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Is agreement on healthcare possible?

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Guest RoscoesDad
1 hour ago, Jack Bauer said:

I think that's a naive response.  You can treat most conditions inexpensively.  A few groups of drugs are contributing heavily to increasing costs.  Cancer drugs are expensive.  Autoimmune drugs are expensive.  Hepatitis drugs are expensive.  HIV drugs are expensive.  I can treat diabetes, hypertension, cholesterol, and all that stuff for pretty cheap.  Antibiotics are cheap.  Treatment for most ortho conditions is cheap.  

What I'm saying is there's a small group of conditions that are driving up significant cost, niche conditions that only a small portion of the populace experiences.  That doesn't mean they don't deserve treatment, but that's what this whole thread is about.  Where do you draw the line?  The company has billions invested in these medications.  They have several failed medications along the way that didn't make it to market.  They deserve to recoup those costs.  If you truly limit their income by setting prices, then you blunt the innovation and desire for people to invest in this stuff.  

EDIT: Hepatitis is being cured around the world due to the model we have in the US.  That was unimaginable 20 years ago.  I wish the medication was cheaper, but it doesn't even bug me that it's not.  If I had Hepatitis and there was a drug that cost 90k for treatment, I'd give my left nut for that.  I think they are going to cure Type 1 diabetes pretty soon.  Same with cystic fibrosis.  

Just generally speaking this is an issue that will never get resolved as long as we have a 'for profit' healthcare model.  Because healthcare is not a model in which profits can be made.  That's just how it is and I would assume you agree.  Someone's going to be on the short end of the stick.  So the question one asks themselves is should that be the sick person who gets denied care and just die off?  The medical provider, the insurance company or the govt?   I am about as anti-Christian as one can get, but somehow I manage to find myself believing in the Hippocratic Oath and that every person on earth deserves to be treated when they are sick and destitute.  I assume you took that oath correct?  

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15 minutes ago, RoscoesDad said:

Just generally speaking this is an issue that will never get resolved as long as we have a 'for profit' healthcare model.  Because healthcare is not a model in which profits can be made.  That's just how it is and I would assume you agree.  Someone's going to be on the short end of the stick.  So the question one asks themselves is should that be the sick person who gets denied care and just die off?  The medical provider, the insurance company or the govt?   I am about as anti-Christian as one can get, but somehow I manage to find myself believing in the Hippocratic Oath and that every person on earth deserves to be treated when they are sick and destitute.  I assume you took that oath correct?  

I'm not sure we'd even have a cure for hepatitis if we didn't have a "for profit" model.  You take the good and bad.  I don't think anyone is suggesting we should let the sick die off.  Even in places with universal care, like Canada, people wait for procedures and treatment until it's too late sometimes, so there's good and bad about all systems.  I had a student earlier this year who was Canadian and her grandmother wasn't treated in time for her ovarian cancer.  They didn't do the surgery immediately and she had to wait.  The cancer progressed and she died.  People think this stuff doesn't go on in other countries who have universal care, but it does.

I mean, we have not for profit hospitals around here, and they still do tons of business.  They do make profits, but they'll throw that back in to their own company, or remodel the lunch room for the sixth time, etc. 

I believe in the Hippocratic oath as well, which is why you see us all treat people that couldn't get treatment otherwise.  I'd love if we all had access to great care and the best of everything.  I'm a physician's assistant, and deal with the same problems in health care that physicians do, so I haven't taken the oath, but I believe in the principles that are outlined in it and try to practice safe, evidence based, and ethical care when treating people.

@Chile_Ute is a PA as well, I think the only docs on the board are bluerules and @NMpackalum.

Quote

I swear to fulfill, to the best of my ability and judgment, this covenant:...

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can but I will always look for a path to a cure for all diseases.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

 I mean, I don't see anything wrong with practicing medicine the way that it's outlined above.

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53 minutes ago, RoscoesDad said:

Just generally speaking this is an issue that will never get resolved as long as we have a 'for profit' healthcare model.  Because healthcare is not a model in which profits can be made.  That's just how it is and I would assume you agree.  Someone's going to be on the short end of the stick.  So the question one asks themselves is should that be the sick person who gets denied care and just die off?  The medical provider, the insurance company or the govt?   I am about as anti-Christian as one can get, but somehow I manage to find myself believing in the Hippocratic Oath and that every person on earth deserves to be treated when they are sick and destitute.  I assume you took that oath correct?  

This is absolutely the most ignorant thing anyone could say.   It demands a person with so little education they didn't pay attention to any thing that has happened in the last 500 years of history.

The only fix for healthcare, the only way you get low prices, new miracle drugs and affordable health care is a for profit, capitalist system.  The only way you drive down costs is a capitalist system and the efficiencies they create.  The only way you drive down cost but still cure hepatitis is a for profit system that allows a company to make huge investments and huge profits when successful.  The only way you can afford to create drugs for small patient populations and large patient populations is in a capitalist system where pricing is flexible.

Communism doesn't work idiot.

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8 hours ago, Jack Bauer said:

I think that's a naive response.  You can treat most conditions inexpensively.  A few groups of drugs are contributing heavily to increasing costs.  Cancer drugs are expensive.  Autoimmune drugs are expensive.  Hepatitis drugs are expensive.  HIV drugs are expensive.  I can treat diabetes, hypertension, cholesterol, and all that stuff for pretty cheap.  Antibiotics are cheap.  Treatment for most ortho conditions is cheap.  

What I'm saying is there's a small group of conditions that are driving up significant cost, niche conditions that only a small portion of the populace experiences.  That doesn't mean they don't deserve treatment, but that's what this whole thread is about.  Where do you draw the line?  The company has billions invested in these medications.  They have several failed medications along the way that didn't make it to market.  They deserve to recoup those costs.  If you truly limit their income by setting prices, then you blunt the innovation and desire for people to invest in this stuff.  

EDIT: Hepatitis is being cured around the world due to the model we have in the US.  That was unimaginable 20 years ago.  I wish the medication was cheaper, but it doesn't even bug me that it's not.  If I had Hepatitis and there was a drug that cost 90k for treatment, I'd give my left nut for that.  I think they are going to cure Type 1 diabetes pretty soon.  Same with cystic fibrosis.  

Since when is making a factual statement a naive response?  

Look at the data I posted.  Only one category is seeing significant increase due to pricing actions.   One!   Did you even bother to read it.  Others are growing 3-6% but that change is due to increased usage.  I expect Tools and Lawful to ignore the data to fit their worldview but not you.   

Do you suppose they possibly had to cover R&D costs 20 years also?  Big Pharma raising prices has nothing to do with covering R&D expenses and everything to do with increasing earnings per share.  The gap between US and European pricing grew right in line with the change in executive compensation.

here is one article...

https://www.google.com/amp/www.cbsnews.com/amp/news/whats-behind-the-sharp-rise-in-prescription-drug-prices/

Here is another for you with a clear quote...

report released on Tuesday in the Journal of the American Medical Association took a deep dive into the question of why the US has such high drug prices and offered some possible short-term solutions to the problem.

"Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices," the researchers from Brigham and Women's Hospital in Boston found. "Rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear."

 

 

 

 

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6 hours ago, RoscoesDad said:

Just generally speaking this is an issue that will never get resolved as long as we have a 'for profit' healthcare model.  Because healthcare is not a model in which profits can be made.  That's just how it is and I would assume you agree.  Someone's going to be on the short end of the stick.  So the question one asks themselves is should that be the sick person who gets denied care and just die off?  The medical provider, the insurance company or the govt?   I am about as anti-Christian as one can get, but somehow I manage to find myself believing in the Hippocratic Oath and that every person on earth deserves to be treated when they are sick and destitute.  I assume you took that oath correct?  

Just to be clear, despite Tools protestations I am fine with a for profit model when the elements that make a functioning market are in place.  

Many portions of medicine work fine because people can opt in or out based on expense.   Cosemetic medical procedures are a good example of this market phenomenon.  Veterinary medicine is another medical market that functions well because if the prices get too high people opt out.  It is not uncommon for Pet owners to decide a treatment is too expensive and choose to Euthanize an animal.  That is what happens in functioning markets.  Because people opt out of treatments in Vet Medicine, suppliers must drive down costs to be accepted in the marketplace by enough consumers.  

But other portions of healthcare are missing fundamental elements required in a functioning market. 

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2 hours ago, sactowndog said:

Since when is making a factual statement a naive response?  

Look at the data I posted.  Only one category is seeing significant increase due to pricing actions.   One!   Did you even bother to read it.  Others are growing 3-6% but that change is due to increased usage.  I expect Tools and Lawful to ignore the data to fit their worldview but not you.   

Do you suppose they possibly had to cover R&D costs 20 years also?  Big Pharma raising prices has nothing to do with covering R&D expenses and everything to do with increasing earnings per share.  The gap between US and European pricing grew right in line with the change in executive compensation.

here is one article...

https://www.google.com/amp/www.cbsnews.com/amp/news/whats-behind-the-sharp-rise-in-prescription-drug-prices/

Here is another for you with a clear quote...

report released on Tuesday in the Journal of the American Medical Association took a deep dive into the question of why the US has such high drug prices and offered some possible short-term solutions to the problem.

"Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices," the researchers from Brigham and Women's Hospital in Boston found. "Rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear."

Less than a third of increased spending on drugs is due to drug pricing. That number is equal to that due to inflation and the increased number of prescriptions doled out to aging healthcare consumers.

Talk about ignoring data to fit your worldview. That is literally all you've done in this thread.

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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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12 hours ago, sactowndog said:

Since when is making a factual statement a naive response?  

Look at the data I posted.  Only one category is seeing significant increase due to pricing actions.   One!   Did you even bother to read it.  Others are growing 3-6% but that change is due to increased usage.  I expect Tools and Lawful to ignore the data to fit their worldview but not you.   

Do you suppose they possibly had to cover R&D costs 20 years also?  Big Pharma raising prices has nothing to do with covering R&D expenses and everything to do with increasing earnings per share.  The gap between US and European pricing grew right in line with the change in executive compensation.

here is one article...

https://www.google.com/amp/www.cbsnews.com/amp/news/whats-behind-the-sharp-rise-in-prescription-drug-prices/

Here is another for you with a clear quote...

report released on Tuesday in the Journal of the American Medical Association took a deep dive into the question of why the US has such high drug prices and offered some possible short-term solutions to the problem.

"Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices," the researchers from Brigham and Women's Hospital in Boston found. "Rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear."

 

 

 

 

I guess I look at it as a few niche products that have significantly improved life for many people as being the increase in cost.  With many of those being niche markets, what is the incentive for the drug company to develop the drug if they can't make back their R/D costs and make profits? Overall, however, most medications to treat common conditions are pretty inexpensive.

The solutions you've provided us with won't solve the problem you're angry about, imo.  The government is the problem  For every epipen or daraprim disaster, you can thank the government for giving a patent to a particular company to produce this without competition.  The bioactive drugs we use for RA and other autoimmune disease represent a very competitive market with significant competition, and the cost is what it costs, and I don't feel it's price gouging.  Those drugs are incredibly expensive to develop with multiple failures along the way.  

You can't use epi pen or daraprim for your example of increased drug cost, and then demand the government step in to regulate the market on those.  They started the unbalanced market to begin with and it's bullshit.  There's literally no reason for them to have done that to all the asthma and anaphylaxis people that need epi pens outside of corporate and government cronyism.

 

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http://www.xconomy.com/seattle/2014/09/02/which-countries-excel-in-creating-new-drugs-its-complicated/#

US companies have developed more new products than the rest of the world combined according to this article.

Table


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/

This shows that US companies outpace the rest of the world as well.

Quote

Thirty-six percent of all NMEs were developed in the United States (Figure 1). The United Kingdom was the next largest source of NME development (10.4%). Examination of drugs with patents (n = 288) revealed that 126 (43.7%) of the NMEs had their earliest patent filed by inventors in the United States. Of the 288 drugs with patents in force at the time of FDA approval, 28 (10%) had more than 1 country listed as the home country of the patent holder. The distribution of inventor countries did not appreciably change if we assigned the second country listed on the patent as the inventor

So, it looks like there's more innovation here, but some countries outpace the US on a per capita basis.  Also, the US has more overall development by a lot but there's other countries that use price controlling with success and still have some innovation, but it really depends on what countries choose as their focus.

Quote

Pharmaceutical innovation is an international enterprise. Higher prescription drug spending in the United States does not disproportionately privilege domestic innovation. Conversely, many countries with national health systems and drug pricing regulation were significant contributors to pharmaceutical innovation.

I'd conclude that we do more here, but there's other contributors worldwide that contribute as well, even in some countries with price controls and government intervention.  

It'll be interesting to see how this moves forward.

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1 hour ago, Jack Bauer said:

 

The solutions you've provided us with won't solve the problem you're angry about, imo.  The government is the problem  For every epipen or daraprim disaster, you can thank the government for giving a patent to a particular company to produce this without competition.  The bioactive drugs we use for RA and other autoimmune disease represent a very competitive market with significant competition, and the cost is what it costs, and I don't feel it's price gouging.  Those drugs are incredibly expensive to develop with multiple failures along the way.  

 

What solution would you be referring to?   I haven't proposed any specific solution.   

My point is you can't solve the cost problem without addressing prescription drug pricing.   No evidence exists to show the rise is related to R&D costs, base components to fashion a demand curve are missing.  The facts are what they are.   

Then the question is what can be done to control unlimited pricing power without harming innovation.  Plenty of markets innovate without unlimited pricing power.  

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13 hours ago, thelawlorfaithful said:

Less than a third of increased spending on drugs is due to drug pricing. That number is equal to that due to inflation and the increased number of prescriptions doled out to aging healthcare consumers.

Talk about ignoring data to fit your worldview. That is literally all you've done in this thread.

Your comment would be true if I said dealing with drug pricing was the only item that needed to be done.

i already agreed with your suggestion to consolidate all programs into a refundable tax credit.

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1 hour ago, sactowndog said:

What solution would you be referring to?   I haven't proposed any specific solution.   

My point is you can't solve the cost problem without addressing prescription drug pricing.   No evidence exists to show the rise is related to R&D costs, base components to fashion a demand curve are missing.  The facts are what they are.   

Then the question is what can be done to control unlimited pricing power without harming innovation.  Plenty of markets innovate without unlimited pricing power.  

You proposed a solution in your initial post moron.

You can't even keep track of your own proposals your so incompetent.

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10 minutes ago, bluerules009 said:

You proposed a solution in your initial post moron.

You can't even keep track of your own proposals your so incompetent.

No I stated we needed to deal with unrestrained pricing power but have repeatedly stated their are multiple ways to address the issue to insure appropriate returns on investment occur. 

Tools your like the freedom caucus of whom it was said they don't want to get to yes.  

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13 minutes ago, sactowndog said:

No I stated we needed to deal with unrestrained pricing power but have repeatedly stated their are multiple ways to address the issue to insure appropriate returns on investment occur. 

Tools your like the freedom caucus of whom it was said they don't want to get to yes.  

Sure you did, you have proposed communism several times for every part of the medical economy.

Don't be shy, own your shit moron.

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2 hours ago, sactowndog said:

What solution would you be referring to?   I haven't proposed any specific solution.   

My point is you can't solve the cost problem without addressing prescription drug pricing.   No evidence exists to show the rise is related to R&D costs, base components to fashion a demand curve are missing.  The facts are what they are.   

Then the question is what can be done to control unlimited pricing power without harming innovation.  Plenty of markets innovate without unlimited pricing power.  

Haven't you been insinuating the government should step in and price control?  The article I posted showed that there's innovation with other countries, but not as much as with our system. 

Quote

1) Life saving drugs and equipment were get a longer patent life but also are price controlled.

 

companies must also provide low cost clinics staffed by nurses for people to attend

That's what you said in the first post of this thread.  

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1 hour ago, Jack Bauer said:

Haven't you been insinuating the government should step in and price control?  The article I posted showed that there's innovation with other countries, but not as much as with our system. 

That's what you said in the first post of this thread.  

It's not just that companies in other countries develope drugs too, they do. But a lot of the money that funds these drugs comes from an American market without price controls. It's not just American drug companies who's research would get slaughtered by price controls.

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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3 hours ago, sactowndog said:

What solution would you be referring to?   I haven't proposed any specific solution.   

My point is you can't solve the cost problem without addressing prescription drug pricing.   No evidence exists to show the rise is related to R&D costs, base components to fashion a demand curve are missing.  The facts are what they are.   

Then the question is what can be done to control unlimited pricing power without harming innovation.  Plenty of markets innovate without unlimited pricing power.  

Name one with comparable development costs and barriers to entry as is found in the pharmaceutical industry.

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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2 hours ago, Jack Bauer said:

Haven't you been insinuating the government should step in and price control?  The article I posted showed that there's innovation with other countries, but not as much as with our system. 

That's what you said in the first post of this thread.  

Price controlled doesn't necessarily mean a hard price caps.   Numerous methods to set returns or tie returns to R&D expenses are possible and valid paths forward.

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20 hours ago, Jack Bauer said:

I guess I look at it as a few niche products that have significantly improved life for many people as being the increase in cost.  With many of those being niche markets, what is the incentive for the drug company to develop the drug if they can't make back their R/D costs and make profits? Overall, however, most medications to treat common conditions are pretty inexpensive.

The solutions you've provided us with won't solve the problem you're angry about, imo.  The government is the problem  For every epipen or daraprim disaster, you can thank the government for giving a patent to a particular company to produce this without competition.  The bioactive drugs we use for RA and other autoimmune disease represent a very competitive market with significant competition, and the cost is what it costs, and I don't feel it's price gouging.  Those drugs are incredibly expensive to develop with multiple failures along the way.  

You can't use epi pen or daraprim for your example of increased drug cost, and then demand the government step in to regulate the market on those.  They started the unbalanced market to begin with and it's bullshit.  There's literally no reason for them to have done that to all the asthma and anaphylaxis people that need epi pens outside of corporate and government cronyism.

 

BTW Jack.  I'm far from angry.  It's just dumb IMHO to take on healthcare for anyone without more controls on the fastest growing expense item.   That includes the elderly.

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