majorities of Americans rate the coverage (69%) and quality (80%) of the healthcare they personally receive as "excellent" or "good." By contrast, Americans are much less positive about healthcare in the U.S. in general, with a bare majority rating the quality of U.S. healthcare positively (55%) and about a third giving positive reviews to U.S. healthcare coverage (34%).

https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx

So people like their healthcare but they think that the healthcare that others receive isn't good.

 

[ByeByePoly]

Everything ultimately comes down to markets.

People try very hard to circumvent them though. Or get someone else to pay and sometimes that works for a while. But there are disadvantages that aren't always immediately clear.

If you think that an industry is making a lot of profits, prove it. Don't just say that he, she, the man behind the tree is making a fortune. Show me the income statement and balance sheet. It's only reasonable to prove it to yourself before you try to convince someone else of something.

WASHINGTON, D.C. -- As the incoming Congress prepares to debate further changes to the U.S. healthcare system, solid majorities of Americans rate the coverage (69%) and quality (80%) of the healthcare they personally receive as "excellent" or "good." By contrast, Americans are much less positive about healthcare in the U.S. in general, with a bare majority rating the quality of U.S. healthcare positively (55%) and about a third giving positive reviews to U.S. healthcare coverage (34%).

https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx

So people like their healthcare but they think that the healthcare that others receive isn't good.

The only fair comparison of US healthcare to other countries would be with other western democracies that do not have universal healthcare. Good luck finding that sample. Any country that leaves out millions of poor will likely have extra resources for high end care. I would think people coming here to use our members only healthcare would be expected ... not a validation of our choice.

Profit and loss per industry isn't the place to start imo ... it would be the total cost. For example, consider a pharmaceutical company that spends $millions on executive pay, lobbying, tax lawyers, patent lawyers, advertising, etc. Hypothetically let's say their income statement and balance sheet have them breaking even. That hardly proves (on it's own) that the company represents an acceptable cost in the system. What about analysis in moving all of big pharma under NIH ... much of the cost go away when it is no longer for profit. Are we a species that will only produce needed drugs for greed and billions?

I honestly believe the first needed step for the nation would be a world class presentation on the current healthcare system. It would have to be entertaining or not enough would watch. It would clearly show first from a high level which buckets are the big drivers. Maybe big pharma isn't the big problem ... and you end up drilling down on the actual biggest cost drivers. I'm not talking about a Michael Moore movie ... more of a long Ted Talk interesting enough to give the opposing tribes actual facts to start from. Yeah ... might do nothing to move debate past "freedom vs universal healthcare" , but it would be fairly novel to start with facts before ideology and economics scripture.

I'm not sure who should present this, it's think tank level stuff. I think this should already have been rolled into government ... citizen education on the facts prior to party debates, bills and votes. I watched almost all of the Obamacare debates ... all show and no facts.

Which ... btw ... makes it laughable we expect presidential candidates to dance for us on these pathetic debates and tell us your healthcare plan in the 2 minutes CNN let's you talk (with the others waving their hands interrupting your 2 minute universal healthcare plan).

 

[undecided]

They are not obscene. They are to offset the losses that the hospitals incur for Medicare and Medicaid reimbursements below cost and also for those without insurance that skip out on the bills.

My son is employed by the parent of the hospital and I read their financial reports and they haven't done all that well in the past couple of years. They have spent any gains on shoring up their pension funds, now at 102% coverage. This is why Medicare for all won't work - it will bankrupt hospitals.

I think we are brainwashed to think that. I've traveled to Europe extensively. Twice I had to buy meds there and the retail price at the pharmacy was cheaper than my co-pay would have been back in the States. And that was for name brand meds not the generics they peddle here now. I think this inflation permeates the whole system.

 

[movdqa]

The only fair comparison of US healthcare to other countries would be with other western democracies that do not have universal healthcare. Good luck finding that sample. Any country that leaves out millions of poor will likely have extra resources for high end care. I would think people coming here to use our members only healthcare would be expected ... not a validation of our choice.

Profit and loss per industry isn't the place to start imo ... it would be the total cost. For example, consider a pharmaceutical company that spends $millions on executive pay, lobbying, tax lawyers, patent lawyers, advertising, etc. Hypothetically let's say their income statement and balance sheet have them breaking even. That hardly proves (on it's own) that the company represents an acceptable cost in the system. What about analysis in moving all of big pharma under NIH ... much of the cost go away when it is no longer for profit. Are we a species that will only produce needed drugs for greed and billions?

I honestly believe the first needed step for the nation would be a world class presentation on the current healthcare system. It would have to be entertaining or not enough would watch. It would clearly show first from a high level which buckets are the big drivers. Maybe big pharma isn't the big problem ... and you end up drilling down on the actual biggest cost drivers. I'm not talking about a Michael Moore movie ... more of a long Ted Talk interesting enough to give the opposing tribes actual facts to start from. Yeah ... might do nothing to move debate past "freedom vs universal healthcare" , but it would be fairly novel to start with facts before ideology and economics scripture.

I'm not sure who should present this, it's think tank level stuff. I think this should already have been rolled into government ... citizen education on the facts prior to party debates, bills and votes. I watched almost all of the Obamacare debates ... all show and no facts.

Which ... btw ... makes it laughable we expect presidential candidates to dance for us on these pathetic debates and tell us your healthcare plan in the 2 minutes CNN let's you talk (with the others waving their hands interrupting your 2 minute universal healthcare plan).

But your point was that these guys make a lot in profits. So you don't care to pursue this avenue?

Do you consider it possible for a company to produce a product that has more benefit to the consumer than their products cost? Even with vast riches for executives and good salaries for employees? If Microsoft could do this for personal computer software and Apple could do this for phones, why can't a health insurance company do it for companies? It takes a huge amount of work to set up a network, manage the payments, provide permission systems, staff 7x24 systems so that employees can get emergency care, advice or referrals. The question is: is it worth the cost? In the private world, if it weren't the cost, then companies would find another solution. And we're back to markets.

What I see is US pharma companies coming up with new, expensive drugs that can cure things that were never curable before. Solvadi is one of these classes of drugs. We can let Hepatitis move around various populations or we can pay Gilead $100K per patient for a course of treatment to cure them and not spread it to other people. And then, of course, we have a few other companies come out with competing products a year later. Do executives make a lot? I'd guess that they do at the big companies. But they take a lot of risk at the small ones. And at the big ones too. It probably wouldn't take too much in failures to tank a company.

From what I can see of NCI, they do clinical trials, come up with ideas that may completely work - and then shuffle them to hospitals or private companies to develop and market. They seem to be more about inventing things then doing the R&D and engineering to get something in production. There are scientists that want to move onto the next part of the leading edge instead of doing engineering work. If moving engineering to national healthcare systems worked, then why don't we see this in other countries?

BTW, Singapore had a good healthcare system when it was private. They have a good healthcare system when it became universal. They focused on adding supply, and also on nutrition and exercise. If you're overweight as a schoolkid, you're pulled out and put on special diet and exercise to get your BMI to normal. Wouldn't that be fun to see here?

Massachusetts is having the discussion and analysis that you're looking for. Massachusetts benefits from big pharma. There are a lot of good jobs for scientists in the state. Massachusetts also has the best insurance rate in the country and provides world-class healthcare to its residents. But they are always looking to cut costs. So the debate is on here. What you here in the political world is not what you have to deal with systemically. Making villains out of players doesn't really get you anywhere. Look at places where things are going well. And then try to do similar things. If most people are happy with the current system, why would you try to tear it down? It's like schools - most people think that their schools are fine but they thing that schools in general are awful.

I'd say we should fix what's broken instead of tearing the whole thing down.

 

[movdqa]

I think we are brainwashed to think that. I've traveled to Europe extensively. Twice I had to buy meds there and the retail price at the pharmacy was cheaper than my co-pay would have been back in the States. And that was for name brand meds not the generics they peddle here now. I think this inflation permeates the whole system.

My opinion there would be that other countries should be paying a lot more for drugs we develop here.

 

[Curiosity]

Sounds like me the past two years.

My bills for care came to $600K retail. I paid about $4,000 of it. My out-of-pay max was $2,000/year so I didn't really worry about copays and expenses. I'd basically rack up $2,000 pretty early in the year and then insurance covered everything else. I think that negotiated costs came out to about $250K. This was world-class care in Boston. I went to the ER twice, one for an intestinal blockage and the other for a heart issue that resulted from dehydration.

On access: no issues with access in NH. The intake process at Dana Farber/Brighams and Women was quite a challenge. I found out that they do massive volume and it's assembly line medicine. They have a lot of clients from around the country and from many other countries. Once you get through intake, though, getting appointments is not difficult. I think that they realize that time is of the essence when you're dealing with cancer.

Question for you: did you play tennis through treatment? My latest tennis video was during chemo and radiation and, to my knowledge, it's the only one out there. I've run into some people that slept most of the day on chemo. I've heard of some people running half-marathons through chemo and a lot of people work through chemo but almost everyone has far less energy and stamina and the immune system gets depressed making it dangerous around cold and flu season.

I did play "tennis light" during the pre-adjuvant chemo/radiation, during weeks when I could eat. Stopped when my hair fell out, laugh. (It all grew back, but not before I had to renew my passport. Great photo.) I exercised more pre-surgery, on the advice of my surgeon. I have to quote his advice two weeks before surgery: "Keep exercising. The operation I'm going to do is going to kick your ass." Well, he was right. He had insisted on an 7th week of radiation before surgery was possible. T was in a bad location...

The adjuvant chemo after surgery was by far the worst because it was alternating weeks, one of the two drugs one week, then the other, and at higher dosage than the pre-adjuvant. It was actually awful. I did, however, lose lots of weight, from 6' 2" 205 lbs. down to 163. (Back to 200 now.) I think post-treatement, N.E.D., then "cured," the worst was difficulty concentrating during long meetings or reading briefs. I was prescribed Adderall, which absolutely did the trick until my chemistry improved.

 

[movdqa]

I did play "tennis light" during the pre-adjuvant chemo/radiation, during weeks when I could eat. Stopped when my hair fell out, laugh. (It all grew back, but not before I had to renew my passport. Great photo.) I exercised more pre-surgery, on the advice of my surgeon. I have to quote his advice two weeks before surgery: "Keep exercising. The operation I'm going to do is going to kick your ass." Well, he was right. He had insisted on an 7th week of radiation before surgery was possible. T was in a bad location...

The adjuvant chemo after surgery was by far the worst because it was alternating weeks, one of the two drugs one week, then the other, and at higher dosage than the pre-adjuvant. It was actually awful. I did, however, lose lots of weight, from 6' 2" 205 lbs. down to 163. (Back to 200 now.) I think post-treatement, N.E.D., then "cured," the worst was difficulty concentrating during long meetings or reading briefs. I was prescribed Adderall, which absolutely did the trick until my chemistry improved.

Your treatment sounds like mine.

28 days of chemotherapy and radiation, two months recovery, surgery (mine was 5.5 hours), two months recovery, surgery to install a chest port, 8 rounds of chemo with two drugs instead of one and at higher doses. The chemo was via the chest port. The alternative was to carry a pump for two days and go 12 rounds. I have some permanent side-effects from the adjuvant chemo, mild arthritis in the fingers, neuropathy in the toes.

I've never heard of Adderall prescribed for chemo side-effects but I'm glad that the researchers are always experimenting.

 

[movdqa]

Profit and loss per industry isn't the place to start imo ... it would be the total cost. For example, consider a pharmaceutical company that spends $millions on executive pay, lobbying, tax lawyers, patent lawyers, advertising, etc. Hypothetically let's say their income statement and balance sheet have them breaking even. That hardly proves (on it's own) that the company represents an acceptable cost in the system. What about analysis in moving all of big pharma under NIH ... much of the cost go away when it is no longer for profit. Are we a species that will only produce needed drugs for greed and billions?

Do you own any companies? If the company that you owned didn't make profits, what would you do?

That's right, you'd fire management, and get in new management that makes profits. The shareholders own the company, not management. If management isn't making profits, then either the shareholders fire management or you get private equity or hedge funds that buy up enough shares to take control and either replace management or get management to do their jobs.

Companies aren't charities.

 

[ByeByePoly]

But your point was that these guys make a lot in profits. So you don't care to pursue this avenue?

Do you consider it possible for a company to produce a product that has more benefit to the consumer than their products cost? Even with vast riches for executives and good salaries for employees? If Microsoft could do this for personal computer software and Apple could do this for phones, why can't a health insurance company do it for companies? It takes a huge amount of work to set up a network, manage the payments, provide permission systems, staff 7x24 systems so that employees can get emergency care, advice or referrals. The question is: is it worth the cost? In the private world, if it weren't the cost, then companies would find another solution. And we're back to markets.

What I see is US pharma companies coming up with new, expensive drugs that can cure things that were never curable before. Solvadi is one of these classes of drugs. We can let Hepatitis move around various populations or we can pay Gilead $100K per patient for a course of treatment to cure them and not spread it to other people. And then, of course, we have a few other companies come out with competing products a year later. Do executives make a lot? I'd guess that they do at the big companies. But they take a lot of risk at the small ones. And at the big ones too. It probably wouldn't take too much in failures to tank a company.

From what I can see of NCI, they do clinical trials, come up with ideas that may completely work - and then shuffle them to hospitals or private companies to develop and market. They seem to be more about inventing things then doing the R&D and engineering to get something in production. There are scientists that want to move onto the next part of the leading edge instead of doing engineering work. If moving engineering to national healthcare systems worked, then why don't we see this in other countries?

BTW, Singapore had a good healthcare system when it was private. They have a good healthcare system when it became universal. They focused on adding supply, and also on nutrition and exercise. If you're overweight as a schoolkid, you're pulled out and put on special diet and exercise to get your BMI to normal. Wouldn't that be fun to see here?

Massachusetts is having the discussion and analysis that you're looking for. Massachusetts benefits from big pharma. There are a lot of good jobs for scientists in the state. Massachusetts also has the best insurance rate in the country and provides world-class healthcare to its residents. But they are always looking to cut costs. So the debate is on here. What you here in the political world is not what you have to deal with systemically. Making villains out of players doesn't really get you anywhere. Look at places where things are going well. And then try to do similar things. If most people are happy with the current system, why would you try to tear it down? It's like schools - most people think that their schools are fine but they thing that schools in general are awful.

I'd say we should fix what's broken instead of tearing the whole thing down.

"But your point was that these guys make a lot in profits. So you don't care to pursue this avenue?"

I do ... but only initially for the high cost buckets. I think you should go for the low hanging costly fruit first.

For example ... if we had a total healthcare pie chart we could trust ... and it showed pharmaceutical products only amounted to 1% of total healthcare costs ... move on. Doesn't mean you don't deal with pharma companies goughing people on their insulin, but that could be a legal path that doesn't need a major healthcare change/redesign.

If ... the pharmaceutical cost is 25% of the pie chart ... yeah ... time for some big pharma drilling.

"I'd say we should fix what's broken instead of tearing the whole thing down."

I am for universal equal healthcare for everyone as a right ... if you are breathing you get it (yes Gold ... migrants in our custody). I am also against "separate but equal" ... it is never equal. I am agnostic on the design ... private, public, hybrid ... have been since Obamacare debate first started. Obamacare should have been a contest of universal healthcare proposals from both parties. My belief is "for profit" would never cover poor people ... so that will never provide universal healthcare by itself.

I would have expected the GOP proposal to be something like:

1) keep what we had
2) cover pre-existing somehow ... who knows with Paul Ryans whiteboard
3) have the uninsured but private policies and pay for it with tax revenue or a separate Paul Ryan box on his whiteboard

Run the costs ... compare to Dem proposals.

Instead we got "more would get covered ... not socialism ... freedom ... no one between you and your doctor except United Healthcare dude in a cubicle".

GOP doesn't want to cover pre-exhisting, doesn't want to cover the unisured, doesn't want to protect against medical bk. They should own it and say it out loud ... but float the bs they have a better replacement that they can't describe out loud in public.

I'm so glad the debate keeps moving toward the GOP having to say out loud "no universal coverage". Might be put off for another 6 years ... but that train is coming.

btw ... fixing what we have was the problem Obama had ... very hard to start from scratch with legacy systems. I would have liked to see insurance divorced from the employer (many business owners would to ... they have to waste time on something that should be none of their business, and not part of their business).

 

[ByeByePoly]

Do you own any companies? If the company that you owned didn't make profits, what would you do?

That's right, you'd fire management, and get in new management that makes profits. The shareholders own the company, not management. If management isn't making profits, then either the shareholders fire management or you get private equity or hedge funds that buy up enough shares to take control and either replace management or get management to do their jobs.

Companies aren't charities.

No ... you missed my point. I want to know the industry percentage of total healthcare cost to know if it's worth review. If big pharma only amounts to 1% ... than their profits/etc isn't a big issue in the scheme of things. You are talking about a lower level something else ... health of a company. Let me say it this way. If big pharma was only 1% of the total healthcare cost ... and we found out they were all barely keeping the doors open ... then they could make a lot more profit and not matter to overall costs ... 1% doubled would be 2%.

 

[movdqa]

"But your point was that these guys make a lot in profits. So you don't care to pursue this avenue?"

I do ... but only initially for the high cost buckets. I think you should go for the low hanging costly fruit first.

For example ... if we had a total healthcare pie chart we could trust ... and it showed pharmaceutical products only amounted to 1% of total healthcare costs ... move on. Doesn't mean you don't deal with pharma companies goughing people on their insulin, but that could be a legal path that doesn't need a major healthcare change/redesign.

If ... the pharmaceutical cost is 25% of the pie chart ... yeah ... time for some big pharma drilling.

"I'd say we should fix what's broken instead of tearing the whole thing down."

I am for universal equal healthcare for everyone as a right ... if you are breathing you get it (yes Gold ... migrants in our custody). I am also against "separate but equal" ... it is never equal. I am agnostic on the design ... private, public, hybrid ... have been since Obamacare debate first started. Obamacare should have been a contest of universal healthcare proposals from both parties. My belief is "for profit" would never cover poor people ... so that will never provide universal healthcare by itself.

I would have expected the GOP proposal to be something like:

1) keep what we had
2) cover pre-existing somehow ... who knows with Paul Ryans whiteboard
3) have the uninsured but private policies and pay for it with tax revenue or a separate Paul Ryan box on his whiteboard

Run the costs ... compare to Dem proposals.

Instead we got "more would get covered ... not socialism ... freedom ... no one between you and your doctor except United Healthcare dude in a cubicle".

GOP doesn't want to cover pre-exhisting, doesn't want to cover the unisured, doesn't want to protect against medical bk. They should own it and say it out loud ... but float the bs they have a better replacement that they can't describe out loud in public.

I'm so glad the debate keeps moving toward the GOP having to say out loud "no universal coverage". Might be put off for another 6 years ... but that train is coming.

btw ... fixing what we have was the problem Obama had ... very hard to start from scratch with legacy systems. I would have liked to see insurance divorced from the employer (many business owners would to ... they have to waste time on something that should be none of their business, and not part of their business).

Should have voted Romney in. His healthcare system is the best in the country. I think that the coverage rate is either 97.5% or 98.5%.

 

[movdqa]

No ... you missed my point. I want to know the industry percentage of total healthcare cost to know if it's worth review. If big pharma only amounts to 1% ... than their profits/etc isn't a big issue in the scheme of things. You are talking about a lower level something else ... health of a company. Let me say it this way. If big pharma was only 1% of the total healthcare cost ... and we found out they were all barely keeping the doors open ... then they could make a lot more profit and not matter to overall costs ... 1% doubled would be 2%.

I have no idea as to what it is. I do know that negotiated rates can be far lower than retail rates.

I had one chemo bill: $11,000, negotiated rate: $1,000.

There are other problems with universal coverage too.

If you have one fantastic hospital, how do you determine who gets to use it?

If you have one fantastic doctor, how do you determine who gets to use it? In Canada, they do have private healthcare and I've heard of places that don't take insurance - you go there and you pay what their rates are.

 

[movdqa]

No ... you missed my point. I want to know the industry percentage of total healthcare cost to know if it's worth review. If big pharma only amounts to 1% ... than their profits/etc isn't a big issue in the scheme of things. You are talking about a lower level something else ... health of a company. Let me say it this way. If big pharma was only 1% of the total healthcare cost ... and we found out they were all barely keeping the doors open ... then they could make a lot more profit and not matter to overall costs ... 1% doubled would be 2%.

You make points but when I point out the problems, you change the discussion. It would be easier if you didn't make points only to disavow them later on.

 

[undecided]

Do you own any companies? If the company that you owned didn't make profits, what would you do?

That's right, you'd fire management, and get in new management that makes profits. The shareholders own the company, not management. If management isn't making profits, then either the shareholders fire management or you get private equity or hedge funds that buy up enough shares to take control and either replace management or get management to do their jobs.

Companies aren't charities.

Explain why a drug in Europe costs $5-$10 and here $600. Same drug, same company.....

 

[ByeByePoly]

Should have voted Romney in. His healthcare system is the best in the country. I think that the coverage rate is either 97.5% or 98.5%.

Nah ... McConnell would have trashed it also.

 

[Curiosity]

Your treatment sounds like mine.

28 days of chemotherapy and radiation, two months recovery, surgery (mine was 5.5 hours), two months recovery, surgery to install a chest port, 8 rounds of chemo with two drugs instead of one and at higher doses. The chemo was via the chest port. The alternative was to carry a pump for two days and go 12 rounds. I have some permanent side-effects from the adjuvant chemo, mild arthritis in the fingers, neuropathy in the toes.

I've never heard of Adderall prescribed for chemo side-effects but I'm glad that the researchers are always experimenting.

I only got one month off before and after surgery. The Adderall was prescribed for "I can't focus for more than ten minutes anymore after all the chemo." Distinction without a difference? I always considered myself alert and able to focus for very long periods of time. By the end of the whole C thing I distinctly felt highly distractable and a bit fuzzy. For an attorney, focusing during very long reads and in prolonged meetings is just essential. At 5 mg, usually three days a week, sometimes four, it did the trick. A life-saver.

 

[ByeByePoly]

I have no idea as to what it is. I do know that negotiated rates can be far lower than retail rates.

I had one chemo bill: $11,000, negotiated rate: $1,000.

There are other problems with universal coverage too.

If you have one fantastic hospital, how do you determine who gets to use it?

If you have one fantastic doctor, how do you determine who gets to use it? In Canada, they do have private healthcare and I've heard of places that don't take insurance - you go there and you pay what their rates are.

I have not been having much luck finding a pie chart that breaks down the cost. This was the best I have found so far.

If accurate ... hospital and surgeons more of the cost than the meds. But this is exactly my point .... we all should know this before we end up at ideology. For example.... is the 11% prescription drug cost just patient meds ... doesn't big pharma also provide hospitals with meds/IV bags, etc. I am too lazy to pursue it at the moment, but just making the point we should have some idea where this huge healthcare bill goes.

FIGURE 1: PIE CHART OF TOTAL HEALTH CARE SPENDING
Figure 1:
Pie Chart of Total Health Care Spending

Hospital Care31%

Physician & Clinical Services22%

Prescription Drugs11%

Other Spending36%



https://www.justice.gov/atr/figure-1-pie-chart-total-health-care-spending

 

[ByeByePoly]

Explain why a drug in Europe costs $5-$10 and here $600. Same drug, same company.....

@movdqa ... not ganging up here, but wanted to add to this question.

Who would you allow to control drug prices? I don't really have choices like buying cars, or tennis racquets. I get what my insurance covers, and what my Walgreens carries, and there is not debate about it. I pay what the insurance decided I would pay. That's not really free market stuff.

The drug companies have been jacking up insulin cost .... because they can. Dirt cheap to make ... but they can. Is that something we all have to be cool with because it's the free market?

 

[Rattler]

You win the FIRE award.

If only I knew what that was.

 

[Pete Player]

Been off-line for too long, 100 messages to cover...

I just love my process. The more I work on my game and trying to get better the next body part DORs. Now it is my angle trailing the hamsring injured leg. Swollen like a barrel and hurts like hell.

And haven’t played tennis except for one hour in the midsummer eve in Estonia. Affects my swing rythm and makes every shot feel like a toss of dize. Can barely walk. Due to see a specialist tomorrow morning


——————————
No more on -sorry, again on pain meds - all contributed matter and anti-matter are subject to disclaimer

 

[movdqa]

Explain why a drug in Europe costs $5-$10 and here $600. Same drug, same company.....

Europe extorts our drug companies.

 

[movdqa]

I only got one month off before and after surgery. The Adderall was prescribed for "I can't focus for more than ten minutes anymore after all the chemo." Distinction without a difference? I always considered myself alert and able to focus for very long periods of time. By the end of the whole C thing I distinctly felt highly distractable and a bit fuzzy. For an attorney, focusing during very long reads and in prolonged meetings is just essential. At 5 mg, usually three days a week, sometimes four, it did the trick. A life-saver.

I took no time before and two weeks after but was working the day after surgery from bed. I should have taken a month or two but there was a lot of work pressure

 

[movdqa]

I have not been having much luck finding a pie chart that breaks down the cost. This was the best I have found so far.

If accurate ... hospital and surgeons more of the cost than the meds. But this is exactly my point .... we all should know this before we end up at ideology. For example.... is the 11% prescription drug cost just patient meds ... doesn't big pharma also provide hospitals with meds/IV bags, etc. I am too lazy to pursue it at the moment, but just making the point we should have some idea where this huge healthcare bill goes.

FIGURE 1: PIE CHART OF TOTAL HEALTH CARE SPENDING
Figure 1:
Pie Chart of Total Health Care Spending

Hospital Care31%

Physician & Clinical Services22%

Prescription Drugs11%

Other Spending36%



https://www.justice.gov/atr/figure-1-pie-chart-total-health-care-spending

I look at the care I received, all of the people involved that I could see, the cost of systems and technology and, of course, redistribution and it seems rational. Hospitals aren’t making a lot of money. Many are losing money and closing.

 

[movdqa]

If only I knew what that was.

Early retirement

 

[ByeByePoly]

You make points but when I point out the problems, you change the discussion. It would be easier if you didn't make points only to disavow them later on.

A good match player adapts to the opponent ... you are good ... I went to plan B.

 

[undecided]

@movdqa ... not ganging up here, but wanted to add to this question.

Who would you allow to control drug prices? I don't really have choices like buying cars, or tennis racquets. I get what my insurance covers, and what my Walgreens carries, and there is not debate about it. I pay what the insurance decided I would pay. That's not really free market stuff.

The drug companies have been jacking up insulin cost .... because they can. Dirt cheap to make ... but they can. Is that something we all have to be cool with because it's the free market?

I said nothing about price control. Those cheap prices are the regular prices in the pharmacy. Obviously there is some gouging going on in the US and that's why the lobbyists passed laws to disallow importation of meds from other countries by the patients themselves even when the meds are the same ones made by the same companies that sell it in the USA for 10x.

 

[undecided]

Europe extorts our drug companies.

They are not 'ours'. Most drug companies are multinationals. And, there is no extortion. Those prices are retail.

 

[ByeByePoly]

I said nothing about price control. Those cheap prices are the regular prices in the pharmacy. Obviously there is some gouging going on in the US and that's why the lobbyists passed laws to disallow importation of meds from other countries by the patients themselves even when the meds are the same ones made by the same companies that sell it in the USA for 10x.

Yeah ... I just quit buying three meds from Canada a couple of months ago. My mother had a couple of meds (last 5 years) still under US patent protection, and I could buy the generics from Canada. It's not technically legal, but US doesn't enforce it if just for personal use and less than three months meds. I saved significant money per month (used blueskydrugs online). I was not checking her insurance formulary pricing (who does), and along the line the US patents expired and I could get the generics in US with even cheaper copay than what I was paying for Canadian generics.

You mentioned "not our drug companies ... multinationals". Check your meds you buy locally ... look for manufacturer. Much of the time it will appear to be US ... but often just a US based distributor of drugs from India, China, etc. I had a laugh with my primary doctor about tariffs on China ... we have medicine cabinets filled with drugs from China.

I didn't mean you said anything about price control ... just asking Mov how he would handle the US price gouging.

 

[movdqa]

They are not 'ours'. Most drug companies are multinationals. And, there is no extortion. Those prices are retail.

Not the prices I was referring to.

 

[movdqa]

Yeah ... I just quit buying three meds from Canada a couple of months ago. My mother had a couple of meds (last 5 years) still under US patent protection, and I could buy the generics from Canada. It's not technically legal, but US doesn't enforce it if just for personal use and less than three months meds. I saved significant money per month (used blueskydrugs online). I was not checking her insurance formulary pricing (who does), and along the line the US patents expired and I could get the generics in US with even cheaper copay than what I was paying for Canadian generics.

You mentioned "not our drug companies ... multinationals". Check your meds you buy locally ... look for manufacturer. Much of the time it will appear to be US ... but often just a US based distributor of drugs from India, China, etc. I had a laugh with my primary doctor about tariffs on China ... we have medicine cabinets filled with drugs from China.

I didn't mean you said anything about price control ... just asking Mov how he would handle the US price gouging.

Charge a reasonable amount around the world so that the US doesn't have to subsidize everyone else.

The threat is that countries will just ignore patents on US drugs. And that's the extortion.

 

[Nostradamus]

I have not been having much luck finding a pie chart that breaks down the cost. This was the best I have found so far.

If accurate ... hospital and surgeons more of the cost than the meds. But this is exactly my point .... we all should know this before we end up at ideology. For example.... is the 11% prescription drug cost just patient meds ... doesn't big pharma also provide hospitals with meds/IV bags, etc. I am too lazy to pursue it at the moment, but just making the point we should have some idea where this huge healthcare bill goes.

FIGURE 1: PIE CHART OF TOTAL HEALTH CARE SPENDING
Figure 1:
Pie Chart of Total Health Care Spending

Hospital Care31%

Physician & Clinical Services22%

Prescription Drugs11%

Other Spending36%



https://www.justice.gov/atr/figure-1-pie-chart-total-health-care-spending

Does that other spending include prostate messages ? I was told by internal medicine doctor that it has tremendous benefits as you get older

 

[ByeByePoly]

Does that other spending include prostate messages ? I was told by internal medicine doctor that it has tremendous benefits as you get older

Prostrate text messages

 

[Nostradamus]

Prostrate text messages

I meant massages

 

[movdqa]

I just listened to a MacroVoices podcast with Danielle Di-Martino Booth. She said that we're in currency wars mode. I was just floored that Europe would look to undercut is in central bank rates. We've been raising rates for years while they have been in QE mode. We've been in QT mode. Draghi preempted the Fed by announcing that he was going to resume QE in January. They never even got to QT. We just want to cut 1/4 point to get to about 2.15%. Germany's 10-year is -0.36%, yes, negative. Europe just wants to be a leach by any means possible - drugs, currency, exports, whatever. There are indications that Germany is already in recession. I'll wait for the numbers.

 

[undecided]

Charge a reasonable amount around the world so that the US doesn't have to subsidize everyone else.

The threat is that countries will just ignore patents on US drugs. And that's the extortion.

https://www.pharmaceutical-technology.com/features/top-pharmaceutical-companies/
Half of the top-10 companies are not US based.

 

[movdqa]

https://www.pharmaceutical-technology.com/features/top-pharmaceutical-companies/
Half of the top-10 companies are not US based.

Doesn't really matter where they are based. That's usually a tax issue.

Those based in Europe, though, are happy to charge the US prices to the US and the negotiated prices to European countries. Extortion is still extortion, whether or not it's US-based or other. That said, the model is to let small companies take all of the risk and then the large companies buy out the winners. The question is: where is that risk taking place.

 

[undecided]

Doesn't really matter where they are based. That's usually a tax issue.

Those based in Europe, though, are happy to charge the US prices to the US and the negotiated prices to European countries. Extortion is still extortion, whether or not it's US-based or other. That said, the model is to let small companies take all of the risk and then the large companies buy out the winners. The question is: where is that risk taking place.

Do you have evidence of this 'extortion'? And, how can they extort their own firms? Some are german/swiss/british, etc.

 

[movdqa]

Do you have evidence of this 'extortion'? And, how can they extort their own firms? Some are german/swiss/british, etc.

What was posted above. The evidence is that all of the Europeans, Canadians, etc. brag about how little they pay for life-saving drugs compared to what we pay.

Europe tells drug companies what they will pay. That's extortion. It's certainly not market-based. Those companies, can, however, recoup their costs in the US. If the US went to a system based on dictating prices, then those companies would see much lower profits and wouldn't be able to fund new discovery. Simple market-stuff. Econ 101.

 

[undecided]

What was posted above. The evidence is that all of the Europeans, Canadians, etc. brag about how little they pay for life-saving drugs compared to what we pay.

Europe tells drug companies what they will pay. That's extortion. It's certainly not market-based. Those companies, can, however, recoup their costs in the US. If the US went to a system based on dictating prices, then those companies would see much lower profits and wouldn't be able to fund new discovery. Simple market-stuff. Econ 101.

This is all conjecture, retail pricing is not set by 'Europeans'....

p.s. It's not just Europeans. I've been to Mexico and the Caribbean. Prices are much lower there as well.

 

[ByeByePoly]

What was posted above. The evidence is that all of the Europeans, Canadians, etc. brag about how little they pay for life-saving drugs compared to what we pay.

Europe tells drug companies what they will pay. That's extortion. It's certainly not market-based. Those companies, can, however, recoup their costs in the US. If the US went to a system based on dictating prices, then those companies would see much lower profits and wouldn't be able to fund new discovery. Simple market-stuff. Econ 101.

Isn't that just an offer?

 

[movdqa]

This is all conjecture, retail pricing is not set by 'Europeans'....

p.s. It's not just Europeans. I've been to Mexico and the Caribbean. Prices are much lower there as well.

Rubbish. Look at the Gilead deal for their TIL service to the UK. Recent article. I've seen articles about country deals in the past. Look at the posts here on Germany's system for paying for drugs.

 

[movdqa]

Isn't that just an offer?

Look at India's approach. We'll pay this or we'll make it ourselves.

 

[movdqa]

The Glivec situation is not unique. India has granted compulsory licenses to other cancer drugs, including Bayer’s Nexavar, Roche’s Tarceva, and Pfizer’s Sutent. These licenses allow India generic drug manufacturers to make these drugs with impunity. These actions have been justified by the secretary of India’s Pharmaceuticals department in the following way: “We need to ensure that expensive drugs are available at affordable rates to the poor.” It is hard to argue with that philosophy. However, India is expanding this policy beyond expensive cancer drugs. Again, just this past week, the Indian Supreme Court refused to prevent an Indian generic manufacturer, Glenmark Pharmaceuticals, from manufacturing and selling Merck’s diabetes drug, Januvia, in India. Merck will likely appeal this decision. While it is an important drug, Januvia does not carry an expensive price tag. In fact, when it was launched in India, Merck charged $0.86/tablet, one-fifth the US cost. Nevertheless, despite recognizing the need to make Januvia affordable in India, Merck’s intellectual property for this drug will be ignored in this country for the foreseeable future.

In addition to not granting patents for new drugs, the Indian government sets prices for drugs that are patented, but this is not just for expensive medications. There are now 348 drugs that have price caps. However, India has now introduced a new element to this policy. Drugs that have some form of innovation that can be attributed to Indian researchers can be IMMUNE from price controls for five years. Three types of innovation can qualify for this benefit:

https://www.forbes.com/sites/johnla...ces-except-for-home-grown-drugs/#395888572cba

 

[ByeByePoly]

Look at India's approach. We'll pay this or we'll make it ourselves.

Not familiar with India's policy ... but it sounds like:

I offer $50 to someone to mow my lawn. They want $60, and I decide to mow my own lawn. ???

Oh ... you are talking patents ... reading your post now.

 

[movdqa]

Not familiar with India's policy ... but it sounds like:

I offer $50 to someone to mow my lawn. They want $60, and I decide to mow my own lawn. ???

Not even close. Read the article.

It's more like I'll steal your lawn mower and mow my own lawn.

 

[movdqa]

Prices for new drugs are established in Germany through collective negotiations between a single buyer (the umbrella organization representing the insurers, also known as the Sickness Funds) and a single seller, the drug maker. Given this bilateral monopoly, one might predict gridlock, with insurers insisting that high prices threaten the solvency of the system and manufacturers insisting that low prices threaten innovation.

However, both sides are under strong public and political pressure to come to an agreement. If none can be negotiated, the drug’s price is established by an arbitration panel with representatives from each side plus an appointed chair. The manufacturer can refuse the arbitrators’ price and withdraw its product, but then forgoes all sales in the continent’s largest market and knows it will enter price negotiations for its next drug with a reputation for being uncooperative.

From 2011, when this price structure was established, to mid-March 2019, the German pharmaceutical system has conducted assessments and pricing for 230 drugs. Of these, 35 drugs had a price set by arbitration and 28 were withdrawn from the market by their manufacturers.

https://www.commonwealthfund.org/blog/2019/how-drug-prices-are-negotiated-germany

The problem with this is that Germany doesn't pay for the failures - the drug companies have to eat those costs. They can do that because we pay full-fare in the United States.

 

[movdqa]

A very nice read: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193451/

It goes over the policies in four major European Countries in detail and also talks about the problems that those countries have with their policies as a backdrop for the political discussion in the United States. I saved it to read later on but it's definitely wonkish. One of the big surprises is

 

[Pete Player]

Here there is nearly allways the generic option available if the patents are released, unlesss the doctor has put a specific note for a brand on the prescription. A farmacist is obliged to introduce the generic option to all customers, yet you are not bound to swap.

The generics, yet the same effective substance may have different efficecy on different people due to the other substances on the pill. Bizarre, but true from experience.

The mandatory presenting of the generic alternative has pulled the prices down some. The common health care covers some for every citizen on prescription meds, exept for some of the high-priced options, which will go thru scrutiny and are released to the coverable for an individual, if there is no other type of drug, that will cure, what they have or if they have allready tried all the other substances without response.


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No more on -sorry, again on pain meds - all contributed matter and anti-matter are subject to disclaimer