Healthcare going forward

[Kabluey]

You are assuming that the advertising is just a wasted expense. Obviously the companys are not just throwing money away. They have concluded that the advertising generates enough in additional sales to pay for the ads plus additional profit.

None of which necessarily motivates drug companies to develop new drugs.

Why bother spending R&D on things like diabetes prevention when you can market a nifty looking injector?
Why research heart drugs when you can market low dose aspirin under a trendy lifestyle brand?
Why address chronic pain when you can market the same ibuprofen as being suitable for several different types of condition, each at different price points?

Companies prefer to make money without investment or risk. Perfectly rational, but counter productive.

How much is spent in the USA on marketed drugs that have no greater effect than generics?

 

[Benvolio]

That is bullshit. Have you not been reading what I have written? Canada has no prescription drug advertising, and our companies are making a profit at a fraction of the cost of the exact same drugs in your country. Still lots of R&D. Still lots of new drugs. Still lots of profit. Still lots of companies. Still lots of golden eggs.

As usual, you have no argument and we have the proof.

Admit it. The gun and drug lobbies own the United States.

That is very dishonest. The few Canadian drug companies, like all such companies, advertise in the United States because that is the big market world wide. A quick google reveals Valeant as a Canadian drug company with big advertising:

https://www.google.com/url?sa=t&rct...P4BiAmFBMhNtnthDIdMyJA&bvm=bv.144224172,d.amc

" And on Ad Age’s top 10 list of the fastest-growing spenders for the year, half were pharma companies. Novo Nordisk ranked highest of those at No. 4 with a 195% spending increase year-over-year to reach $261 million. Valeant Pharmaceuticals was No. 5 with an 88% increase to $441 million, followed by GlaxoSmithKline at No. 6 with a 56% increase to $948 million in ad spending."

Valeant's business model is buying smaller companies and jacking their prices way up. This is from Wikipedia: "An important part of the growth strategy for Valeant has been acquisitions of medical and pharmaceutical companies and subsequent price increases for their products.[73] As a result of this strategy, smaller pharmaceutical companies refocused away from research and development towards serial acquisitions of existing technologies, more aggressive marketing and rapid price increases to enhance growth.[74] Valeant's strategy of exponential price increases on life-saving medicines has been described by Berkshire Hathaway vice chairman Charlie Munger as "deeply immoral" and "similar to the worst abuses in for-profit education."[75] This strategy has also attracted negative attention of regulators in the United States[74] particularly after the publication in the New York Times of an article by Andrew Pollack on price gouging of specialty drugs.[76][77][78][79][80][81]"

Source Link: https://en.wikipedia.org/wiki/Valea...f_acquisitions_and_subsequent_price_increases

 

[KaraBulut]

Not necessarily so. When I had the kidney cancer in 2003 and had my kidney taken out, I saw *ALL* of the bills initially, because it took the insurance company more than four months to start paying ANYTHING.

You got a itemized patient bill. Normally, you would only get those if you were self-pay or you call to request a detail bill after your insurance company pays. Most hospital billing systems have been changed to send an electronic bill to the insurance company; after the insurance pays, a statement (which only show the totals not the detail) and a dunning letter are sent out.

They don't want the public to see the specific prices.

Having worked in accounting, I think the term “write off” to describe transactions in which a reduced price is offered to customers (patients) who are members of a particular [insurance] group would be better described as a discount.

The FASB guidelines have the hospitals debiting the AR at full price but offsetting revenue with an estimated contractual writeoff. When the payment is received, cash is debited and the estimate is reversed and the actual contractual adjustment is recorded. After the insurance payment is received and the patient responsibility is calculated. The patient portion would be debited to a bad debt allowance account if the patient does not pay their portion. For Medicare, there's an estimated reimbursement calculated at the time of billing based upon the diagnosis (DRG/MDC) since Medicare pays via the Prospective Reimbursement System and not the actual detailed charges.

In the case of charity care, the bill is initially recorded to credit specific department revenue accounts and then the A/R is credited and a charity care writeoff account is debited. This transaction is done at gross amount without any adjustment in the amount for a contractual. So, it's in the best interest of a hospital to inflate prices since they can write-off the inflated sum to charity.

If you're interested in understanding the illogical healthcare accounting system, Stephen Brill has a great chapter on it in his book, America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System. The book is a very detailed summary of how the ACA came to be and how politics overrode logic in a lot of the details in the bill.

 

[opinterph]

FASB guidelines

I should have anticipated that FASB guidelines would address the issue. I was simply thinking out loud (through my fingertips).

… it's in the best interest of a hospital to inflate prices since they can write-off the inflated sum to charity.

That makes perfect sense.


(Thanks for the link to Mr. Brill’s book.)

 

[Alnitak]

Companies need to advertise to sell more to recover investment and make a profit. No profit, no company, no R&D, no new drugs, no golden eggs.

The problem with science today is that it is a multi-million - billion dollar enterprise. Gone are the days when a simple apparatus that cost a few bucks could lead to a Earth shattering discovery as in the case of aspirin, insulin, or penicillin. All of the frontiers of science today cost nine digit figures, armies of technicians and lab researchers and assistants, expensive equipment and materials.

 

[KaraBulut]

It's simple: Ryan doesn't want to get sacked as Speaker and have a Tea Party Neandertal replace him.

But see, this is where there's some cognitive dissonance in the arguments to repeal. The Freedom Caucus (which is what the Tea Party activitists in Congress are calling themselves these days ) are opposed to any measure that increases the deficit. They are fundamentalists when it comes to the pay-as-you-go rules. But only a couple of the Caucus voted against the repeal, in spite of the CBO's clear statements that the repeal will escalate the deficit over the next decade:

One of the FC members made a statement about why he voted "no":

Amash, who in addition to being a member of the Freedom Caucus is chairman of the libertarian-minded Liberty Caucus, also opposed the resolution because of the spending levels, calling it "the worst budget we've had since I've been in Congress."

Source

(Thanks for the link to Mr. Brill’s book.)

Brill also wrote a series of good articles in Time Magazine that were the predecessors to the book.

Another really great opinion piece that highlights the distortion of prices across the globe is the following LA Times piece:
How a bite from a stray dog shows the sick state of U.S. healthcare

In this editorial, a patient who was bitten by a stray dog while overseas details how much the treatment cost in various countries. In Thailand, the rabies shot cost her $18.50. In the US, the bill from a hospital was $5,254.85 because she had to go to an emergency room to get the injection. Even when she went to a private clinic in the US, the bill was $427.

 

[gsdx]

What would have been the bill (in equivalent-to-US-dollars) if they had been entirely uninsured in Canada, and gotten entirely a la carte care?

Some numbers I could find are average numbers for births in Toronto. Natural childbirth costs from $2000 to $3000 according to pre-natal classes. The average hospital room (private) costs about $300 per day. Medications, I'm guessing, is extra.

A circumcision costs $300.

http://www.savespendsplurge.com/how-much-it-might-cost-to-give-birth-in-toronto-ontario-canada-2014/

 

[KaraBulut]

And now Congressmen are ducking out the side door to avoid discussions with constituents about the effects of repealing the ACA:

Congressman Coffman leaves frustrated crowd

While the crowd was waiting inside the lobby, singing and chanting, Aurora Police officers are putting up crime scene tape to create a perimeter outside of the library. This allowed Coffman to leave secretly at about 3:24 p.m. unbeknownst to those still waiting to see him. The community event was scheduled from 2:00 p.m. to 3:30 p.m.

"We were told at one point everyone would get their time and then he sneaks out six minutes early. I think he couldn't handle it," Stephanie Brook Chavez, Aurora resident, said.

Like many Congressmen, his contact forum on the house.gov website filters by zip code so that only constituents can leave him feedback. Fortunately, he has a Twitter account: @RepMikeCoffman

 

[Kabluey]

That is very dishonest. The few Canadian drug companies, like all such companies, advertise in the United States because that is the big market world wide. A quick google reveals Valeant as a Canadian drug company with big advertising:

Note that Ben's quoted text about Canadian company Valeant supports the arguments made about drug companies exploiting the US market.

 

[luckynumbah7]

What would have been the bill (in equivalent-to-US-dollars) if they had been entirely uninsured in Canada, and gotten entirely a la carte care? For example, if she was a U. S. woman who had the premature baby in Canada and, of course, not covered by the national healthcare.


Not necessarily so. When I had the kidney cancer in 2003 and had my kidney taken out, I saw *ALL* of the bills initially, because it took the insurance company more than four months to start paying ANYTHING. I had one of those total-piece-of-shit insurance policies which left me paying slightly more than one-half of the $27,000+ that the ordeal was billed for...and the main part of it, the hospital bill, wasn't paid until after five months...and within a week of the promised date for my bill to go to Collection, which would have of course added thousands of dollars to it.

Here, even when you do everything right, you can be fucked.

Yep. When I broke my foot the bill was actually higher than that; I saw the whole thing practically speed through the mail with an attachment from my insurance inquiring whether "Are you sure anyone isn't responsible so we don't have to pay? Please fill out this form just one more time" or we'll bill you. I can only be so clear about how standing up broke my damned foot.

That's despite being on medicaid. They'll try every way they can not to pay.

 

[gsdx]

Note that Ben's quoted text about Canadian company Valeant supports the arguments made about drug companies exploiting the US market.

And Valeant is in deep financial trouble. It is liquidating holdings just to stay ahead. It's stocks have plummeted and it is under investigation.

Ben's example doesn't seem to support his argument very well.

 

[Benvolio]

And Valeant is in deep financial trouble. It is liquidating holdings just to stay ahead. It's stocks have plummeted and it is under investigation.

Ben's example doesn't seem to support his argument very well.

Then it does not support your claim that canadian drug companies are very profitable without advertising in Canada.

 

[vulgar_newcomer]

]its important to remember that Trump has said that he wants to be able to negotiate drug prices, something democrats have never been strong on[/B]. if they had, the obamacare issue wouldnt be nearly the political football that it has become.

also let us not forget, 14 senate democrats, including my own, just voted against the sanders amendment to lower drug prices.

now Trump may have some political success because corporate democrats failed to act when they had the chance.

Do you people just make this shit up, or is the goal to trap and spread fake bullshit to other non critical low information voters?

WASHINGTON, April 18, 2007 — A pillar of the Democratic political program tumbled today when Republicans in the Senate blocked a proposal to allow Medicare to negotiate lower drug prices for millions of older Americans, a practice now forbidden by law.

[Quoted Text: Truncated] © 2017 The New York Times Company

http://www.nytimes.com/2007/04/18/washington/18cnd-medicare.html

 

[Kabluey]

Then it does not support your claim that canadian drug companies are very profitable without advertising in Canada.

It proves that poor quality pharmas that do nothing to improve the state of the art can come from anywhere.
And that they're often poorly run.

 

[gsdx]

Then it does not support your claim that canadian drug companies are very profitable without advertising in Canada.

Prescription drug advertising has been banned for ages. The drug companies have been doing just fine. You just happened to latch onto one of the more shady companies. Advertising isn't necessary.

Besides, we get enough drug advertising on American television stations. Seriously, I love the commercials where it takes longer to list off all of the side effects than it does to advertise the product.

Argue all you want. Banning drug advertising has worked. If it didn't, our prices would be higher than yours.

You see, people don't see a commercial for a drug and think, "Oh. I'll get my doctor to prescribe them for me." Nobody sees a commercial for a drug and decides to go out and catch the condition that they drug is going to treat. Nobody. I certainly didn't see a commercial for Metformin and think, "That sounds like fun. Taking Metformin for the rest of my life. I think I'll get diabetes so I can take them."

And now there are dozens of commercials on American TV for other treatments for blood sugar and A1C reducers, and there are very serious dangers with them, including death. Prescription drugs are supposed to help keep people alive. Not kill them.

Legitimate prescription drugs do not need advertising. The fly-by-night pill pushers do.

 

[kallipolis]

Legitimate prescription drugs do not need advertising. The fly-by-night pill pushers do.

Well noted, for physicians are inundated/updated with information from the various pharmaceutical companies, advertising their new products, as are pharmacists who in Greece provide a valuable service ensuring that patients do not have to rely on visits to physicians for every ailment.

 

[gsdx]

Well noted, for physicians are inundated/updated with information from the various pharmaceutical companies, advertising their new products, as are pharmacists who in Greece provide a valuable service ensuring that patients do not have to rely on visits to physicians for every ailment.

There used to be a fairly common practice in advertising where they wouldn't even describe what the drug was for. They invariably showed people doing nothing in particular and then a voice-over would say, "Ask your doctor about Brand X." They don't do that anymore. The doctors were doing the advertising for the drug company, and the doctors weren't even paid for it. Are there still free samples?

 

[kallipolis]

There used to be a fairly common practice in advertising where they wouldn't even describe what the drug was for. They invariably showed people doing nothing in particular and then a voice-over would say, "Ask your doctor about Brand X." They don't do that anymore. The doctors were doing the advertising for the drug company, and the doctors weren't even paid for it. Are there still free samples?

Part of the business strategy...

 

[MakeDigitalLove]

Drug advertising should be banned in USA as well. It is almost legal drug dealing. Considering how deceiving the commercials are, listing off the side effects in a very quick manner while showing you pretty pictures of a healthy person.

There is an adult swim short movie of a drug advertisement. It is pretty disturbing but drives the point of what is wrong with these commercials.

 

[peeonme]

Drug advertising is really disease advertising. You have a bored housewife sitting alone, she feels like nobody cares.
She sees a commercial and in it they show another woman being catered to and fawned over by a person acting as a dr. and his staff, they almost walk her out to her car and open the door for her.

"Maybe, that's what I need" and off she goes.
I say she because women seem to be far more concerned and susceptible then men. I hesitate to say too much as I know we have some Drs. on JUB.
But I am married to a woman, finally when i had to take over her medical care we (the new drs. and myself) started to take her off of some meds that she didn't seem to need.

At one time she was on over 10 prescriptions, now only 4, one of them is insulin and that has been adjusted to where she know takes half of what she was on.

I used to bang my head against the wall when she would have stomach pains and be sent to a gastroenterologist for an endoscopy and then i would find that she was on 1000 mgs. of Naproxen daily
It was a prescription dose.
My point is that some pills cause more problems than they cure, then instead of stopping that med. another one is given to treat the symptoms of the first. And, on it goes.

On another occasion she developed an infection on her leg, the dr. put her on a 1o day course of antibiotics. After 10 days the infection spread, so she was sent to a dermatologist who said it was just a regular infection, nothing special. Another 10 days of antibiotics, (these were all name brands and cost more), 10 days later the infection was worse.
I had tried to stay out of it, her dr. and I didn't like each other much. Finally i looked at her leg up close and saw no indication of her body fighting this infection.

I told the wife to ask her dr. if she was on any meds. that would interfere with her immune system. It turned out that she was on an immune suppressant because she has ulcerative colitis. She should only have been on them for a certain amount of time but her dr. kept refilling her rx. She stopped the pill and after one more course of antibiotics her leg had cleared up.

To be quite honest, we are as careless as hell in the USA about pills. I am 64 and am on one rx. for epilepsy, i hate taking that as it makes me grumpy and slows down my thought process.