Healthcare going forward

[Benvolio]

Yes at 146. It is not a video, but an article entitled why the US pays more for drugs than other countries. But I can no longer access it without subscribing.

 

[gsdx]

Has anybody mentioned the hight cost of drugs in the US might be necessary to pay all the class-action lawsuits when people start dying?

 

[gsdx]

One other reason why drug prices are so much lower in Canada. No prescription drug advertising. None. Nada.

Billions are saved on advertising alone. No need to pass it along to consumers.

 

[Kulindahr]

It's true that the paperwork and red tape as increased. It's also true that managed care is the worst offender. Having to get referrals for doctor visits. Having to get treatment authorizations. Complicated billing and complicated explanation of benefits. It's why there's at 1-2 people in every physician office who spend their days in a call queue with insurance companies.

It's also true that the insurance company that has the smallest amount of overhead is the Medicare system. The issue is that Medicare is underfunded - the program is still paying out more than it takes in.

The last several clinics I've gone to have all had "specialists" whose only job was to keep up to date on and understand the multitude of different insurance forms and requirements from the array of different companies, so they could make sure it was all done right by the billing people for the physicians and other providers at the clinics. A half- to full-time job, just keeping track of that!

- - - Updated - - -

The more time the doctors spend on paperwork, the fewer patients seen and the higher the bills. More clerical help to be paid from doctors fees.

So you should support having just one insurance company.

 

[Kulindahr]

Well, that's a more cogent argument.

The push to import drugs from Canada is to benefit consumers. The pricing of drugs in the US driven by the wholesale cost- the price at which manufacturers sell to the wholesale providers. If those wholesale drug prices are lower in every country other than the US, that's probably a sign that it's not the cost of the drugs that are driving the price. And it doesn't explain why drugs that were $100 in 2007 increased to $600 after an investor hedge fund bought them.

It's an argument that you used before and we explained to you that US drug companies spend far more on marketing drugs than on R&D.

So only one major company spends more on research than on advertising!

There's a place to hit to support Medicare: tax all advertising spending that is more than 20% of what's spent on research at 25%; over 35% at 33.33%; more than 50% at 50%; more than 60% at 66.67%, more than 75% at 100%.

 

[Benvolio]

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.

 

[Kulindahr]

So, back to topic. It is interesting that the governors are pressuring Congress behind the scenes to slow the process down.

Editorials are already dissecting Paul Ryan's obfuscation about the issue and claims that there's a replacement plan:
Here are the lies Paul Ryan told about Obamacare during his town hall meeting

The final paragraph:

The most important question that Ryan dodged on Thursday, and again after Friday’s House vote, is what’s the rush? Repealing almost any part of the ACA will leave the individual insurance market in worse shape than it is now, and possibly worse than it was before the ACA. That’s especially true as long as no replacement plan is on the table. There are many routes to improving the Affordable Care Act without eroding public protections. If Ryan is truly intent on improving the lives of Americans dependent on the act, why does he have to shroud his intentions with misstatements and misrepresentations?

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

This is essentially a religious matter for Tea Party adherents: regardless of evidence, regardless of good sense, regardless of what it does to their constituents, the Tea Party worships the destruction of all things Obama. It's not faith, because faith requires at least some evidence pointing toward the object of faith, it's pure irrational delusion. And so bowing down to the idol, Ryan spouts whatever works to maintain the loyalty of the devotees.

 

[Kulindahr]

New drugs have patent monopoly for a limited period of time after it is approved for sale. At the end of the patent period other companies can manufacture and sell it as a generic drug, without having to pay any part of the research expense or regulatory approval. Therefore the company must recover its research and development within that limited period between approval and the expiration of the patent. So yes, it is critical to market it sggressively during the patent period and that requires marketing expense, which also must be recovered. Yes, they want to make a profit, but new research is paid from profit from older drugs.
Liberals cannot understand any of this. Boo hoo drug companies want profits. Boo hoo drug companies advertise. Liberals always want the golden eggs but they hate that goose.

So if they advertised half as much, they could do more research essentially at no cost.

And that would be good business sense: spend more on research, find more products, get ahead of the competition by having more products.

 

[Kulindahr]

That is true. The idea behind these price negotiations is to reduce the cost but still maintain profitability for the manufacturer and producer. No one is served if the pharmaceutical companies aren't viable. These negotiations also remove the need to run expensive TV ads and print ads.

On a related note, in the big negotiations around the ACA, the industry lobbying group Phrma- did agree to $90 billion in pricing concessions in exchange for blocks on importation of drugs from Canada and continued agreement that Medicare and Medicaid would not negotiate for lowered prices. Only the Veterans Administration negotiates for volume discounts. Source

So, we've seen that the Republicans want to repeal the ACA but keep the bans on Canadian imports. Let's see what happens with the Medicare D and Medicaid pricing negotiations are permitted and whether the ACA pricing concessions are also repealed. (Hint: don't hold your breath that patients will benefit in this regard, either).

Collective bargaining falls under the right of freedom of association. NOT allowing entities to negotiate prices is against free enterprise.

So the question is why Republicans oppose free enterprise on this matter. I know large insurance companies negotiate bulk prices, it's how they can cover prescription costs without obscenely high premiums. So it's only moral to allow Medicare and Medicaid to negotiate volume discounts -- their 'customers' have no less collective bargaining rights than those of Blue Cross or anyone else.

So to the forum's conservatives: why do you support people who are fighting to distort the free market? who are opposing the individual rights of Americans?

 

[opinterph]

The way that it works is that the facility charges an incredibly inflated price. If the patient has insurance, the difference between the charge master price and the contractual price is written off as a loss. If the patient is unable to pay, the charge master price is written off as charity.

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. Hence, the transaction could record the full retail price (if that data is considered useful) and offset the gross receipt from the sale by the amount of discount. (e.g. office visit $150, less group discount $90 = net sale $60). From an accounting perspective, it makes just as much sense to record only the $60 received; however, either method renders the same result on the bottom line.

On the other hand, it would be misleading to lump uncollectible accounts with discounts – again depending on how useful the medical practice wants its numbers to be. In addition, there should be a distinction between inability to pay and failure to pay (bad debt).

In terms of uncollectible accounts, I tried to locate an estimate of value to determine the extent to which uncompensated services are rendered as a result of patient inability to pay (AKA charity). I wanted to know if the ACA had the effect of reducing charity care, as a result of greater insurance coverage among the population.

The information I seek seems elusive; however, it appears that hospitals in states that did not expand their eligibility for Medicaid are also the states with the least generous charity programs. It also appears that the number of private pay and charity-care cases has decreased in states where Medicaid was expanded.

Dan Munro, author of “Casino Healthcare” and Forbes Contributor, wrote in February 2014 that hospitals provide uncompensated care (inability to pay + failure to pay) amounting to about $46 billion. Using pre-ACA data, he estimated that physicians in private practice provide about $66 billion in uncompensated care. Add to that another $8-9 billion associated with bad debt for purchases of prescription medications and you get around $120 billion annually.

How much "bad debt" do physicians write off nationally per year due to patient non-payment?​

National Health Expense totaled $3.2 trillion in 2015, or $9,990 per person, and accounted for 17.8% of Gross Domestic Product (GDP).

Total health spending was sponsored by:

• federal government (28.7 percent)

• households (27.7 percent)

• private business (19.9 percent)

• state and local governments (17.1 percent)

• other private revenues (6.7 percent)

NHE Fact Sheet​

 

[Kulindahr]

One other reason why drug prices are so much lower in Canada. No prescription drug advertising. None. Nada.

Billions are saved on advertising alone. No need to pass it along to consumers.

That's really a sensible law, either that or restrict the advertising to just facts -- no drama, no touching scenes, just information.

Why? Because the vast majority of people aren't qualified to judge whether a given medication is suitable to them, and even for those who might be the advertising doesn't provide any actual information for making such a decision.

 

[Kulindahr]

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.

Unless it's aimed at professionals who can evaluate the value of the products, it's an immoral expense. SO whether they're throwing money away or not, they're harming society.

In fact it's been shown that pharmaceutical direct advertising to potential patients is a significant cause of over-prescribing. Given the harm that over-prescribing does, the cost of that harm should be charged to the pharmaceutical companies. In truth, this is just another case of companies wanting to externalize costs, behave irresponsibly and pass the cost on to someone else,and politicians eager to aid them in that immoral behavior because of the checks the companies write for campaign coffers.

 

[gsdx]

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.

And all along you've been trying to convince us that the price is all about R&D. We call you on it and now your tune (as usual) has done an about face.

Ban prescription drug advertising. Drug prices will come down. Problem solved and America will be a little bit greater.

 

[Benvolio]

So if they advertised half as much, they could do more research essentially at no cost.

And that would be good business sense: spend more on research, find more products, get ahead of the competition by having more products.

The advertising increases the recovery of investment and profit.

 

[Benvolio]

And all along you've been trying to convince us that the price is all about R&D. We call you on it and now your tune (as usual) has done an about face.

Ban prescription drug advertising. Drug prices will come down. Problem solved and America will be a little bit greater.

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.

 

[Benvolio]

Unless it's aimed at professionals who can evaluate the value of the products, it's an immoral expense. SO whether they're throwing money away or not, they're harming society.

In fact it's been shown that pharmaceutical direct advertising to potential patients is a significant cause of over-prescribing. Given the harm that over-prescribing does, the cost of that harm should be charged to the pharmaceutical companies. In truth, this is just another case of companies wanting to externalize costs, behave irresponsibly and pass the cost on to someone else,and politicians eager to aid them in that immoral behavior because of the checks the companies write for campaign coffers.

Companies always have to recover costs by sales to consumers. How else recover costs? How stay in business? You guys have no concept of business or economics, do you?
The other purpose of advertising is to educate the public as to the existence, purpose, and potential side effects of drugs. You know from the ads that all drugs have potential side effects. Trial lawyers love to bring lawsuits over side effects claiming the company should have advised as to the the side effects.

 

[gsdx]

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.

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.

 

[Stardreamer]

The final paragraph:



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

This is essentially a religious matter for Tea Party adherents: regardless of evidence, regardless of good sense, regardless of what it does to their constituents, the Tea Party worships the destruction of all things Obama. It's not faith, because faith requires at least some evidence pointing toward the object of faith, it's pure irrational delusion. And so bowing down to the idol, Ryan spouts whatever works to maintain the loyalty of the devotees.

From what I'm seeing today in the news it looks like Trump's saying that the replacement will happen at the same time as the repeal is working in Ryan's favor. It looks like more and more of the Republican Congress Critters are realizing that if they mess this up they will be paying for it.

 

[frankfrank]

When all was said and done, the couple received a bill for just over $200,000 US.

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.

Only after the insurance company pays will you get a statement showing your residual responsibility: you'll never see that $80,000 bill.

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.

Cory Booker Joins Senate Republicans to Kill Measure to Import Cheaper Medicine From Canada

Even HIM?? What the fuck?

This country is so screwed.

 

[evanrick]

This is actually the real problem with the ACA, it focused on dealing providing full coverage and not enough on controlling and encouraging lower costs. Giving the government health programs the power to negotiate drug prices would have been a big step in doing this but instead conservatives block any attempt to do that.

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. 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.