Trump and Obamacare (1 Viewer)

[El Floppo]

I wonder how different things would be had America opted for single payer back when Medicare was first introduced. 

and without getting nasty- I'd love for somebody to discuss the pros and cons of single payer. TIA.

 

[timschochet]

inter-state competition, as proposed by Trump... is this feasible? 

pre ACA, I assumed this would be a better way, especially for those of us in locales where we get screwed, but I know nothing about the ins and outs of it and would be interested in hearing more.

fwiw- pre ACA, as an independent contractor, I was paying $2,200/month for my family of 4. more than 25k/year.

It is feasible. But my understanding is it's not going to save a ton of money. 

 

[timschochet]

We have to look at why healthcare costs so much. Why can I get my blood pressure medicine in Mexico (where it is made in Europe instead of the US) for the same cost as my co-pay here.

Why does my GP have to refer me to a specialist all the time for tests he can run?

Why do my doctor friends spend more time filling out paperwork than they do with patients?

I can go to a pharmacy in Mexico, talk to a doctor there, and get a prescription for medication. The doctor diagnoses without the need for extensive testing.  Why does it take a visit to my GP, then a visit to a specialist, then a blood test to get the same treatment?

Why are we no longer the client, but the insurance company is?

Why does my pregnant daughter have to go to an OB/GYN when my wife never did for all three of our kids? Why do they feel the need to run three ultrasounds?

Why can you not even buy tetanus vaccines with also having pertussis & diphtheria vaccine in it?

Why do you need annual flu shots when they have the ability to inoculate you for longer periods?

There is more than insurance out of control here. The entire medical insurance industry is a milking machine and we are the cow's udders. We need to find a way to get more general practitioners into the industry. Or to give more responsibility to PAs, maybe even RNs. The problem isn't the insurance: it is why the insurance requires so much paperwork of the doctors. We need to look at cutting paperwork, cutting excessive regulation, and protecting the medical industry from unwarranted legal claims.

This is a terrific post, and these are all great points. But other than single payer, which has problems of its own, I can't think of a good way to solve these issues. 

 

[The Commish]

inter-state competition, as proposed by Trump... is this feasible? 

pre ACA, I assumed this would be a better way, especially for those of us in locales where we get screwed, but I know nothing about the ins and outs of it and would be interested in hearing more.

fwiw- pre ACA, as an independent contractor, I was paying $2,200/month for my family of 4. more than 25k/year.

There is no legitimate reason we can't do healthcare like other countries...none.  The only thing preventing it is cash, the politicians and the companies providing them the cash.  We CAN have state competition.  We CAN refuse to put up with pharma companies taking a dump on us.  Personally, given the climate of healthcare in this country, I think the most logical thing is a government provided option on the private market.  All that said, I don't think our country's healthcare should be a "for profit enterprise", and no, I don't believe that would stifle innovation, research and/or progress in finding cures for disease and carrying for the human race.  

 

[timschochet]

and no, I don't believe that would stifle innovation, research and/or progress in finding cures for disease and carrying for the human race.  

Why not? Serious question because this obviously everyone's big fear about any kind of socialized medicine plan. 

 

[gianmarco]

 It's not the insurance companies that are making out like bandits in the system.   It's healthcare providers and pharmaceutical companies.    Our medical costs for the exact same treatments and medicines are ridiculous. 

 

[The Commish]

and no, I don't believe that would stifle innovation, research and/or progress in finding cures for disease and carrying for the human race.  

Why not? Serious question because this obviously everyone's big fear about any kind of socialized medicine plan. 

Because there are few major break through events that occur in the private sector.  Almost all of them come from people working in academics, post doc positions etc.  The foundation of this country's medical knowledge is on the academic side, not the private sector.  I can assure you, those on the academic side are going to keep grinding regardless of what our health insurance / healthcare structure looks like.

 

[Arsenal of Doom]

This is a terrific post, and these are all great points. But other than single payer, which has problems of its own, I can't think of a good way to solve these issues. 

Most of the items on @bueno's list are related to lack of cost transparency to consumers that result in over-consumption, or moral hazard. The best way to address that would be to have people purchase insurance policies themselves as opposed to the current situation where it comes from employers. Currently employers cover around 2/3 of the premium cost for employees and even that is usually a pre-tax deduction so people probably don't think about what it's costing more than a couple times a year. Employers also generally only have a handful of plans and have historically been pretty liberal with low deductibles since those are considered attractive benefits to recruit and retain talent (how employers ended up being the main source of insurance to begin with). 

Low deductibles and comprehensive coverage encourages people to maximize the benefit and support the high degree of specialization we see here compared to other health systems. 

 

[timschochet]

Because there are few major break through events that occur in the private sector.  Almost all of them come from people working in academics, post doc positions etc.  The foundation of this country's medical knowledge is on the academic side, not the private sector.  I can assure you, those on the academic side are going to keep grinding regardless of what our health insurance / healthcare structure looks like.

Well I'd love to believe this. Do you have any studies that back this up?

 

[timschochet]

Most of the items on @bueno's list are related to lack of cost transparency to consumers that result in over-consumption, or moral hazard. The best way to address that would be to have people purchase insurance policies themselves as opposed to the current situation where it comes from employers. Currently employers cover around 2/3 of the premium cost for employees and even that is usually a pre-tax deduction so people probably don't think about what it's costing more than a couple times a year. Employers also generally only have a handful of plans and have historically been pretty liberal with low deductibles since those are considered attractive benefits to recruit and retain talent (how employers ended up being the main source of insurance to begin with). 

Low deductibles and comprehensive coverage encourages people to maximize the benefit and support the high degree of specialization we see here compared to other health systems. 

One of the most pressing issues he brought up is GPs sending patients out for specialized testing, when they could do it themselves, or overtesting. What can we do about this? I assume that it's a result of malpractice lawsuits?

 

[Arsenal of Doom]

Employer provided insurance is also an under-reported part of the lack of wage growth for the last three decades, as insurance has taken up a larger and less predictable component of total employee compensation. I've always thought HC reform advocates have wasted a really good pro-business selling point in pushing for more gov't involvement in the HC system, since gov't would largely be replacing the employer role and free up resources and OpEx for companies to use elsewhere. 

 

[Arsenal of Doom]

One of the most pressing issues he brought up is GPs sending patients out for specialized testing, when they could do it themselves, or overtesting. What can we do about this? I assume that it's a result of malpractice lawsuits?

Yeah, part of it is defensive medicine which involves over-testing whether done by the GP or a specialist. It also probably has to do with the relative shortage of GPs today and abundance of specialists. Honestly this is a tricky issue because the specialists are probably giving better care in most instances, so GPs are acting in their patients' best interests by doing referrals. 

As a personal example, I tore my calf working out last year and initially went to my GP about it. He basically told me to ice it for a couple days and then try to slowly get back to normal activity and it would heal in a few months. He said I might try a walking boot during the day but it was optional and might not help.  I then self-referred to an orthopedic specialist because I wanted a second opinion and this doctor had me in a boot out of the office. He said he sees a dozen or so of those a year, including many people who come in after months of not healing. If you wear the boot, the healing time is 4-6 weeks and the specialist had never had a patient not respond  when they wore it. 4 weeks later I was out of the boot in PT, running again a couple weeks later. 

So the answer for fewer specialists is really less demand for specialists, which gets back to the moral hazard thing. Defensive medicine is a little tougher because it's not all driven by malpractice. Tort reform has happened at the state level and hasn't really resulted in much cost-saving. Moral hazard plays into it as well since health consumers don't pay much beyond co-pays for many tests. 

 

[urbanhack]

Mr and Mrs MOP saw our health care costs skyrocket in the last several years. Obamacare felt like a heavy burden on those who choose to,get up and go to work everyday. I have never been able to get past that point. Penalized for working and having a job and keeping people alive in general. 

Very disheartening

Hang in there.

 

[bigbottom]

Most of the items on @bueno's list are related to lack of cost transparency to consumers that result in over-consumption, or moral hazard. The best way to address that would be to have people purchase insurance policies themselves as opposed to the current situation where it comes from employers. Currently employers cover around 2/3 of the premium cost for employees and even that is usually a pre-tax deduction so people probably don't think about what it's costing more than a couple times a year. Employers also generally only have a handful of plans and have historically been pretty liberal with low deductibles since those are considered attractive benefits to recruit and retain talent (how employers ended up being the main source of insurance to begin with). 

Low deductibles and comprehensive coverage encourages people to maximize the benefit and support the high degree of specialization we see here compared to other health systems. 

Yep.  My new employer has a higher deductible/hsa plan (to which the employer contributes) which is really the lowest out of pocket cost option for most employees, and the structure incentivizes the employee to be a conscientious consumer of medical benefits.  In other words, employees are incentivized to be more informed and deliberative in terms of cost. I think these types of plans/structures are critical in reducing overconsumption of health care benefits.

 

[flapgreen]

There's nothing wrong with the thread - it's a good topic for discussion- how about we stick to it.

Except there was a former thread detailing everything by people who knew what they were talking about and this one will be a bunch of clueless blowhards bickering amongst themselves. 

 

[The Commish]

Well I'd love to believe this. Do you have any studies that back this up?

Not outside the circle of development.  Is that good enough?  Private labs account for very few of the "breakthroughs" we get.  The "breakthroughs" come from academic labs more often than not.  Now, it's true that once the breakthrough happens, the application is usually driven by the private sector.  Perhaps that's your concern.  Personally, I have a hard time envisioning a system where science is pushing forward learning all these various things and then put it on a shelf where no one wants to apply it.

For example take this CRISPR approach to gnome editing.  That was a scientist in an academic lab who made the discovery.  I have a hard time envisioning the scenario where such a discovery is made and the net result is it's shelved with nothing more than a comment like "huh....that's pretty cool....good to know".  

I'd be willing to call the private industries bluff on this argument and sleep fine while doing it.

 

[El Floppo]

Except there was a former thread detailing everything by people who knew what they were talking about and this one will be a bunch of clueless blowhards bickering amongst themselves. 

Considering how long that other thread is, I just assumed it was a #### show and avoided. An I wrong? 

Was hoping for more condensed, specific discussion in here. And so far the only digressing are posts like yours.

 

[Arsenal of Doom]

Yep.  My new employer has a higher deductible/hsa plan (to which the employer contributes) which is really the lowest out of pocket cost option for most employees, and the structure incentivizes the employee to be a conscientious consumer of medical benefits.  In other words, employees are incentivized to be more informed and deliberative in terms of cost. I think these types of plans/structures are critical in reducing overconsumption of health care benefits.

This has been the trend for a while, going back before ACA was passed really. There's some decent correlating evidence that it works, at least to slow the rate of growth in  healthcare spending.

There was a similar movement in the 90s to HMOs, which control costs through managed care and having integrated payer/provider interests. Costs grew at a slower rate but those plans weren't popular and employers moved back to more flexible plans that employees prefer. Premiums have also been rising more slowly in the group health market since ACA passed, though total health spending has risen because of 22 million more insured. 

I'd still prefer to see insurance decoupled completely from employers. Have the gov't pay for the first unit of coverage for everyone, basic coverage along the lines of medicaid w/ cost offsets to help w/ co-pays for lower incomes. Basically stepping into the roll employers play today, most of the coverage would still go through private insurance companies, let the gov't negotiate the rates for basic coverage. Could keep a public option of Medicaid/Medicare or just roll it all through negotiated contract w/ insurers. Then allow insurance companies sell over the top of that to provide expanded networks, more access to specialists, etc. Basically the way Medicare Advantage works. 

This set up addresses moral hazard because the basic plan would limit specialization and have cost-sharing components. It addresses the problem of adverse selection because  everyone is covered and insurance companies can operate with their premium products more like the standard insurance model. You can work in was to help reduce defensive medicine w/ malpractice caps/gov't backing for providers offering basic plan services, fewer specialists on the basic network, etc. Free riders are reduced since all citizens are in the plan.

No plan is ever going to be exactly perfect but I think we ultimately end up with something like what I've described above. Unless we develop medical tech that improves health outcomes at dramatically lower costs first, which I actually think is reasonably likely.    

 

[timschochet]

Not outside the circle of development.  Is that good enough?  Private labs account for very few of the "breakthroughs" we get.  The "breakthroughs" come from academic labs more often than not.  Now, it's true that once the breakthrough happens, the application is usually driven by the private sector.  Perhaps that's your concern.  Personally, I have a hard time envisioning a system where science is pushing forward learning all these various things and then put it on a shelf where no one wants to apply it.

For example take this CRISPR approach to gnome editing.  That was a scientist in an academic lab who made the discovery.  I have a hard time envisioning the scenario where such a discovery is made and the net result is it's shelved with nothing more than a comment like "huh....that's pretty cool....good to know".  

I'd be willing to call the private industries bluff on this argument and sleep fine while doing it.

Well as I wrote I really want to believe you. Over the years and especially since Obamacare I have moved closer and closer to single payer being the best solution to our health care problems. But I'll admit this one issue gave me lots of pause. 

 

[Tau837]

I think the most logical thing is a government provided option on the private market.

How do you see this as being different than the Obamacare co-ops, most of which have failed?

All that said, I don't think our country's healthcare should be a "for profit enterprise", and no, I don't believe that would stifle innovation, research and/or progress in finding cures for disease and carrying for the human race.

Can you unpack how you think this could work in such a way as to remove the for profit focus but retain the motivation for organizations to undertake innovation and research? I have seen reports that it costs $2.5B to $5B to bring a new drug to the marketplace. What organizations will be willing to undertake that kind of investment and risk without a profit motive?

 

[Tau837]

Because there are few major break through events that occur in the private sector.  Almost all of them come from people working in academics, post doc positions etc.  The foundation of this country's medical knowledge is on the academic side, not the private sector.  I can assure you, those on the academic side are going to keep grinding regardless of what our health insurance / healthcare structure looks like.

This is false. From NEJM The Private Sector Discoveries Account for 79--90% of Pharmaceutical Products:

The study found that for the 18-year period from 1990 through 2007, FDA approved 1541 new-drug applications. Of the 1541 total approvals, only 143 (9.3%) resulted from PSRIs.

 

[Tau837]

Not outside the circle of development.  Is that good enough?  Private labs account for very few of the "breakthroughs" we get.  The "breakthroughs" come from academic labs more often than not.  Now, it's true that once the breakthrough happens, the application is usually driven by the private sector.  Perhaps that's your concern.  Personally, I have a hard time envisioning a system where science is pushing forward learning all these various things and then put it on a shelf where no one wants to apply it.

For example take this CRISPR approach to gnome editing.  That was a scientist in an academic lab who made the discovery.  I have a hard time envisioning the scenario where such a discovery is made and the net result is it's shelved with nothing more than a comment like "huh....that's pretty cool....good to know".  

I'd be willing to call the private industries bluff on this argument and sleep fine while doing it.

Yeah, well, it's a good thing you aren't in charge then. More info to disprove your stance, from Public and Private Sector Contributions tothe Research & Development of the Most Transformational Drugs of the Last 25 Years (bolding/underlining is my emphasis):

Much has indeed changed in the paradigm by which biopharmaceutical R&D is conducted since
the authors undertook their first analysis of the relative contributions of the public and private
sectors to the discovery and development of new medicines nearly two decades ago. What has not
changed is that when you examine the drugs that have contributed the most and are still contributing
significantly to the health and well-being of the US and even globally, the role of the biopharmaceutical
industry is pivotal in the translation from theory to therapy. In fact, two decades of reliable
analyses by academia and government, assessed using a variety of methodological approaches,
consistently demonstrate that 67 percent to 97 percent of drug development is conducted by the
private sector.

...

For example, 54% of basic science milestones were achieved predominantly by the public sector,
and 27% by the private sector. For discovery milestones, it was 15% by the public sector, and 58%
by the private sector. The private sector was again dominant in achieving the major milestones for
both the chemistry/manufacturing/controls and drug development phases, in 81% and 73% of the
drugs reviewed, respectively. For 19-27% of the case histories in all categories, dominance of one
sector versus the other could not be determined. The research that was done was expansive in its
scope, often spanning oceans in the geographic reach of the institutions involved, as well as extending
over decades, an average of 25 years from discovery to approval.

...

The results of our analysis confirm just how critical the private sector is to the time and resource
consuming process of drug development. While the basic science underpinning the key disciplines 
needed to discover and develop drugs is often initiated in academia, it is pharma firms, in particular,
where these disciplines grow to give the necessary critical mass, expertise and experience needed
for successful drug discovery. Disciplines like medicinal chemistry, process chemistry and formulation,
drug metabolism and pharmacokinetics, and safety sciences are practiced at a scale and level
of competence and integration in the industry that far outstretch academic applications.

But some remain skeptical of the role of the private sector in this important enterprise, and assert
that it could and should be exclusively within control (at least financially) of the government. This
begs the question: How Much Government Funding Would be Needed to Replace Industry New Drug
R&D? In response, we made an effort to conservatively assess what the additional cost to government
and taxpayers would be if such a radical policy change were made. To keep the analysis consistent
with the period covered by the particular innovative compounds that we study in detail in
this report, we initially restricted attention to new drugs approved from 1987 to 2002. The estimates
suggest that conservatively the NIH budget would have to nearly double to maintain just the flow of
the most innovative drug approvals, and would have to increase nearly two-and-half times to maintain
the development of all new drugs. The relative inexperience of government in the latter stages
of the R&D continuum would likely result in the government spending significantly more on developing
new drugs than does the industry. We found even higher relative costs for drugs approved
from 2003 to 2011. Given the trends for industry R&D costs and NIH budget appropriations, it is
also likely that an analysis of more recent and future approvals would show more substantial
increases in the relative cost of private sector R&D.

 

[The Commish]

None of this is talking about the discoveries...the applications?  Yes.  The foundation?  No.  All this is the shiny new houses built on the foundations created in the academic world.  Congrats on the pharm companies producing 40 drugs that treat the same thing.  The foundation and discovery (like the CRISPR type discoveries) took place in an academic lab.  You are talking about the creation of Tylenol, Advil and Aleeve.  I am talking about the medical discoveries that let us know those things could be of benefit to us.

 

[timschochet]

This is a fascinating debate. I'm honestly not sure which side to believe. 

 

[urbanhack]

This is a terrific post, and these are all great points. But other than single payer, which has problems of its own, I can't think of a good way to solve these issues. 

More regulation? Cap profits? Make certain parts of our health care not for profit?

Oh wait....you love the free market. 

Enjoy!

 

[Tau837]

None of this is talking about the discoveries...the applications?  Yes.  The foundation?  No.  All this is the shiny new houses built on the foundations created in the academic world.  Congrats on the pharm companies producing 40 drugs that treat the same thing.  The foundation and discovery (like the CRISPR type discoveries) took place in an academic lab.  You are talking about the creation of Tylenol, Advil and Aleeve.  I am talking about the medical discoveries that let us know those things could be of benefit to us.

But both are required. You seem to act like only the academic portion is really needed. If that is what you are saying, you're wrong. If it isn't, you haven't made it clear how the rest of it will still happen if you take away the profit motive.

 

[Riversco]

We have to look at why healthcare costs so much. Why can I get my blood pressure medicine in Mexico (where it is made in Europe instead of the US) for the same cost as my co-pay here.

Why does my GP have to refer me to a specialist all the time for tests he can run?

Why do my doctor friends spend more time filling out paperwork than they do with patients?

I can go to a pharmacy in Mexico, talk to a doctor there, and get a prescription for medication. The doctor diagnoses without the need for extensive testing.  Why does it take a visit to my GP, then a visit to a specialist, then a blood test to get the same treatment?

Why are we no longer the client, but the insurance company is?

Why does my pregnant daughter have to go to an OB/GYN when my wife never did for all three of our kids? Why do they feel the need to run three ultrasounds?

Why can you not even buy tetanus vaccines with also having pertussis & diphtheria vaccine in it?

Why do you need annual flu shots when they have the ability to inoculate you for longer periods?

There is more than insurance out of control here. The entire medical insurance industry is a milking machine and we are the cow's udders. We need to find a way to get more general practitioners into the industry. Or to give more responsibility to PAs, maybe even RNs. The problem isn't the insurance: it is why the insurance requires so much paperwork of the doctors. We need to look at cutting paperwork, cutting excessive regulation, and protecting the medical industry from unwarranted legal claims.

I think you might be onto something here. Trump should mandate that GPs or lesser health care professionals can perform the same services as specialists.  Or maybe create a second class of licensed doctors that operate cheaply, and you can buy insurance that covers only visits to them.  

 

[Riversco]

More regulation? Cap profits? Make certain parts of our health care not for profit?

Oh wait....you love the free market. 

Enjoy!

You can make a case that health care is currently not a free market due to the massive amounts of regulations (and qualifications of doctors) on performing even the most simplest of diagnoses or procedures.  These things drive up the cost.

 

[The Commish]

But both are required. You seem to act like only the academic portion is really needed. If that is what you are saying, you're wrong. If it isn't, you haven't made it clear how the rest of it will still happen if you take away the profit motive.

Yes...both discovery and application are needed, but the application side is completely out of control and it's specifically because we have no real and true regulation that protects the consumer in this country.  Do we really need 40 different brands of ibuprofen?  I would say we do not.  But we have them today (between the brands and the various generics) because the companies have successful marketing groups, not because they are needed.  We have an incredible amount of waste on the application side of the equation all in the name of "competition" and it's really not that at all.  These companies know they don't have to really worry about their costs because they will be allowed (by our government) to make it up in what they charge us as consumers.  Where other countries put restrictions on these companies, our government does not and it's all done in the name of "capitalism".  The reality is, the United States is footing the a good chunk of the profit burden for most of the rest of the world.

 

[Tau837]

Yes...both discovery and application are needed, but the application side is completely out of control and it's specifically because we have no real and true regulation that protects the consumer in this country.  Do we really need 40 different brands of ibuprofen?  I would say we do not.  But we have them today (between the brands and the various generics) because the companies have successful marketing groups, not because they are needed.  We have an incredible amount of waste on the application side of the equation all in the name of "competition" and it's really not that at all.  These companies know they don't have to really worry about their costs because they will be allowed (by our government) to make it up in what they charge us as consumers.  Where other countries put restrictions on these companies, our government does not and it's all done in the name of "capitalism".  The reality is, the United States is footing the a good chunk of the profit burden for most of the rest of the world.

IMO you are focused on the wrong part of application. It is the $2.5B to $5B to bring the first instance of a new medication to market that matters most and requires a profit motive. Without that, how do you see new medications reaching consumers?

Beyond that, we need some generic(s) to follow to force cost of the drug down through, yes, competition. I agree we don't 'need' 40 generics, but the point of generics is to lower cost, so I don't think there is a major problem with generic manufacturers passing inflated costs on to the consumers, since that would result in a product that wouldn't sell.

Yes, the US is paying a disproportionate burden for bringing new meds to the world. But if you eliminate that through regulation, the outcome will be a drastic reduction in breakthrough meds reaching consumers. That seems like an undesirable outcome, does it not?

If you disagree, explain how you propose it should and would work. It wouldn't hurt if you could post some links that support your position. 

 

[Jackstraw]

One of the under reported consequences of repealing the ACA is the elimination of lifetime limits under the ACA. If they repeal that provision you can essentially do the right thing, carry insurance, pay your premiums, the whole deal and still be bankrupt when you get sick. Most policies pre ACA carried a million dollar lifetime limit. You get cancer or some other serious condition and you can burn through that pretty quickly and find yourself in the same position as the deadbeats that carry no insurance whatsoever. 

We talk about personal responsibility above in the thread but the old system allows free riders as much as the  ACA does. 

I'm single payer all the way though I realize that is probably a non starter with this congress/administration. 

 

[BeaverCleaver]

One of the under reported consequences of repealing the ACA is the elimination of lifetime limits under the ACA. If they repeal that provision you can essentially do the right thing, carry insurance, pay your premiums, the whole deal and still be bankrupt when you get sick. Most policies pre ACA carried a million dollar lifetime limit. You get cancer or some other serious condition and you can burn through that pretty quickly and find yourself in the same position as the deadbeats that carry no insurance whatsoever. 

We talk about personal responsibility above in the thread but the old system allows free riders as much as the  ACA does. 

I'm single payer all the way though I realize that is probably a non starter with this congress/administration. 

Not all of this is true.

http://www.cbsnews.com/news/no-lifetime-limit-on-health-coverage-is-a-good-deal-for-americans/

PWC also points out that currently, 45 percent of the insured already have policies with unlimited coverage, 22 percent have caps of $1 million-$2 million, and 32 percent have limits of $2 million or greater.

The reason why these policies don't cost much extra is that very few people have such high healthcare costs.

 

[Sand]

One of the most pressing issues he brought up is GPs sending patients out for specialized testing, when they could do it themselves, or overtesting. What can we do about this? I assume that it's a result of malpractice lawsuits?

Tort reform.  Despite the claims (which I believe to be spurious) that this won't affect medical costs much I believe we need to let up on defensive medical practices just a tad.  IMO it will make a huge difference.  Most medical issues are pretty rote - having a play book for most things should help reduce costs tremendously.

For example take this CRISPR approach to gnome editing.  That was a scientist in an academic lab who made the discovery.  I have a hard time envisioning the scenario where such a discovery is made and the net result is it's shelved with nothing more than a comment like "huh....that's pretty cool....good to know".  

Ok, now this has gone too far.  Leave my lawn art ALONE.  If not it's time to shut it down.

 

[Sand]

We have to look at why healthcare costs so much. Why can I get my blood pressure medicine in Mexico (where it is made in Europe instead of the US) for the same cost as my co-pay here.

This is pretty huge.  If we could remove the cost controls for the US, but delay implementation for 2 years to allow pharma to spread these costs to everyone else in the world it would be a huge boon to everyone.  There's no reason for the US to bear the cost of 90% of the R&D costs, which we currently are.

Why do my doctor friends spend more time filling out paperwork than they do with patients?

You can largely blame O for that one - " On February 17, 2009, President Barack Obama signed the American Recovery and Reinvestment Act (ARRA). Title XIII of ARRA, called the Health Information Technology for Economic and Clinical Health Act (HITECH), allocated $19.2 Billion toward the development of healthcare IT. "

Meaningful Use is a huge time suck.  It's also one of the main reasons that so many independent offices are going away and hospitals are gobbling up these guys - the paperwork is so onerous that one needs the economies of scale to survive.

Why can you not even buy tetanus vaccines with also having pertussis & diphtheria vaccine in it?

Why do you need annual flu shots when they have the ability to inoculate you for longer periods?

Becuase that's the way the assembly line is setup?  This seems an odd one to pick out - I doubt the combined vaccine is much more expensive than the single.

Annual flu shots change because flu changes.  Each year they try to hit what will be out there.  A single long vaccine won't be nearly as effective, from my understanding.

There is more than insurance out of control here. The entire medical insurance industry is a milking machine and we are the cow's udders. We need to find a way to get more general practitioners into the industry. Or to give more responsibility to PAs, maybe even RNs. The problem isn't the insurance: it is why the insurance requires so much paperwork of the doctors. We need to look at cutting paperwork, cutting excessive regulation, and protecting the medical industry from unwarranted legal claims.

The AMA is the most powerful union in the country - they control the number of medical degrees, thus the number of doctors in circulation.  And they restrict them to keep salaries up.  

 

[Sand]

None of this is talking about the discoveries...the applications?  Yes.  The foundation?  No.  All this is the shiny new houses built on the foundations created in the academic world.  Congrats on the pharm companies producing 40 drugs that treat the same thing.  

This is distinctly untrue.  Pharma in the last decade has branched out a lot and is researching drugs for much more rare disorders.  Link.

 

[The Commish]

None of this is talking about the discoveries...the applications?  Yes.  The foundation?  No.  All this is the shiny new houses built on the foundations created in the academic world.  Congrats on the pharm companies producing 40 drugs that treat the same thing.  

This is distinctly untrue.  Pharma in the last decade has branched out a lot and is researching drugs for much more rare disorders.  Link.

These aren't mutually exclusive.  The phram companies all have their answer to "pain killers".  They all have their answer to "cough medicine".  Right down the line.  I was JUST in Walmart and there were 27 different cough medicines out on the shelf...generic and brand name together.  There are essentially two different active ingredients between the 27.  That's what I am referring to.  All the cost of supplying us "choice" in those 27 "different" medicines are passed on to us.

ETA:  And I am talking about this in the context of our history and how we got to where we're at.  That a company is now branching out doesn't change what has happened in the past and how these companies have behaved for decades (allowed to behave this way by our government via lobbies) to get us to this place of inflated costs.

 

[Tau837]

The phram companies all have their answer to "pain killers".  They all have their answer to "cough medicine".

Yeah, see, this is where I think your stance breaks down. My wife has been suffering from severe intractable chronic pain for the past 18 years. She has tried 20+ pain medications, and their benefits and side effects vary widely for her... but anyone with any understanding in this area knows that other individuals may experience different benefits and different side effects than my wife does. This is one reason for the variety of meds.

As for your cough medicine example, IMO you are again oversimplifying. It is not just about the active ingredients. It is about how much of those active ingredients, as well as the other ingredients. For example, the other ingredients can contribute to making a medication 'daytime' vs. 'night time'. There is clearly a use for that distinction IMO.

Generic medication can vary within a tolerance for every ingredient included in a medication. It can make a difference. My wife probably takes ~20 meds every day (not all pain meds), and, based on her experience, in a handful of cases, she has a specific preference for certain brand name drugs and certain generics, again because of how well they work for her, which may be different than other people.

Respectfully, IMO your entire stance on this issue is coming across as poorly informed and closed-minded.  

 

[The Commish]

IMO, using the 80/20 rule isn't being close minded.  It's quite the opposite.  IMO, using the exception as the rule is what is closed minded.  I'm not looking at this from your wife's perspective, rather one much broader than that.  That's not to say I don't understand exactly where you're coming from and why you'd have an interest in pushing back when a loved one falls into the 20% part of the equation.  I get it and I don't discount your position.  We are coming from two completely different places though and will most likely not agree but it has nothing to do with being "closed minded" or "poorly informed" on my part.  In this case, it's a matter of perspective it seems.

 

[Zow]

Mine went up 68% in 2017. The plan I had in 2016 is no longer offered cause the insurer I used lost so much money. 

But I live in a state where a vast majority get their healthcare from employers. So the only uninsured were small businesses and those with pre-existing conditions. 

Basically me and my wife (healthy 30-somethings) and 3 healthy kids are in a 'group' with a bunch of super sick old people. Yeah!

Exactly the same case for me and my family. It sucks.

 

[Tau837]

IMO, using the 80/20 rule isn't being close minded.  It's quite the opposite.  IMO, using the exception as the rule is what is closed minded.  I'm not looking at this from your wife's perspective, rather one much broader than that.  That's not to say I don't understand exactly where you're coming from and why you'd have an interest in pushing back when a loved one falls into the 20% part of the equation.  I get it and I don't discount your position.  We are coming from two completely different places though and will most likely not agree but it has nothing to do with being "closed minded" or "poorly informed" on my part.  In this case, it's a matter of perspective it seems.

I appreciate this response, and my wife is very clearly in the 1%, not 20%. Fortunately, while I used her as an example since you reference pain killers, my perspective in this tangent of discussion is based on much more than her situation.

You have yet to actually explain how you think the significant role in bringing new medications to market would be implemented if we eliminate profit motive. You have complained about waste but you haven't actually proposed a viable alternative. Do you have one? For example, who would do it, and how would it be funded?

 

[The Commish]

I appreciate this response, and my wife is very clearly in the 1%, not 20%. Fortunately, while I used her as an example since you reference pain killers, my perspective in this tangent of discussion is based on much more than her situation.

You have yet to actually explain how you think the significant role in bringing new medications to market would be implemented if we eliminate profit motive. You have complained about waste but you haven't actually proposed a viable alternative. Do you have one? For example, who would do it, and how would it be funded?

With the current situation of our system, elimination completely is not possible.  Steps to making it possible way in the future would include a cap on profits and protections of citizens to the absurd prices we are forced to pay that make up for the losses in other countries because those countries don't allow the price gouging.  If we too draw a line in the sand, I am confident we will see it doesn't cost $20 billion dollars to create a new epi-pen (this is an illustration with hyperbole to make a point...not literal).  Another step would be reducing the patent times, allowing generics into the market much quicker.  

I'm not sure if we ever hear the "this will terminate innovation as we know it" meme from anyone but the companies and "economists" working for those companies/industries.  It's fear mongering IMO.  I simply don't believe these companies would not work to make money.  That's what their shareholders expect them to do.  That's what they are here for.  They can't be eliminated but they can be forced to reign in "costs" (as they describe them).

I'm in the middle of a book called "The Entrepreneurial State" written by Mariana Mazzucato.  So far it is categorically rejecting many of the popular beliefs that private enterprise is responsible for the innovations in this country.  Not just in pharmaceuticals, but technology and other areas as well.  

A did a quick google search and browsed this article that gives some thoughts similar to where I am going and how I look at this particular topic.  This is certainly a topic I am not an expert in and am learning as I go, but it seems to me that while we dog our government harshly (and I certainly do) there is no denying they have done some very good things that have spurned some significant growth in areas of medicine and technology.  I see no reason, should these companies choose to not lead on innovation, the scientists creating the foundation for them couldn't pick up the ball and run with it.  

 

[Da Guru]

      On ‎12‎/‎23‎/‎2016 at 2:33 PM, mr roboto said:

Mine went up 68% in 2017. The plan I had in 2016 is no longer offered cause the insurer I used lost so much money. 

But I live in a state where a vast majority get their healthcare from employers. So the only uninsured were small businesses and those with pre-existing conditions. 

Basically me and my wife (healthy 30-somethings) and 3 healthy kids are in a 'group' with a bunch of super sick old people. Yeah!

Things like this need to be fixed.