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sactowndog

Is agreement on healthcare possible?

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8 hours ago, sactowndog said:

First off you show you are completely missing the point I'm making.  

In the case of a breakthrough drug or a drug in a niche, competition doesn't exist.  Your point is valid it is due to government intervention and that intervention is the granting of a patent!!  Under a normal market, close substitutes exist which a person can choose or the person can choose to forgoe the product entirely.   Those other alternatives create a demand curve for that business where sales volume rises or falls based on price.   Neither of those options exist in the case of a life saving patent protected drug or device.   The business can jack the price 1000% and see no change in demand.   

The fact this exact scenario has happened over and over in real life not theory proves the point.  If you had a 1000% increase in price you should see a sales drop if you have a functioning market.   These companies don't see one at all.   Why because the people on the drug have no choice.   They have to take it.   That fact is why less than scrupulous actors are buying the rights to these drugs and increasing the prices by orders of magnitude,. Turing acquiring and raising the price of Daraprim 5000% is an example of the pricing power inherent in these markets.  And these price changes don't have a single thing to do with return on Research and Development.   

Turing crippled their brand in the process. And by raising the price like they did  they made the market inviting for competition to enter it. Congrats Turing, you screwed yourself. Funny how the free market corrects itself.  The same thing happened with Mylan and the Epipen. T hey jacked up the price and destroyed their brand, creating a market that allowed competitors to enter where before it wasn't cost effective when the Epipen wasn't at the high price.

 

 

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I have two thoughts on this that haven't already been discussed to death.

First, any health care plan needs to acknowledge that we are in a demographic bubble of spending. There are a lot of baby boomers that are getting older and the millennials, the biggest generation, are only starting to get our footing economically. In my opinion we are near the apex of health spending because of this. As time goes on and boomer echelons die and don't need any more spending, our spending will decrease. As millennials transition from "entry to low level manager" to "mid to high level manager" careers, we're going to have an economic (and revenue) explosion.

Second, I like the idea of big companies and big agencies providing free health care clinics. I remember reading an article about how the state of Montana provided a free to Montana state employees clinic in Helena. Their accountants estimated that it saved them a TON of money and the doctors and nurses loved working there because they had essentially zero billing responsibility. They got their salary, it was paid for by the state, the end. They could also be more proactive in terms of patient health because they're coming in to the free clinic and they don't have to worry about scaring off clients. I don't think something like this should be mandated but encouraged? Absolutely. Maybe even with tax breaks for large companies with big corporate campuses.

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4 hours ago, sactowndog said:

First off you show you are completely missing the point I'm making.  

In the case of a breakthrough drug or a drug in a niche, competition doesn't exist.  Your point is valid it is due to government intervention and that intervention is the granting of a patent!!  Under a normal market, close substitutes exist which a person can choose or the person can choose to forgoe the product entirely.   Those other alternatives create a demand curve for that business where sales volume rises or falls based on price.   Neither of those options exist in the case of a life saving patent protected drug or device.   The business can jack the price 1000% and see no change in demand.   

The fact this exact scenario has happened over and over in real life not theory proves the point.  If you had a 1000% increase in price you should see a sales drop if you have a functioning market.   These companies don't see one at all.   Why because the people on the drug have no choice.   They have to take it.   That fact is why less than scrupulous actors are buying the rights to these drugs and increasing the prices by orders of magnitude,. Turing acquiring and raising the price of Daraprim 5000% is an example of the pricing power inherent in these markets.  And these price changes don't have a single thing to do with return on Research and Development.   

Let's use autoimmune drugs as an example.  You can treat these illnesses with things as simple as nsaids or methotrexate.  Humira and Enbrel are to the point of being the gold standard, but that doesn't mean that you can't treat them with other, cheaper options.  Both are prohibitively expensive and your typical person can't afford them at all.  I'd love if they were cheap.  It would make a huge difference to my sister, who needs Enbrel to function on a normal basis.  OTOH, the company should be reimbursed for their invention too.  The problem arises when the rest of the world refuses to accept a price and the company sells to them anyway at the government mandated price.  Then they jack up the prices here because they know it will get paid, and US citizens are then subsidizing the worlds drug costs.  I think you'd see fairer pricing worldwide if that wasn't happening.  

So, no, you can't mandate a price on these things.  And you can't have other countries doing it either, or it throws the market off balance.   If everyone would pay their fair share, the price would be lower overall here.
 

 

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11 minutes ago, happycamper said:

I have two thoughts on this that haven't already been discussed to death.

First, any health care plan needs to acknowledge that we are in a demographic bubble of spending. There are a lot of baby boomers that are getting older and the millennials, the biggest generation, are only starting to get our footing economically. In my opinion we are near the apex of health spending because of this. As time goes on and boomer echelons die and don't need any more spending, our spending will decrease. As millennials transition from "entry to low level manager" to "mid to high level manager" careers, we're going to have an economic (and revenue) explosion.

Second, I like the idea of big companies and big agencies providing free health care clinics. I remember reading an article about how the state of Montana provided a free to Montana state employees clinic in Helena. Their accountants estimated that it saved them a TON of money and the doctors and nurses loved working there because they had essentially zero billing responsibility. They got their salary, it was paid for by the state, the end. They could also be more proactive in terms of patient health because they're coming in to the free clinic and they don't have to worry about scaring off clients. I don't think something like this should be mandated but encouraged? Absolutely. Maybe even with tax breaks for large companies with big corporate campuses.

How can we incentivize big companies to do this?

We’re all sitting in the dugout. Thinking we should pitch. How you gonna throw a shutout when all you do is bitch.

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Just now, thelawlorfaithful said:

How can we incentivize big companies to do this?

Tax breaks. Duh.

Also maybe 5 year subsidies to insurance premiums with a stair step decrease in subsidy for the last 2.5 years or so. Get their employees used to going to the free in office clinic, get them used to getting preventative checkups and getting their kids and shots and whatnot at the clinic with basically no overhead, and I'm going to take a wild guess that the insurance premiums the company pays will decrease more than the cost of the clinic itself.

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2 minutes ago, happycamper said:

Tax breaks. Duh.

Also maybe 5 year subsidies to insurance premiums with a stair step decrease in subsidy for the last 2.5 years or so. Get their employees used to going to the free in office clinic, get them used to getting preventative checkups and getting their kids and shots and whatnot at the clinic with basically no overhead, and I'm going to take a wild guess that the insurance premiums the company pays will decrease more than the cost of the clinic itself.

I like it.

(I knew tax breaks was the answer. But since I've already staked out my position as the congressmen in Big Pharma's pocket I figured I'd better let someone else say it).

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8 hours ago, sactowndog said:

Again your too stupid to even argue the point about diminishing utility.  Why don't you look it up, read the definition, and then come back when you can speak knowledgeably how it relates to individual decision making in healthcare.

I don't care about diminishing utility retard it is just an excuse for IRL''s like you to kill people for your convenience.

People should make their own decisions in a free economy.    Your socialist systems have failed mightily and all your excuses are bullshit.

 

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5 hours ago, thelawlorfaithful said:

Turing crippled their brand in the process. And by raising the price like they did  they made the market inviting for competition to enter it. Congrats Turing, you screwed yourself. Funny how the free market corrects itself.  The same thing happened with Mylan and the Epipen. T hey jacked up the price and destroyed their brand, creating a market that allowed competitors to enter where before it wasn't cost effective when the Epipen wasn't at the high price.

 

 

Turing's patent had long since expired.   So while Martin proved you could raise prices, it doesn't prove anything about competition coming in when patents are in play.   

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40 minutes ago, bluerules009 said:

I don't care about diminishing utility retard it is just an excuse for IRL''s like you to kill people for your convenience.

People should make their own decisions in a free economy.    Your socialist systems have failed mightily and all your excuses are bullshit.

 

Did you say something intelligent or just mindlessly blather on in the same manner.   You claim to support market driven economies but have yet to demonstrate an understanding of its core principles.   

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4 hours ago, happycamper said:

Tax breaks. Duh.

Also maybe 5 year subsidies to insurance premiums with a stair step decrease in subsidy for the last 2.5 years or so. Get their employees used to going to the free in office clinic, get them used to getting preventative checkups and getting their kids and shots and whatnot at the clinic with basically no overhead, and I'm going to take a wild guess that the insurance premiums the company pays will decrease more than the cost of the clinic itself.

I can support this but is it more efficient than a local clinic?

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2 minutes ago, sactowndog said:

Turing's patent had long since expired.   So while Martin proved you could raise prices, it doesn't prove anything about competition coming in when patents are in play.   

The patents are a governmental reaction to government's other intervention, regulations. These are the barriers that make bringing a drug to market astronomically expensive. They are also incredibly important. We want to know our drugs are exactly what they say they are, and do exactly what they say they do. Anything less is unacceptable. But the process is not cheap and incredibly risky for investors. So to entice the massive amounts of money that make innovation possible, the government gives the few drugmakers who successfully bring one to market a monopoly for a short period of time.

If you're going to have the stringent regulations we need, you need patents. Without patents there is no money, without money there is no innovation, without innovation those who get sick in the future are screwed.

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5 hours ago, Jack Bauer said:

Let's use autoimmune drugs as an example.  You can treat these illnesses with things as simple as nsaids or methotrexate.  Humira and Enbrel are to the point of being the gold standard, but that doesn't mean that you can't treat them with other, cheaper options.  Both are prohibitively expensive and your typical person can't afford them at all.  I'd love if they were cheap.  It would make a huge difference to my sister, who needs Enbrel to function on a normal basis.  OTOH, the company should be reimbursed for their invention too.  The problem arises when the rest of the world refuses to accept a price and the company sells to them anyway at the government mandated price.  Then they jack up the prices here because they know it will get paid, and US citizens are then subsidizing the worlds drug costs.  I think you'd see fairer pricing worldwide if that wasn't happening.  

So, no, you can't mandate a price on these things.  And you can't have other countries doing it either, or it throws the market off balance.   If everyone would pay their fair share, the price would be lower overall here.
 

 

So while you say other countries can't.... other countries do and they aren't changing.   So then what....

Drug pricing is growing at double digit growth with a significant percent attributable to pricing growth unlike the rest of healthcare.   You can't address health care costs without addressing drug pricing.   

Health Spending by Type of Service or Product:

  • Hospital Care (32 percent share): Spending for hospital care increased 5.6 percent to $1.0 trillion in 2015 compared to 4.6 percent growth in 2014. The faster growth in 2015 was driven by continued growth in non-price factors such as the use and intensity of services. However, hospital price growth was just 0.9 percent in 2015, which was the lowest rate of growth since 1998. Hospital services, from a payer perspective, experienced faster growth in Medicaid and private health insurance spending; however this strong growth was slightly offset by slower growth in Medicare hospital spending.

  • Physician and Clinical Services (20 percent share): Spending on physician and clinical services increased 6.3 percent in 2015 to $634.9 billion. This was an acceleration from growth of 4.8 percent in 2014 and was the first time since 2005 that the growth rate exceeded 6.0 percent. As with hospitals, the faster growth in overall physician and clinical services spending was driven by continued growth in non-price factors. Price growth for physician and clinical services, however, declined 1.1 percent in 2015, driven by the expiration of temporary increases in Medicaid payments to primary care physicians.

  • Other Professional Services (3 percent share): Spending for other professional services reached $87.7 billion in 2015, an increase of 5.9 percent and an acceleration from growth of 5.1 percent in 2014. Spending in this category includes establishments of independent health practitioners (except physicians and dentists) that primarily provide services such as physical therapy, optometry, podiatry, or chiropractic medicine.

  • Dental Services (4 percent share): Spending for dental services increased 4.2 percent in 2015 to $117.5 billion, which was an acceleration from 2.4 percent growth in 2014. Out-of-pocket spending for dental services (which accounted for 40 percent of dental spending) increased 1.8 percent in 2015 after increasing 0.8 percent in 2014. Private health insurance (which accounted for 47 percent of dental spending) increased 3.0 percent in 2015 following 2.1 percent growth in 2014.

  • Other Health, Residential, and Personal Care Services (5 percent share): Spending associated with other health, residential, and personal care services grew 7.8 percent in 2015 to $163.3 billion after increasing 5.0 percent in 2014. The robust growth was driven by 10.0 percent growth in Medicaid spending, which represented nearly 57 percent of all spending in this category. This category includes expenditures for medical services that are generally delivered by providers in non-traditional settings such as schools, community centers, and the workplace; as well as by ambulance providers and residential mental health and substance abuse facilities.

  • Home Health Care (3 percent share): Spending growth for freestanding home health care agencies accelerated in 2015, increasing 6.3 percent to $88.8 billion following growth of 4.5 percent in 2014. Stronger growth in both Medicare (2.6 percent) and Medicaid (6.0 percent) spending -- the two largest payers which accounted for 76 percent of home health spending -- along with faster growth in private health insurance and out-of-pocket spending drove the overall acceleration in 2015.

    • Nursing Care Facilities and Continuing Care Retirement Communities (5 percent share): Spending for freestanding nursing care facilities and continuing care retirement communities increased 2.7 percent in 2015 to $156.8 billion. The slightly faster growth in 2015 (from 2.3 percent growth in 2014) was mainly due to the faster growth in Medicare spending of 5.6 percent versus 2.5 percent in 2014.

    • Prescription Drugs (10 percent share): Retail prescription drug spending decelerated in 2015, increasing 9.0 percent to $324.6 billion. Although growth in 2015 was slower than the 12.4 percent growth in 2014, spending on prescription drugs outpaced all other services in 2015. The strong spending growth for prescription drugs is attributed to the increased spending on new medicines, price growth for existing brand name drugs, increased spending on generics, and fewer expensive blockbuster drugs going off-patent.

    • Durable Medical Equipment (2 percent share): Retail spending for durable medical equipment, which includes items such as contact lenses, eyeglasses and hearing aids, reached $48.5 billion in 2015, and increased 3.9 percent, slightly faster than the 3.5 percent growth in 2014.

    • Other Non-durable Medical Products (2 percent share): Retail spending for other non- durable medical products, such as over-the-counter medicines, medical instruments, and surgical dressings, grew 3.7 percent to $59.0 billion in 2015. 

 

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32 minutes ago, sactowndog said:

I can support this but is it more efficient than a local clinic?

Probably.

No reimbursement concerns, located ideally to encourage people to attend, people's work has a vested interest in getting them to go, no dealing with medicare

Remember that every argument you have with someone on MWCboard is actually the continuation of a different argument they had with someone else also on MWCboard. 

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19 minutes ago, thelawlorfaithful said:

The patents are a governmental reaction to government's other intervention, regulations. These are the barriers that make bringing a drug to market astronomically expensive. They are also incredibly important. We want to know our drugs are exactly what they say they are, and do exactly what they say they do. Anything less is unacceptable. But the process is not cheap and incredibly risky for investors. So to entice the massive amounts of money that make innovation possible, the government gives the few drugmakers who successfully bring one to market a monopoly for a short period of time.

If you're going to have the stringent regulations we need, you need patents. Without patents there is no money, without money there is no innovation, without innovation those who get sick in the future are screwed.

Patents are offered to inventors as a reward to their innovation.  It's not tied to their regulatory burden.   

Potentially patent protection should be extended for drugs addressing critical functioning or life in depth but only in return for caps in pricing.   

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20 minutes ago, Joe from WY said:

I think they should just tax fat people. Obesity is the biggest contributor to health problems. Tax the fat. 

 

Again I would encourage and agree with incentives to get in shape.  They already allow differentiated pricing due to smoking.  I would add based on weight. 

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59 minutes ago, sactowndog said:

Did you say something intelligent or just mindlessly blather on in the same manner.   You claim to support market driven economies but have yet to demonstrate an understanding of its core principles.   

HA! HA! HA! HA! HA! HA! HA! HA! HA! HA! HA! HA! HA! HA!

 

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51 minutes ago, thelawlorfaithful said:

The patents are a governmental reaction to government's other intervention, regulations. These are the barriers that make bringing a drug to market astronomically expensive. They are also incredibly important. We want to know our drugs are exactly what they say they are, and do exactly what they say they do. Anything less is unacceptable. But the process is not cheap and incredibly risky for investors. So to entice the massive amounts of money that make innovation possible, the government gives the few drugmakers who successfully bring one to market a monopoly for a short period of time.

If you're going to have the stringent regulations we need, you need patents. Without patents there is no money, without money there is no innovation, without innovation those who get sick in the future are screwed.

 

It is the typical policy of an IRL like Sactowndog to hate capitalism and steal from it at every opportunity.  This is just another example.

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4 minutes ago, bluerules009 said:

 

It is the typical policy of an IRL like Sactowndog to hate capitalism and steal from it at every opportunity.  This is just another example.

Again you have no clue as I proposed extending patent protection but keep trying with your delusional statement rules.

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1 minute ago, sactowndog said:

Again you have no clue as I proposed extending patent protection but keep trying with your delusional statement rules.

You have nothing but communism in mind.    Everything you have proposed will hurt patients, our economy and our freedoms.

Your not even worth the time it takes to laugh at you.  HA! HA! HA! HA! HA! HA! HA! HA! HA! HA!

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44 minutes ago, sactowndog said:

So while you say other countries can't.... other countries do and they aren't changing.   So then what....

Drug pricing is growing at double digit growth with a significant percent attributable to pricing growth unlike the rest of healthcare.   You can't address health care costs without addressing drug pricing.   

Health Spending by Type of Service or Product:

  • Hospital Care (32 percent share): Spending for hospital care increased 5.6 percent to $1.0 trillion in 2015 compared to 4.6 percent growth in 2014. The faster growth in 2015 was driven by continued growth in non-price factors such as the use and intensity of services. However, hospital price growth was just 0.9 percent in 2015, which was the lowest rate of growth since 1998. Hospital services, from a payer perspective, experienced faster growth in Medicaid and private health insurance spending; however this strong growth was slightly offset by slower growth in Medicare hospital spending.

  • Physician and Clinical Services (20 percent share): Spending on physician and clinical services increased 6.3 percent in 2015 to $634.9 billion. This was an acceleration from growth of 4.8 percent in 2014 and was the first time since 2005 that the growth rate exceeded 6.0 percent. As with hospitals, the faster growth in overall physician and clinical services spending was driven by continued growth in non-price factors. Price growth for physician and clinical services, however, declined 1.1 percent in 2015, driven by the expiration of temporary increases in Medicaid payments to primary care physicians.

  • Other Professional Services (3 percent share): Spending for other professional services reached $87.7 billion in 2015, an increase of 5.9 percent and an acceleration from growth of 5.1 percent in 2014. Spending in this category includes establishments of independent health practitioners (except physicians and dentists) that primarily provide services such as physical therapy, optometry, podiatry, or chiropractic medicine.

  • Dental Services (4 percent share): Spending for dental services increased 4.2 percent in 2015 to $117.5 billion, which was an acceleration from 2.4 percent growth in 2014. Out-of-pocket spending for dental services (which accounted for 40 percent of dental spending) increased 1.8 percent in 2015 after increasing 0.8 percent in 2014. Private health insurance (which accounted for 47 percent of dental spending) increased 3.0 percent in 2015 following 2.1 percent growth in 2014.

  • Other Health, Residential, and Personal Care Services (5 percent share): Spending associated with other health, residential, and personal care services grew 7.8 percent in 2015 to $163.3 billion after increasing 5.0 percent in 2014. The robust growth was driven by 10.0 percent growth in Medicaid spending, which represented nearly 57 percent of all spending in this category. This category includes expenditures for medical services that are generally delivered by providers in non-traditional settings such as schools, community centers, and the workplace; as well as by ambulance providers and residential mental health and substance abuse facilities.

  • Home Health Care (3 percent share): Spending growth for freestanding home health care agencies accelerated in 2015, increasing 6.3 percent to $88.8 billion following growth of 4.5 percent in 2014. Stronger growth in both Medicare (2.6 percent) and Medicaid (6.0 percent) spending -- the two largest payers which accounted for 76 percent of home health spending -- along with faster growth in private health insurance and out-of-pocket spending drove the overall acceleration in 2015.

    • Nursing Care Facilities and Continuing Care Retirement Communities (5 percent share): Spending for freestanding nursing care facilities and continuing care retirement communities increased 2.7 percent in 2015 to $156.8 billion. The slightly faster growth in 2015 (from 2.3 percent growth in 2014) was mainly due to the faster growth in Medicare spending of 5.6 percent versus 2.5 percent in 2014.

    • Prescription Drugs (10 percent share): Retail prescription drug spending decelerated in 2015, increasing 9.0 percent to $324.6 billion. Although growth in 2015 was slower than the 12.4 percent growth in 2014, spending on prescription drugs outpaced all other services in 2015. The strong spending growth for prescription drugs is attributed to the increased spending on new medicines, price growth for existing brand name drugs, increased spending on generics, and fewer expensive blockbuster drugs going off-patent.

    • Durable Medical Equipment (2 percent share): Retail spending for durable medical equipment, which includes items such as contact lenses, eyeglasses and hearing aids, reached $48.5 billion in 2015, and increased 3.9 percent, slightly faster than the 3.5 percent growth in 2014.

    • Other Non-durable Medical Products (2 percent share): Retail spending for other non- durable medical products, such as over-the-counter medicines, medical instruments, and surgical dressings, grew 3.7 percent to $59.0 billion in 2015. 

 

That's your breakdown?  I'd say the biggest draw on the overall medical system isn't doctors, drugs, or hospitals.  It's the increasing bunch of muckety mucks that don't produce or do anything besides increase regulatory burden.  We've increased over the 12 years in droves with the suits upstairs.  I wouldn't say they produce any tangible product that justifies their salary, but they sure like to tell us what we need to be doing. 

growth-in-administrators.jpg

This is your problem, which in part is due to the government, due to nonsense and compliance with all of their stupid, regulated programs. 

How are you going to address drug pricing when the rest of the world won't pay their fair share?

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