It would have been more helpful to pull sales as well.
Indomethicin is an old drug without much use and then narrow it down to suppositories it’s an even smaller market. Plus there are a dozen plus alternatives you could use.
Think of like producing a microprocessor design from 1970 where alternatives exist. Super niche. Demand is maybe 100 units per year. What would you charge?
Here’s another way of looking at it: if you need to use this obscure medicine rather than the alternatives because your condition is comparatively rarer, is it just that you should have to pay through the nose for it?
Take it to the extreme: you have a very, very rare life-threatening illness. Since only 20 or so people a year are diagnosed with this, the drugs to treat it would have to cost 1.5MM just to be decently profitable.
Is that a just healthcare system? A kind of inverted lottery in which the “luckier” you are the more likely to go bankrupt.
One might reasonably conclude that trying to run the entirety of the healthcare system as a capitalist enterprise is perverse and trades the misery of the many for the profit of a few. In such cases, we should rightly consider all possible alternatives.
1 main point to this: true "insurance" could reasonably cover edge cases, including frankly some insurance covered by the state. The US "insurance" market is not really that, it's a price negotiator/health care provider/strange thing that honestly doesn't resemble any other "insurance" product. Even though we use some terms that resemble capitalism, health care is in no way a capitalist market. It's a different beast.
>Since only 20 or so people a year are diagnosed with this, the drugs to treat it would have to cost 1.5MM just to be decently profitable... Is that a just healthcare system?
If it cost 1 trillion to add a year to the life of just one person, should society pay it, even if that trillion is then not able to be used for lots of other societal needs?
Arguing for policy while ignoring opportunity costs leads to more human suffering than would otherwise result.
> Demand is maybe 100 units per year. What would you charge?
Perhaps capitalism is not the best strategy to apply to healthcare. Folks in need of healthcare will always be a minority - a niche market - after all. The most prolific diseases typically only have 3-6M cases at any given time in the US.
Should a person go destitute to pay for their care, just so some company's supply/demand curve is properly fitted?
Just to be clear, the American health care system is in no way "capitalist". It just has some of the trappings of capitalism.
(There are so many examples of this, including for this case that Medicare/Medicaid are government programs where they pay whatever the drug companies ask.)
The pharmaceutical market - specifically this company who is charging $10,000 for a medication in one market and under $200 in another - is certainly following capitalist methodologies: "Charge what the market can bear."
So you’re saying someone who is producing a niche product a minimal units should be forced to charge a low price? Regardless what their cost of goods is?
That's almost never what people arguing for government intervention in healthcare pricing actually want. They want an affordable price at the point of sale to the patient while the government uses tax dollars to and fees collected at the pharmacy to smooth out prices and have standing buy orders so that medications are always available to people that need them.
i.e. don't let the supply chains fall over and provide "insurance" for everyone.
This really isn't that crazy in the grand scheme of things. The US right now today does basically this with dairy products.
I said nothing about the cost of goods. My comment has much more to do with setting prices via the supply/demand methodology, which includes "not everyone who can - or needs to - buy it will be able to buy it" margins.
This has little to do with the cost to produce something, other than to set the lowest bounds of the sale price (which by itself is a simplification given the concepts of loss leaders and non-monetary gains).
I'd honestly much prefer if they were charging according to their costs and not market forces.
I'll come out and say it: Pricing people out of your medicine so you can increase your profit margin is capital-E Evil.
That doesn't explain why it's available cheaply in other countries, even privately.
E.g. in the UK a quick check shows me I can buy a pack privately online for $40.
(UK online pharmacies can sell a number of prescription-only drugs privately if they have a doctor carry out an online consultation, which means you basically fill in a form and a doctor will look at your answers and provide a prescription as part of the sales process, or you can send them a prescription you already have).
That essentially means it's literally 10x cheaper to take a two-way ticket to France, have a doctor prescribe it there, buy 3 months worth of treatment and come back to the US.
I wonder how Americans can tolerate this situation.
There are, uh, several different first-world countries in which health insurance is paid by the government which you could scrutinize to see if your assumption is worth assuming.
Or you could scrutinize the projected numbers, which conclude that it would be less expensive, in terms of government healthcare funding, to eliminate all of the ravenous middlemen causing all of the costs.
Kinda like how it'd be cheaper to just give all the homeless people housing, rather than burn shitloads of social and criminal justice funding to keep them on the streets.
These are ideological positions, though, so good luck changing any of them. So are the rolling presses -- they're not there to prop up a healthcare system, they're there to refill the troughs of irresponsible rich people whose enterprises have become "too big to fail". The problem is that the rich people have come to expect this windfall. Maybe we can save some money for them by cleaning up the healthcare and criminal justice systems!!
Ahh, but holding that Sword of Damocles over employees' heads is too valuable! Disincentives quitting, or even dissent. Not sure why the owner class would go for that, TBH.
You are mistaking list prices with cost. Nobody pays list price. List price is an anchor for price negotiation. This works against you as an uninsured individual, because you have no negotiating power. Insurance companies act as the wholesaler and they insist on locking you into a complicated subscription model. They can only do this because drug purchases are heavily regulated.
As someone who hails from a place whose enormous single-bloc healthcare system can dictate the terms you're describing, I don't think that statement is the explanatory gotcha you intend it to be. Those regulations are there for a reason -- to ensure your for-profit healthcare system makes profit. What if the middlemen were gone and it didn't have to?
Sure, middlemen make profit, but nobody makes that kind of profit. Nobody pays these prices. Drug prices in the US system may be elevated, but in the grand scheme of things it's a modest part of the total cost.
Furthermore, the reason that these prices can be charged is the regulatory moat, courtesy of the government. Suppose that same government would enact a single-payer system, what makes you believe it wouldn't pay outrageous drug prices, courtesy of the taxpayer? The mechanism that gives the pharma lobby free reign won't just disappear over night.
> Sure, middlemen make profit, but nobody makes that kind of profit. Nobody pays these prices. Drug prices in the US system may be elevated, but in the grand scheme of things it's a modest part of the total cost.
"Aw, it's not so bad!"
>Furthermore, the reason that these prices can be charged is the regulatory moat, courtesy of the government. Suppose that same government would enact a single-payer system, what makes you believe it wouldn't pay outrageous drug prices, courtesy of the taxpayer? The mechanism that gives the pharma lobby free reign won't just disappear over night.
"But also it's super bad, and it's obviously the best we can do."
Don't know what to tell you -- seemed to work everywhere else. I guess that's American exceptionalism for you!
> "But also it's super bad, and it's obviously the best we can do."
I didn't say that, but it might actually be true. Having the same people that created the current system design a single-payer system or attempt price fixing is unlikely to lead to a better outcome.
To add something to this to illustrate just how expensive the US healthcare system is:
Because of how hamstrung Medicare and Medicaid are - with laws restricting them from leveraging their size properly in negotiations, Medicare and Medicaid combined cost US taxpayers as much per taxpayer as the NHS costs per UK taxpayer.
The big difference, of course, being that this buys us universal coverage in the UK, while Medicaid and Medicare only covers a portion of the US population. So the cost per recipient of care is many times higher.
Then a whole lot of Americans have to pay again in private insurance to actually get cover.
So for a start, Americans ought to campaign to unshackle Medicare. Remove the regulations preventing it from leveraging its size fully and make it subject to pressure to be cost effective, and put the savings into expanding coverage, and you'd already be a huge step closer to solving the problem.
>Activists never demand cheaper (or more transparent) health care. They demand state to pay for it!
...it's cheaper that way. That's-- that's why they say that. You can keep repeating yourself, but tell me, what makes almost every other first-world country better at this than the States? How is it that we can pay so much less and have, in aggregate, better health outcomes? It's a mystery!
Perhaps you find this unpleasant, but the reality is that my government is able to dictate terms to pharmacorps such that we do not have to "pay for drugs like this". The whole point is that the exorbitant costs are not the true costs, they're just what you'll get charged unless you stand together.
Basic economic theory and comparative studies will tell you that a single buyer for healthcare gives that single buyer a lot of leverage, which makes it cheaper.
The ol’ “why should I pay more to insure sick people when I’m healthy?”, followed by the “I’m sick now, can you donate to my GoFundMe treatment find?” routine.
The comments that get me are the replies to the insane bills along the lines of "don't worry about it, just spend 10's or 100's of hours on the phone/filling in forms/arguing with insurance reps and maybe, eventually they'll knock the price down by enough not to bankrupt you"
Expecting sick people or their relatives to navigate that kind of bureaucracy to get the care they need and/or avoid dire financial straits just seems insane to me
This only works if you were already in a financial position to take a small vacation to Paris. If the medicine was sold for $5 in the US, it would have a much larger reach.
Sure, that was just to show how absurdly costly medical treatment has become in the U.S.
Not so long ago I had seen a documentary about how American diabetics couldn't afford insulin and had to purchase their insulin pens in Canada. It's quite a shame for a first-world country with one of the highest per-capita income to have people give up healthcare because it's simply too expensive
It'd be interesting to scale it up significantly. Maybe it would carry more weight? I don't know the legalities involved, but I've heard of some international mail order prescription drugs getting intercepted by the government. Are the laws more permissive when bringing prescriptions prescribed to the traveler, on their person?
Imagine a charter bus that takes a full load of people once per month from the US to Canada from regionally close cities (e.g. Chicago, Cleveland, Seattle, and New York) for insulin and other critical but expensive prescription drugs. The bus takes them to a pharmacy, everyone unloads and picks up their prescriptions, then loads back into the bus. Everything is called in, pre-arranged with the pharmacy for a streamlined operation.
It's a really stupid situation and possible solution that shouldn't be viable. Unfortunately, it probably could be done.
I don't know if there are laws preventing someone from being physically in france while practicing telemedicine in the US, but surely they'd have to be licenses to practice in the US (which the vast majority of french practitioners won't be).
The question is whether the pharmacy is willing to take the hassle of shipping abroad. The UK allows online prescriptions, and lots of pharmacies will basically have you fill in a form and have a doctor give you a prescription as part of the sales process, but most of them still won't ship out of the UK.
Presumably they just don't want the hassle of figuring out regulations or dealing with stuff confiscated at borders.
For drugs that are legal to import into the US surely there must be online pharmacies willing to deliver, though.
> I wonder how Americans can tolerate this situation.
Several reasons this terrible system continues to exist but it essentially boils down to entrenchment.
- The private healthcare industry pays politicians to maintain the status quo. The alternative government run solution does not.
- The private healthcare industry creates propaganda and pays the media to spread it. An improved government run solution does not.
- Many Americans have decent coverage from their employer. For them, it’s not worth upending the system for what might be moderate gains. More over, propaganda has made them expect worse coverage from any alternatives.
- ACA gave many without employer coverage a good enough solution. It’s still expensive as fuck but it subdued enough voters.
So, after considering voters who are happy enough with the devil they know, you don’t have enough votes left to overturn the system.
Isn’t the biggest problem in the US health insurers operating on state level only? This is due to some regulation preventing formation of federal insurers.
I never understood why there are no independent national health insurers (read Allianz for example) providing health care for self employed people like in Europe.
The US has states that are larger than countries in Europe. This may or may not contribute to the problem, but it is tiny in the big picture of US healthcare issues.
The issue in the US is that the system is hugely inefficient compared to the models in Europe. There is an absolutely massive administrative layer between care providers and payers, price negotiations aren't transparent or efficient, the whole system is hugely complex, and the vested interests are incentivized to keep it that way.
Most of the big insurers operate in multiple states. But operation in each state is regulated by that state, and I've heard, but not verified, that most ACA plans offer in-state coverage only, with some exceptions for communities at state borders (if you live near Lake Tahoe, an ACA plan probably covers doctors in the area in NV and CA)
Shopping for plans on the marketplace is already terrible when they all cover the same stuff. It'll be way worse if I have to decide between terrible options for what's covered. Especially since we all know none of that is going to be clear or easily comparable, and certainly not pick the things you want covered.... It'll be like broken bones are in the package that excludes cysts, and brain cancer coverage is not available with any other cancers, and to get coverage for any sort of dermatology, you also need coverage for skiing and parachuting incidents.
As-is, I can take my list of prefered facilities, look and see who has them in network, and then add the premiums to the out of pocket max to find my rough worst case cost and pick the one with the least worst case cost and call it a day. This is usually also the one with the least premiums, so it's also the least cost if I don't visit the doctor at all.
It's also worth bearing in mind that the socialized healthcare system the US does have - the VA - does not have a uniformly good track record. This does a poor job of making the case for a larger socialized system all on its own.
The US has a massive socialized healthcare system much larger than the VA - Medicare. Roughly 18% of Americans are covered by Medicare, a socialized system.
One difference is that the VA is a complete system, with it's own hospitals and staff. Medicare is that half-way solution, a public insurance system which buys medical services for the members from the private sector.
As for the VA system's woes, I would say: yeah, it's definitely possible to build a system that doesn't work well. But that doesn't mean we shouldn't be trying.
Medicare isn't really a socialized healthcare system. Most of the providers aren't government employees, and some providers don't accept Medicare patients because the reimbursement rates are low. Many beneficiaries actually obtain their plans through private insurers with the Medicare Advantage program.
> It's also worth bearing in mind that the socialized healthcare system the US does have - the VA - does not have a uniformly good track record. This does a poor job of making the case for a larger socialized system all on its own.
> Which is to say it's not just propaganda.
No public or private system anywhere in the world has a uniformly good track record.
I find that an extremely low bar since you mention nothing of quality of outcomes. In any case, I guess the US system wouldn’t be “good enough” by your measure.
Interesting you pick the unpopular one, whereas Medicare (62 million people covered) is widely liked and considered successful. In fact, satisfaction levels of Medicare are considerably higher than most private coverage.
The difference of course between Medicare and less popular plans like VA coverage and Medicaid is that people on Medicare have political power, veterans and the poor do not.
Nobody is arguing that you can run a healthcare system badly, but to only point out the worse case is not arguing in good faith.
I picked the VA because it's an attempt at a thoroughly integrated system in a way that Medicare and Medicaid are not.
It's not irrational for people to look at the risk of making a worse system and judge for themselves if they think it's a risk worth taking. Examining a worst case that's within the scope of possible outcomes is a reasonable part of a good-faith process.
But a thoroughly integrated system isn't necessary. One proposal is to simply allow every American to enroll in Medicare, keeping the remainder of the system the same. It's the most expensive option, but since people on Medicare like Medicare, it might be the best next step for user acceptance.
That said, the person I responded to was to my reading optimizing for getting away from the private health care apparatus as much as possible. Medicare For All does not accomplish that.
Yes, the VA is more akin to the UK's NHS (socialized costs/medicine) than a single-payer system like Medicare (socialized insurance/private doctors).
The VA was under-budget even before the two wars started in 2002/2003.
Then the ruined bodies and psyches rolled in, and VA wasn't given additional funding to handle the aftermath.
It's pretty clear how that ends up. The wars above cost $Trillions but the aftermath costs a few more Trillions that VA and other agencies didn't have.
VA efficiency is driven way down by the fact that it is an integrated system that covers a very small, diffusely distributed segment of the population, which is the worst possible case for an integrated (in your sense of having dedicated staff and facilities) system.
Popularity and efficacy are wildly different metrics. Further, Medicare is not a system that gets away from the private healthcare industry that parent was criticizing. The VA's integrated system largely does.
A whole lot of the universal healthcare systems elsewhere also does not "get away from the private healthcare industry". Many countries with universal cover have private hospitals providing the services or private insurers providing part of the insurance solutions, or both, without incurring the problems of the US model.
Here's a first step to solving the US problem: Remove the legal restrictions on Medicare preventing it from negotiating best possible prices, and reinvest whatever it manages to save on expanding coverage.
> It's also worth bearing in mind that the socialized healthcare system the US does have - the VA
That I know of, the US has either 5 or 55, depending on how you count the Medicaid programs run by each state + DC in cooperation with the feds, socialized healthcare systems (Medicare, Medicaid (1 or 51), TriCare, VA, and the Puerto Rico public healthcare system.)
At 9 million covered beneficiaries, the VA system is smaller than Medicare, smaller than Medicaid, and even smaller than California's state Medicaid plan (Medi-Cal).
It’s kind of weird to pretend VA is the socialized healthcare system in the US. (Actually, you can argue that TriCare and VA aren't even true “socialized” systems but employment-based plans for current and former employees, for a subset of federal government employees.)
Yes, underfunded systems tend to perform poorly, especially when society doesn't integrate other necessary services such as housing or unemployment assistance very well.
> Many Americans have decent coverage from their employer. For them, it’s not worth upending the system for what might be moderate gains.
Negative gains I may say. In my experience of the Canadian healthcare and US healthcare systems, the latter, IF you are well insured, feels like a Rolls-Royce whIle the former is like driving a Lada in Pothole City.
I remember the first time I called my provider in the US to book an appointment with a dermatologist. She said "Wednesday", I said "What month?" I couldn't believe it was that same week. I used to wait 2-3 months in Canada. And I had to first get a reference from a ER/generalist doctor.
Also don't forget the US spends on medicare/medicaid/VA about the same % Canada spends on healthcare.
Right, this is the point that is missed in every hacker news / reddit post that spends hours making fun of how bad the US is and how some people get stuck with $50,000 hospital bills.
If you have good work based coverage, our care is excellent. Fast access, and low out of pocket costs.
I do want to improve it for everyone, but I have 0 complaints about my personal access to health care. I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
>I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
We have pretty long wait times in the US for elective surgeries as well. Not as bad as canada, but it can take a bit to get you scheduled for a hip or knee replacement.
Are these waiting times for someone with insurance, or someone on medicare/medicaid? You usually get a better level of service if you are on insurance, as the payment rates are higher.
Kind of? They pay less than say Blue Cross Blue Shield for the same procedure. Many doctors literally limit their medicare patients, i.e. "No more than 20% of my patients can be on medicare"... because doctors like making money too.
Just being insurance doesn't mean much. What the above comment said is true, many doctors don't take Medicaid or severely limit how many patients they have with it. Doctors aren't required to take any/all insurances. Medicaid is avoided because of low reimbursement rate combined with more litigious patients.
I can tell you as someone who was previously on it, it was hands down the best insurance I've ever had. I did not have any issue with getting procedures and drugs covered, which is more than I can say for the private insurance I've had over the years.
Do all doctors take it? No, but I feel like they are in the minority and frankly, if a doctor doesn't take it, I feel they are more motivated by money than caring for their patients.
Yes, the wait times are for insurance. Normally if they care about the medicare vs insurance distinction for payment, they simply don't take medicare at all.
(I’m assuming Canada is much like NZ)
If you don’t want to be on a waiting list get the 60usd/month health insurance from a private company, or maybe your job will already provide that for you.
Canada is not like NZ. Public health insurance has a monopoly on the things it covers. If you get extended coverage it is for things not covered by your public plan.
There’s no way to pay for better/faster treatment if it’s publicly covered.
EDIT: Edited to clarify I'm speaking specifically about Canada as there is some confusion in the replies.
A hospital may or may not be for profit but they aren’t allowed to set their own prices or accept anything except OHIP or other provincial insurance. The exception is if you have no public health insurance (e.g. a tourist) or if it’s for a service not covered like cosmetic plastic surgery.
They do let you pay for a private hospital room though oddly enough.
> There’s no way to pay for better/faster treatment if it’s publicly covered.
This is an outright lie, here in Uruguay and in Chile both with social Healthcare you can enter onto different private plans and that will expedite surgeries, doctor meetings etc
It is something that depends on a country per country basis
We have a fantastic health plan, and my wife had to wait four months, here, in the US, for an important, but not urgent surgery.
The clinic then fucked up billing, overcharged us, and it took another few months for all of this to get sorted out.
The first part of this story isn't too different from the Canadian[1] system, the second is a pile of unnecessary stress added on top.
Between mine and my employer's share, our 2-adult health insurance costs ~$15,000/year, by the way. And what do we get for it? Months long waitlists and clowns that can't even get billing right the first few times.
This may indeed be the Rolls Royce of healthcare, in the sense that it costs a mountain of money, finds expensive ways to break down all the time, and spends half its time in the shop.
[1] Actually, each province in Canada is responsible for running a provincial healthcare system.
> The clinic then fucked up billing, overcharged us, and it took another few months for all of this to get sorted out.
> The first part of this story isn't too different from the Canadian system, the second is a pile of unnecessary stress added on top.
IMO the cost in stress and time of the American system is under-appreciated. We pay way more than other advanced states and have to deal with a whole bunch of companies, all of which seem to be either incredibly incompetent or actively trying to screw us, every time we actually need healthcare, which is precisely when we really don't need more stress or to have extra demands on our time. It's awful.
>Months long waitlists and clowns that can't even get billing right the first few times
I've been getting bloodwork done at my physician's office for two years and Labcorp started sending me bills again. Same insurance, but they just randomly stopped filing with them until I spent long enough on the phone for a few of my hairs to grey.
When I was younger, I got a nasty infection after my wisdom teeth were removed. The ER bill, which was close to $5k for a doctor to look at me for roughly 5 minutes and write me a prescription for antibiotics and some pain meds, bounced between health and dental insurance for months, both saying the other should pay for it, before they kicked the can to my parents.
My mom had connections in the hospital's administration, so she was able to get it coded properly for health insurance to pay it. But I am probably the only person in this thread who can say "my mom is on a first-name basis with the people who can get billing issues resolved by the next day." Everyone else gets to sit on the phone for hours trying to sort it out, hoping that insurance will show mercy or that the hospital will bother recoding, or at least give them a bill they can stomach.
Do you not hear how privileged this sounds? You're lucky enough to have employer-provided healthcare. Even more, it's actually good. Many people don't have either. So yeah, the status quo is great for fortunate you and I'm glad you have zero complaints, but it's all the other people who we're really talking about here. I'm sure Musk and Bezos and Gates have no real issue with current tax code, but when we talk about tax reform, they're not the ones who should have much input.
You'll reach a lot more people without that kind of language. I for one almost instantly dismiss anyone who talks like that. I didn't even read the rest of your post.
It doesn't take profanity to alienate readers who don't already share your views.
I don't know why you're commenting, since you're not the original commenter, and your very comment shows how you already recognize the generic accusation-of-privilege to be the problem (and how the word privilege is heavily coded with political affiliations and a whole pile of antagonistic/moralizing dogma at this point). You already knew how and why it would be inflammatory.
You recognized the problem, and opted to try to reframe it in more favorable terms to deny the possibility for improvement.
If the original commenter wants to reach across that Red Tribe / Blue Tribe divider and have an actual discussion (or even convince a neutral 3rd party of their views), their first sentence (and general tone) is quite counter-productive, and you know this.
> I don't know why you're commenting, since you're not the original commenter,
This is a multi-user forum not a peer2peer chat client.
> and your very comment shows how you already recognize the generic accusation-of-privilege to be the problem
No, I'm saying the accusation of privilege is correct and it's not a problem to point out to people on here that we are privileged. Because we are.
> You already knew how and why it would be inflammatory.
If you're in the top 10% and can't stand being called privileged then the problem isn't the tone of the accuser, it's the person receiving the comment. The sooner privileged people stop acting like the victims, the sooner we can start fixing the worlds actual problems.
> their first sentence (and general tone) is quite counter-productive, and you know this.
Actually I was arguing that it's not counter-productive. It was the point of their post and a point very much worth making.
I've seen both sides of the social scale and we are definitely not on the side that should be getting offended when people should "privilege" ;)
Sure. Under the private system, health providers are incentivized to suggest more expensive treatments over better treatments. Even your expensive care isnt as good as it could be
Great, that’s an area that could be win win, it could earn my support. What won’t is an attempt to get to a Canada style system (haven’t experienced Canada, but have experienced UK).
"Worse healthcare for you and your family because you are privileged" is not particularly compelling to the roughly half of Americans you are yelling at.
I pay almost $1k a month for insurance with a $2500 deductible. Each year my premiums rise another 10-15%. I have to spend hours finding providers that are accepting new patients and usually the wait is long.
This isn't sustainable for me in the long run and I'm definitely considering leaving the US because of it.
> This is the point that is missed in every hacker news / reddit post that spends hours making fun of how bad the US is.
Mostly of the 'making fun' is due to the fact that millions of US citizens have no or little health care and choose not to have treatment because they can't afford it, are limited about what treatments they can have, or have it and are made homeless or live under huge debts.
Just about every country which has some kind of health care system also has private health care/insurance that means you don't have to wait for treatment or have more choice about what, when and where things happen. Because of the competition of the 'free' healthcare systems these policies are usually much, much cheaper that the US.
I work in a company that gives me private medical insurance (which means I might get treated a little early for a non urgent condition, perhaps in a swanky private hospital) but feel good that people that can't afford it won't die, and that I can quit my job and not worry about getting ill.
It's deeper than that though. There is a deep group of rural american's who refuse health care, even when provided by their job at extremely low cost. Doesn't really matter how you change it, the rural american's who don't trust doctors aren't going to do anything different?
“There is a deep group of rural american's who refuse health care, even when provided by their job at extremely low cost.”
Particularly the part about those with insurance not seeking care. The articles cited are concerning vaccine takeup rates, which reasonable people can differ.
We hear about patients being stuck with $6000 bill but did said patient actually pay 6k? Absolutely not, even if uninsured.
also they ignore the role of employer healthcare, or how the NHS is paid for by higher taxes, so Americans are effectively paying less for healthcare in this regard.
So much misinformation and misleading info in the healthcare debate, driven by partisan politics.
The top 50%ish get coverage through jobs that is mostly fine.
The bottom 25% get heavily subsidized plans (often free) from both state and federal programs.
There is a hole there in the middle, but it may be possible to tweak a few programs without throwing out everything. This is basically what ACA tried to do with the backing...
I always find it ironic how quick Silicon Valley is to argue about the need for "disrupting" industries yet how supportive those same individuals are about retaining the current health care system even then they acknowledge it needs to change.
The US health care system is by the far the most complex of any nation state and punishes the losers the worst. It strikes me as something badly in need of disruption. And it's not like we're talking about removing private health care entirely -- if that's what you're scared about?
"Disrupting" health care would involve the federal and state governments massively deregulating health care and insurance so that a private, free market could actually exist. Disruption/competition are quite literally illegal as it stands.
> And it's not like we're talking about removing private health care entirely -- if that's what you're scared about?
I'm personally concerned with the 50 Stalins sort of sentiment surrounding health care. We legislated the current system into existence and its outcomes are perfectly predictable. Why not fix the causes instead of trying to legislative more effects and doubling down on government interference yet again?
> "Disrupting" health care would involve the federal and state governments massively deregulating health care and insurance so that a private, free market could actually exist. Disruption/competition are quite literally illegal as it stands.
The problem isn't regulation. Many other countries are far more regulated in the health care industry and operate a private market just fine. In fact some might even argue that some of the problems with the current US model is a lack of regulation.
The problem I've observed isn't a lack of competition, it's that all of the competition play by the same broken rules. You basically have an industry where people need your service. It's not luxury, it is literally life and death in many cases. People have to use your service, whatever it costs. And you then allow those companies to regulate themselves, companies that will almost always put profit ahead of welfare. That is never going to turn out well. But because libertarianism is very much a core part of the American ideology, whenever the question of how to fix the problem arises you argue that the market needs to be deregulated further. Basically just doing more of the same, as if it will suddenly fix things despite decades of proof that it hasn't already.
Now I'm not going to pretend that other counties have a perfect system. But I do believe the only way you are going to get a health care system that works for everyone is for voters and politicians to want something that is, at least on the surface, very "un-American".
> I'm personally concerned with the 50 Stalins sort of sentiment surrounding health care.
And here lies the problem. People are so brainwashed into thinking any form of social health care is communism and bad. Quite frankly, it's ridiculously misinformed. In fact most of the rest of the developed world has a social health care system AND private health care, capitalism, etc too. On this particular occasion you can actually have your proverbial cake and eat it.
> Why not fix the causes instead of trying to legislative more effects and doubling down on government interference yet again?
Because you're fixing the wrong thing. You're looking at a broken faucet causing water to leak constantly, and instead of fixing that faucet you go and break more faucets thinking that should some how change the behaviour of the first faucet. Then when the flow of water gets too expensive you then start arguing that it's not the leaking faucets at fault, it's the water rates instead. If this weren't a political problem then I'm sure most on here would throw their hands up shouting "learn some basic root cause analysis!"
"Low out of pocket costs" will depend on a several things: your premium, deductible, co-insurance, out of pocket max and whether or not you are in or out of network. All of these numbers and scenarios are going to be different from person to person. For folks living paycheck to paycheck (or slightly above), a $500 medical bill can be devastating. Furthermore, access to care also depends are where you live. If you happen to live in a more rural area, you won't have the same access as someone in a major metro area. [1]
Are you factoring in premiums? Once you factor premiums from both sides (employer and employee), healthcare in the USA is far from low out-of-pocket. Good family coverage is on the order of $2,000 or so a month.
That's not even getting into the garbage plans offered at some places. I've had plans that covered visits to exactly one region hospital system, any other hospitals needed preauthorization, and even those had the potential for rejected claims.
Which brings up another often missed point. When dealing with the lower cost plans, there's a huge risk of having a claim denied. I know for a fact that at least one major insurance provider has a policy to deny every claim and make the hospital rejustify it. If the hospital fails to justify the claim (to the insurance company standards), either the hospital system has to eat the cost, or they bill the patient instead. This is used to get around those "out-of-pocket maximums" cheap insurance is sold on. So you may only have to pay the first $8,000 of the bill, but that only applies to the first $8,000 of what the insurance company agrees is covered.
My out of pocket + premium for my entire family is MUCH MUCH MUCH less than I save in taxes by being an American over European. Pretend health insurance is a "tax" and add it to your total tax rate. Now compare your total tax rate with someone in Germany/Sweden/Norway making similar pay. For most developer type jobs, I think you are going to find that even a $2,000 a month insurance plan a steal.
Let's do the math. So how does public health insurance work in Germany?
* There is a base rate of 14.6% from your gross that split between the employer and employee. The split is not important for our calculation as it will come out of the same budget an employer has for one employee I guess.
* Public insurance providers can demand an additional contribution that was on average additional 1.3 percentage points. The highest I could find is 2.5 percentage points extra.
* There is an upper limit. You only have to pay for your first 58050€ ($67564) a year. For everything you earn above that you do not pay more.
* Family members that do not work or do not earn more than 450€ per month are included for free
So that means from the money your employer has available to pay you a maximum of (14.6 + 2.5) * 58050 / 100 = 9927€ ($11556) a year or 827€ ($963) a month.
If your us jobs are like mine were years back, you’re only paying 20% of the cost of your insurance. Get laid off or quit and use cobra and you’ll learn the real costs.
then you're stuck with your work. Because other work might not provide the same coverage. It's not too bad for programmers because they are spoilt for choice. For many other people it becomes servitude.
I had an emergency room visit for broken ribs complete with an EKG, x-rays, IV, etc come to a grand total of $75 in the US. I assume this happens frequently, but we don't hear about it because no one cares when everything goes right, or perhaps, it doesn't fit the current narrative.
My default (very good insurance) ER bill is $500 for checking in - I could change my mind and walk out 5 minutes after the intake form and still be responsible for that amount.
You have some outlier coverage if your story is factual.
But like my out of pocket max is 3-5k for my entire family. So a few ER visits or have a baby and you are paying $0 the rest of the year.
The reason a doctors visit is 0-$20 and an ER is $500 is because the insurance company is trying to steer you towards the more cost efficient treatment place.
Yes you can go to the ER for a sprained ankle, but often you can wait until the next day and go to the doctor for better treatment for 1/10 the cost.
Incentivizing you to make more budget friendly choices if capitalism. We like capitalism here right?
Your analogy about ERs is based on situations that aren't emergencies, so I'm not really sure how to square that with reality.
Even following that analogy, you shouldn't delay medical attention to save money, and the insurance company shouldn't be dictating or steering any part of your medical treatment, period.
Incentives only work when you have good information and time to make decisions. When you're in an emergency situation, you can't hop on your phone and shop around for the best deals on trauma surgeons and ambulance rides, and frankly that shouldn't be the expectation.
One way to think about it is that there are low wait times on the US because nobody can afford the care. You can skip the queue because all the poor people are kicked out of line.
> If you have good work based coverage, our care is excellent. Fast access, and low out of pocket costs.
Our care might be excellent but the administrative burden is not.
> Fast access, and low out of pocket costs.
Have you ever had to challenge a bill? or find out that the provider you used sent your labs to another provider that was out of your network and now you owe the other provider full price?
> I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
And you don't need to mimic their process. You can have single payer and privatized medicine. If you're wealthy or a company wants to offer a premium insurance then so be it. There will be a market for those "speed lanes" if you want.
Work based coverage is variable at best, and for most people if they opt out of work based coverage they are not compensated by their employer for the money that employer would have otherwise put toward their plan. Which intern makes non work based coverage inaccessible which becomes a form indentured servitude if you need coverage.
Even the low out of pocket costs are vanishing with the introduction of the newer high deductible healthcare plans.
I think something a lot of people don't realize is that their care plan is often dictated by the insurer and employer, not their doctor. Your employer and insurer negotiate annually on your coverage with little input from employees. What medicines and treatments are covered is dictated not by the doctor.
The key thing is that health care is very uneven and unpredictable in the US, in my experience. I have called my primary doctor and gotten a referral the same day to a specialist. I have also waited 3 weeks to get a referral, and another 3 weeks for an actual appointment.
If you want to know what truly excellent health care is like, visit Mayo Clinic. Because of the concentration of doctors in one location, I saw around 12 doctors in a week. That would have taken a year or more through the regular medical system.
Where "excellent" includes shorter length of life, and over-testing, over-diagnosis, and over-treatment (each of which causes harm) because you've got to have something to show for all that insurance spending.
I did contracting for a while, I bought insurance with dental in 2010. It cost me about $120 a month and was comparable to my work. I did some contracting around 2015 and i bought insurance, I was paying $400 with barely any coverage. In my 2010 plan i had no concept of co-insurance, in my 2015 i also have co-insurance, also heard from my friend that when his wife had a baby, they had several doctors half in-network and half out to max out his deductible. He said same hospital for his first kid cost him around $400, second kid at 2017 cost him $4500.
I have many healthcare issues in my family, so I have a lot of experience with this. It is very dependent on the field. Some are booked out for months, others you can get an appointment the week of, it is very hard to predict. Also, most medical professionals leave some amount of week-space open for emergencies, so if you REALLY need to see someone, you can in less than 24 hours in many cases. But if it's routine or part of a larger "wtf is going on" process, it can take a year to get a diagnosis bouncing between different specialists with 1+ month scheduling runways.
Currently, the industry is also facing a labor shortage, so this is making the scheduling even harder. A family member in high school was diagnosed with obstructive sleep apnea (affecting school performance! You only get 8 semesters to mess up!), and it has been (so far) 8 weeks and we still don't have a formal intake for medical equipment. We have a prescription. We just can't get the equipment supplier to process the prescription and send it to us. I ended up paying out of pocket (and doing some crazy shit) to get a machine and supplies. Note: this is with doing what is basically a part-time job squeaky-wheeling everyone I can to try to get things happening. It is the worst.
Blue collar medical workers are quitting in droves because the work sucks and it has garbage pay, and you see the executives making huge salaries. And you get yelled at by people like me trying to make the system move faster. I try to stay friendly, but... I have lost it a few times. Of the seven people in my family, five of us have chronic medical issues.
I was just talking the other day with a friend wishing there was a medical consultancy I could hire. I give them my health insurance info and family demographics and all of the healthcare shit we need done, and then they find the providers, make appointments, file reimbursements with insurance/hsa/fsa tell me how much to put in fsa/hsa each year, deal with the full time job of having a family that needs to deal with the totally bonkers american medical system. They get some commission of whatever comes back to me, and also just some baseline monthly payment for service. PLEASE GOD LET THIS BECOME A THING. Or, you know, a not insane medical system.
If you've ever been on the scheduling side of these things, you'll see that a lot of these waits come down to inefficient scheduling. If you've waited a month for your appointment, there's a good chance there were multiple cancellations before that you didn't hear about.
When I talk to people about socialized medicine I always force them to address the VA. The VA does some things well, but most things terribly. If you want me to vote for socialized medicine, fix your experiment before you scale it.
I have pretty good insurance, and that's not really my experience. The shortest wait I've ever had (for a non-emergency) was 4 weeks for a therapist as a new patient. My optometrist is booked up for the next 6 months (which I found out when I had to reschedule back in June and ended up with an appointment in November). Physician: 3 months. Dermatologist: 2 months. One of my friends has been on a waiting list for an elective surgery for almost 6 months (because she can't afford to go out of network).
The idea of a same-week appointment, especially as a new patient, seems like fantasy to me.
Bruh, you can walk into lenscrafters and get seen the same day and walk out with a pair of glasses. They accept all the vision insurance plans I've had over the past 20 years.
Good points. I ran some numbers and Brits pay more for their healthcare via higher taxes. It's not really free (unless you earn nothing, but the US also has plenty of charity care too). Canada is infamous for long wait times and stuff not being covered (such as dental).
Hopefully you don’t end up with a medical condition that exhausts your PTO and you get kicked off insurance. My neighbor’s go fund me staved off foreclosure for 6 months when his wife had cancer.
That advantage is going away as health networks are allowed to slurp up all of the doctors.
Where I live, 95% of medical practices belong to 2 networks. Step two after consolidation is reduce costs. Long story short, if you don’t have cancer, you’re looking at 90+ days for an appointment.
Dermatologists are a little different in that they can make money selling bullshit spa services. So you may see more variance by region as being cut out of hospital networks isn’t as big of a deal.
My experience with a dermatologist (in the US) ended up being the same as you anticipated it being. Trying to book a new patient appointment myself I was getting quoted availability 2-3 months out.
I was able to get that sped up a bit by having my primary doctor refer me (which my insurance didn't require) and set up the appointment on my behalf. But even then, it ended up being almost 6 weeks out.
I've also had to book GI appointments in a few different locations, and have had some get me in within a week and others that had a multi-month wait.
And some insurance plans in the use are HMO plans[1], which generally have the requirement of going through your primary care doctor for everything and requiring a referral from them to see other physicians.
The biggest gripe I have about the US healthcare system is how impacted it is by employer decisions. Having decent coverage today doesn't mean the coverage will stay decent, even if you stay with the same employer. I've had awesome insurance unexpected swapped out for crap insurance due to an acquisition, had good plans that I took into account when determining whether to take a job disappear the year after during open enrollment season, had the "same" plan change year to year in subtle but impactful ways (like keeping per-person deductibles the same, but adding a condition to meet a minimum family-level deductible in addition to any individual before you actually hit the threshold).
90% people in the US actually probably couldn't see a dermatologist they don't already have a client doctor relationship with this month and we pay a huge chunk of our money to insurance.
This is still a pipe dream for some. It’s still very very common to wait months to see a doctor in the states, especially after the pandemic. I routinely wait months to get into my dermatologist, too. YMMV but this is absolutely not the norm.
1) The conservatives (political right) have eroded public health care any chance they can, such as through cutting budgets to any health-related service over the course of at least the last 20 years. They do this so that they can stand up in front of people and argue that “Wait times are long! If you let us implement private health care you could simply pay for better service!”
2) Even with the reduced budgets and constant attacks by conservatives, if I limp in to emerg with severe pains I’m getting looked at immediately and might be successfully out of surgery by the end of the hour.
On a smaller note, I just had this convo this morning: “Can I book an appt to get my prescription refilled? I know the Dr has to talk to me before writing it” “For sure. I can get you in Nov 28th. Are you completely out?” “Yes I am, I miscalculated and I’m concerned.” “Ok, I’m putting you in for tomorrow afternoon. Does that work for you?”
> More over, propaganda has made them expect worse coverage from any alternatives.
Is it propoganda or lived experience? Everytime someone has come around saying they're going to fix my health insurance for me, it's ended up costing me more for the same service as before.
Come to think of it, I've yet to have an increase in positive experiences concerning my health insurance. Every doctor's visit feels like a new surprise lurking in the dark.
It's propaganda. People who have lived experience of the VA system may have complaints, but they're mosquito bites compared to the lived experience of even people with reasonably good insurance who have gotten sick.
That's because, in a democracy, the incentives aren't to fix problems, but to create more so that you can continue to 'solve' them forever. This is exasperated by the obvious bribes that get flung around in the form of speech fees, employment after political career, and so on which give politicians, even ones ostensibly out to 'fix' your problem, perverse incentives to do the opposite in favor of a massive corporation.
I have heard that European Healthcare, especially in places like Denmark, is top notch and somehow free of this evil: I would love to know how they achieved this.
One other possibly related point is "free healthcare" (as well as free tuition) are "perks" of enlisting in the military. Take away those and I wonder what the recruitment rate would look like.
I've also been thinking, the population segment in the US most likely to have medical expenses and thus see a problem in the system to be fixed are the older generations. But, these generations are on Medicare and Medicaid and thus don't see the same problem as those with expenses who are younger. This is also a large portion of the population that, "doesn't want socialized medical care". So, they in effect, have socialized medical care and it's benefits but don't want anyone else to have it. Is this kind of accurate or am I being too cynical?
The #1 reason we have these crazy expensive drugs is because of our patent system. Ideas are worthless, execution is everything. The free market cannot function when monopolies are arbitrarily granted. End the patent system, and you will end Big Pharma. And we will have more innovation.
As well, employers maintain the status quo because an employee who is literally terrified of losing health care is less likely to even consider quitting.
Study after study has shown that we pay more for medical care + taxes than other countries. As it stands, the excess gets syphoned off to feed the medical industrial complex.
We also pay doctors and nurses and techs significantly more than any other country. And part of that is because we pay pretty much all skilled labor more, so to attract nurses and doctors we need high pay....
A quick google has found pharmacies in the UK selling it privately, unsubsidised, for around $40 for a pack of 10. Much more expensive than the quoted price for France, but certainly nowhere near the current US list price.
The US government spends more on health care per capita than the French people and government. The problem is graft, not cost shifting - and it's a lot easier to see when you look at the numbers by % of GDP.
Here in Canada, we have a half dozen competing generic drug manufacturers. They're not subsidized. My province has a public drug insurer that covers the elderly and very poor. It negotiates a common price as a large insurer tends to do. It's public information. It represents roughly the market cost in bulk to purchase these drugs from for-profit companies in Canada.
We recently moved to Michigan and a factor in doing so was being near the Canadian border for pharmacies. The University of Michigan's health website even talks about this as a possible strategy. This shouldn't happen in a civilized country.
Did that happen in the US in 2020? I thought the overwhelming majority of those claims were dismissed.
The real crime is calling bribes “campaign contributions” and pretending that our politicians (of all parties) aren’t selling their votes to the highest bidder.
Both sides were really shady, with lots of evidence just disappearing. My opinion, as someone from a Soviet country with actual widespread voting fraud, is that the way your election went was a bit suspicious. It was weird in the same way we see when the side that's supposed to win stuffs ballots from dead people, people who didn't turn up, etc. The large sudden bump in votes for Biden also seems suspicious. The fact that Trump got a record number of votes during a pandemic in which his voters almost all voted in person and still lost, is a bit suspicious. The fact that you need to only rig a few counties with a few votes to secure the thin margin by which Biden won, is suspicious. Many things are weird and suspicious. It is possible actual well intentioned people rigged the election to "save America". Whether they did and if it was right, I cannot say, I am not an American, I cannot judge your country.
All that said, based on actual available evidence, I cannot conclude that the election was rigged. It was probably the most scrutinized election in recent memory, leading to us seeing a bunch of suspicious events that probably happen pretty often. Similar to how the 2000 election, Bush vs Gore, was a bit suspicious.
s/suspicious/atypical and so much of the bias is removed. Add in context (pandemic, polarization, etc.) and it makes sense that this wouldn't look the same as other elections.
FDA production approval for a drug is expensive. If a competitor pays and gets a new line approved, the prize is zero, because of competition from the other line. If no competitor pays the prize is almost unlimited, because of no competition.
The government or a charity should fund another line, and should in general provide incentives to companies to not shut down existing approved lines if it would leave only one company standing.
If I was uninsured in the US for whatever reason and needed elective surgery for something with a short enough recovery period, I'd look up UK hospitals.
They're often similarly cheap enough to justify a flight and a hotel stay. Especially as many of them leverage excess capacity at NHS Trusts (some are even operated by NHS Trusts, as the trusts are allowed to offer private services within certain constraints)
> That essentially means it's literally 10x cheaper to take a two-way ticket to France, have a doctor prescribe it there, buy 3 months worth of treatment and come back to the US. I wonder how Americans can tolerate this situation.
I believe that this may be what pushes the American system to change.
I know of several not-rich people, sometimes who have decent or good insurance, who have chosen to go abroad for medical care. The care they get abroad is typically cheaper as well as better.
Given the amount of money the US spends on healthcare, this should rarely be true.
The insurance companies have set up a good gig for themselves, but I think that they may be feeding at the trough a bit too aggressively. When the economy has a big downturn, I think some hard questions will be asked.
Or make a quick short trip to Tijuana with a cheap flight, buy the medicine for $4 dollars (for 15 suppositories) [1] without any prescription and go back to your home within the same day.
While I realize that this particular drug is just an example, we could run some numbers here. The current owner of the drug made $27M in sales this year in the US. At $10k per 30 day supply, that implies that there are at most 2700 people in the US who use this drug (if all of them used it only once per year). If this is a drug that most of its users take all year, then we're now talking about a drug that is taken by very few people every year. The $5 French price point wouldn't be worthwhile for any US based pharma company to take on. This isn't a defense of anyone's pricing model, but I could see very easily why pricing models for very rarely prescribed drugs would naturally start to shoot through the roof in the US. Why is it tolerated? Most people don't feel like they are impacted by it.
This article, and discussion here, seem to both assume people pay the list price. In reality, is that the case very often, especially with this kind of drug?
> Indocin's list price (what uninsured patients would pay) was $198 for 30 suppositories in 2008.
I would not be surprised if they've hiked the list price a ton to game the insurance "what we'll pay" formulas and get more money from insurance companies. As trimbo notes [0], if everyone is paying list price then only 225 people are using this drug consistently. That seems unlikely.
Another interpretation: the biggest beneficiaries of high list prices are the insurance companies. After all, they don't pay that price, and the higher the non-insured price, the more attractive it is to buy health insurance.
So perhaps the drug companies are just responding to demand from their biggest customers.
Shouldn't this be illegal / isn't this already illegal?
Two companies reaching an agreement to supply products at reduced price, but not making the terms of that agreement available to a third entity (uninsured customers)?
If you carefully craft all incentives to create the strong impulse in all participants to do things everyone benefits from without actually phoning them up and saying (let's do it this way), it's not illegal. This describes the why for a lot that is wrong with the world.
It's definitely not illegal in general to charge different prices to different customers, or to keep the terms of your business agreements private.
As for "should it be illegal", most people seem to agree the healthcare industry should be regulated more tightly than commerce in general, but there's plenty of debate about exactly how far we should go.
> I would not be surprised if they've hiked the list price a ton to game the insurance
Seems to be standard business. ONE of my prescriptions for rheumatoid arthritis costs roughly $5000/month without insurance. My insurance, plus additional assistance from the drug maker makes the medication "free" for me. It's clearly a giant, legal insurance scam.
It's almost definitely an insurance scalping strategy, and the number of people needing this drug via this delivery route may actually be that small (or close to it). When companies do this, they usually just hand it out to uninsured patients for cheap or free, not out of the goodness of their hearts but because they want to try and reduce bad PR. The whole Martin Shkreli debacle was incredibly similar, and in the same way that people couldn't seem to talk rationally about the real problem there (high pricing encouraging more high pricing just because insurance will pay for it), the average discussion about this case of pharmaceutical scalping will completely miss the point, too.
Is this one of those things where they have to give it a crazy list price due to insurance regulations but no one actually pays that price? Goodrx has it for less than $10
>Same thing with Martin Shkreli's price hikes, and he gave out those drugs for free to those who needed it.
This appears to suggest that there are people who take enormously expensive theraputic drugs who don't need them, and that Martin Shkreli gave away those enormously expensive therapeutic drugs away to those who actually did.
Whether propoganda, misinformation, or a bald-faced lie, that's not what happened. That never happens, and never will. Shame on you for implying that was the case.
Given the prices at issue, that's most people. Worse yet, who decided the cutoff? When does one make enough money to pay insane life-improving drug prices? How much money is left over afterwards?
"‘My other piece of advice, Copperfield,’ said Mr. Micawber, ‘you know. Annual income twenty pounds, annual expenditure nineteen nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds nought and six, result misery."[0]
I don't think that person implied that at all. That's how I remember the whole Shkreli thing too -- there were about 3,000 people taking that drug he hiked the price on, and 60% of them got it for $1. The remainder got it through health insurance, and for those who couldn't afford it at all, he claims they got it for free. Note I have _not_ fact-checked any of that, but that goes against the typical narrative that people couldn't get the drug because of the price hike.
If your "_not_ fact-checked" description of his behaviour is correct, why did the price go up at all? Unless, prior to the price-hike, those who got it for $1 got it for 50 cents or something, it sounds like the price hike actually hurt the business's bottom line. Why would that happen? If you're correct about this, could it have been a result of the scrutiny? Are there ever any instances where drug costs skyrocket and patients are forced to bear the cost?
Even if a highlighted instance of predatory behaviour was papered over due to said highlight, and even if that papering-over resulted in greater drug availability at lower cost, I think that might have been a result of the spotlight, rather than proof positive that the behaviour isn't awful and doesn't hurt those unlucky enough to fall ill.
I have gout and have learned quite a bit about how fucked this whole system is. I will find some sources but if my recollection serves me right there was an arthritis medication that was developed before FDA approvals. In order to bring it up to FDA approval, companies can assume the burden of approval (clinical trials, etc) and then they basically get the drug. Well, in the time since this has happened a common drug used by many people (many later in life) is now costing medicare tons of money because, well, people are greedy.
I would say this system needs to change but considering the democrats can't even escape from a wet paper bag, i don't see that happening.
People are greedy? The FDA asked that colchicine go through the FDA approval process. A company did so and footed the cost. That’s not greed, that’s a public service.
Colchicine, the old gout drug often cited as a cheap anti-inflammatory, hasn't been such a good deal since FDA approval, a study showed.
The inflation- and rebate-adjusted Medicaid price per pill jumped from $0.24 in 2008 to $4.20 after the FDA officially approved a branded form, Colcrys, through the agency's Unapproved Drug Initiative pathway in 2009.
and
Accordingly, Medicaid spending on single-ingredient colchicine rose 2833%," they wrote, and "58% of this increase was attributable to price increases alone."
and
"Only a fraction of an investment was required for Colcrys, a product that has provided no increased value and an unnecessary, long-term cost burden to the health care system," argued B. Joseph Guglielmo, PharmD, of the University of California San Francisco, in an accompanying editorial. "The current study findings illustrate that we can never allow such an egregious case to take place again."
say what you will but this is just stupid american bullshit.
No, this was entirely intentional on behalf of the FDA. They wanted to move unapproved products out of the dark and move them through a formal approval process.
As a part of that process, they offered market exclusivity as an incentive for a company to spend the time and money to do so. As I said in another response, the filing fee alone is $1.6M. It's not as expensive as a full NDA approval, but it's not free.
And your article lays it all out.
"Their study used Medicaid and Medicare data files through 2017, when combined Medicaid and Medicare claims exceeded $340 million for colchicine.
"Colcrys's manufacturer, which conducted a 1-week trial (n=185), received 3 years' market exclusivity for treatment of acute gout, and the unapproved formulations were soon ordered off the market, resulting in a virtual monopoly," McCormick's group noted."
So the price goes up for 3 years and as a result you get a fully FDA approved drug? Not worth that trade off?
On Friday, Nov. 20, 2020, the U.S. Department of Health and Human Services (HHS) published a Notice through the Federal Register announcing the withdrawal of guidance documents that established the Unapproved Drugs Initiative. This Notice brings to an end a 14-year-old program that has been blamed for significantly contributing to the rising cost.
you're either trolling or lazy... here's an excerpt from the article:
In total, 34 previously unapproved drugs were addressed through the Unapproved Drugs Initiative. In a 2017 analysis, researchers found that 90% of those drugs were approved through the new drug application 505(b)(2) pathway.2 The 505(b)(2) pathway does not require new clinical trial evidence and can be based on literature reviews or bioequivalence studies alone. New market exclusivity for these drugs led to a median price increase of 37% (interquartile range [IQR] = 23–204%) within two years of approval. It also resulted in more supply shortages of these drugs after approval, and these shortages also lasted longer likely because of the exclusivity.
How is it greed that someone goes through the process of getting FDA approval (which is more than just running trials), sets up FDA approved manufacturing, does all the monitoring, etc, then charges for it?
You realize the application fee alone for 505(b)(2) is $1.6M?[1] It's not like someone just emails a few papers with an application form to the FDA and gets FDA approval.
This is the kind of thing that would cause people to distrust government and major pharmaceutical companies when they say a new vaccine should/must be taken by everyone.
Does anyone know about this drug? The generic pill is $10, not sure why the suppository would be $10k. I'm guessing some journalist found some drug that few people use.
The generic version is not available as a suppository. The suppository with a Buzzrx coupon is just shy of $5000 for 14 suppositories, which is about the same as the $10k for 30 suppositories given in the article.
Two quick comments: trying to take generic drugs and lock up their rights to jack prices relies on a govt giving the locked rights. Otherwise somebody else can just make it. There’s little profit in generic drugs, so production can be spotty.
For those comparing vs the us health system, include (a) working f/t with good employer benefits, (b) f/t with less benefits and (c) working part time. And remember to include cobra. And include the state/province/country where the comparison is being done. No absolutes here, either.
Here's the tale: If you have obstruction of your bile ducts below the liver or gallbladder, usually gallstones or sometimes neoplasm, you need an endoscopic retrograde cholangiopancreatography (ERCP) for extraction or sampling.
ERCP is sticking a tube down the throat, stomach, small intestines into a tiny opening at the ampulla of Vater to access the bile ducts. Sometimes this process causes inflammation of the ampulla and associated ducts leading to blockage, and can lead to pancreatitis due to back flow and pressure, because the pancreas also excretes its digestive enzymes via the ampulla).
A few trials circa 2015 showed rectal indomethacin reduced the risk of post-ERCP pancreatitis, and eventually it made its way into the guidelines. It is the only proven preventative treatment, so they have a natural monopoly.
My meaning was that there is no other therapeutic agent available for prevention of post-ERCP pancreatitis. But you're quite right, there must be another reason.
If I had to hazard a guess, it may be the market isn't attractive enough for competitors to establish a national supply chain. Or there's some sort of collusion at play.
To me this represents further evidence why public goods should be left out of the hands of private for profit organizations for whom disease is simply an externality to capitalize on.
252 comments
[ 3.0 ms ] story [ 255 ms ] threadIndomethicin is an old drug without much use and then narrow it down to suppositories it’s an even smaller market. Plus there are a dozen plus alternatives you could use.
Think of like producing a microprocessor design from 1970 where alternatives exist. Super niche. Demand is maybe 100 units per year. What would you charge?
I don't know the market, but it appears that it may be patented until 2030 (https://www.pharmacompass.com/patent-expiry-expiration/indom...). That being said, drug patents are complicated, and there might be competitors for this drug.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/01...
https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=a...
https://clincalc.com/DrugStats/Drugs/Indomethacin
Take it to the extreme: you have a very, very rare life-threatening illness. Since only 20 or so people a year are diagnosed with this, the drugs to treat it would have to cost 1.5MM just to be decently profitable.
Is that a just healthcare system? A kind of inverted lottery in which the “luckier” you are the more likely to go bankrupt.
One might reasonably conclude that trying to run the entirety of the healthcare system as a capitalist enterprise is perverse and trades the misery of the many for the profit of a few. In such cases, we should rightly consider all possible alternatives.
Costs are typically socialized by the federal government.
Instead people view health “insurance” as a healthcare plan. Which is not how the us system was designed.
For those with health insurance the idea would be it cover the 10k+ per pill cost for your rare disorder.
If it cost 1 trillion to add a year to the life of just one person, should society pay it, even if that trillion is then not able to be used for lots of other societal needs?
Arguing for policy while ignoring opportunity costs leads to more human suffering than would otherwise result.
Perhaps capitalism is not the best strategy to apply to healthcare. Folks in need of healthcare will always be a minority - a niche market - after all. The most prolific diseases typically only have 3-6M cases at any given time in the US.
Should a person go destitute to pay for their care, just so some company's supply/demand curve is properly fitted?
(There are so many examples of this, including for this case that Medicare/Medicaid are government programs where they pay whatever the drug companies ask.)
i.e. don't let the supply chains fall over and provide "insurance" for everyone.
This really isn't that crazy in the grand scheme of things. The US right now today does basically this with dairy products.
This has little to do with the cost to produce something, other than to set the lowest bounds of the sale price (which by itself is a simplification given the concepts of loss leaders and non-monetary gains).
I'd honestly much prefer if they were charging according to their costs and not market forces.
I'll come out and say it: Pricing people out of your medicine so you can increase your profit margin is capital-E Evil.
E.g. in the UK a quick check shows me I can buy a pack privately online for $40.
(UK online pharmacies can sell a number of prescription-only drugs privately if they have a doctor carry out an online consultation, which means you basically fill in a form and a doctor will look at your answers and provide a prescription as part of the sales process, or you can send them a prescription you already have).
For that you have regulatory upkeep, cost of manufacturing, and legal liability.
It seems pretty clear why several of the past owners of the brand have gone bankrupts or sold off the product line.
https://s28.q4cdn.com/742207512/files/doc_presentations/2021...
That essentially means it's literally 10x cheaper to take a two-way ticket to France, have a doctor prescribe it there, buy 3 months worth of treatment and come back to the US.
I wonder how Americans can tolerate this situation.
Because there are sociopaths brainwashing half the population into believing affordable medicine is a bad thing.
edit: an explanation; Activists never demand cheaper (or more transparent) health care. They demand state to pay for it! Same as with student loans.
Or you could scrutinize the projected numbers, which conclude that it would be less expensive, in terms of government healthcare funding, to eliminate all of the ravenous middlemen causing all of the costs.
Kinda like how it'd be cheaper to just give all the homeless people housing, rather than burn shitloads of social and criminal justice funding to keep them on the streets.
These are ideological positions, though, so good luck changing any of them. So are the rolling presses -- they're not there to prop up a healthcare system, they're there to refill the troughs of irresponsible rich people whose enterprises have become "too big to fail". The problem is that the rich people have come to expect this windfall. Maybe we can save some money for them by cleaning up the healthcare and criminal justice systems!!
but imagine how much easier it would be to start a business if you didn't need to be a wage slave for the man to insure your family
or all other not poverty stricken countries https://cdn.howmuch.net/articles/poverty-world-map-142d.jpg
As someone who hails from a place whose enormous single-bloc healthcare system can dictate the terms you're describing, I don't think that statement is the explanatory gotcha you intend it to be. Those regulations are there for a reason -- to ensure your for-profit healthcare system makes profit. What if the middlemen were gone and it didn't have to?
Furthermore, the reason that these prices can be charged is the regulatory moat, courtesy of the government. Suppose that same government would enact a single-payer system, what makes you believe it wouldn't pay outrageous drug prices, courtesy of the taxpayer? The mechanism that gives the pharma lobby free reign won't just disappear over night.
"Aw, it's not so bad!"
>Furthermore, the reason that these prices can be charged is the regulatory moat, courtesy of the government. Suppose that same government would enact a single-payer system, what makes you believe it wouldn't pay outrageous drug prices, courtesy of the taxpayer? The mechanism that gives the pharma lobby free reign won't just disappear over night.
"But also it's super bad, and it's obviously the best we can do."
Don't know what to tell you -- seemed to work everywhere else. I guess that's American exceptionalism for you!
I didn't say that, but it might actually be true. Having the same people that created the current system design a single-payer system or attempt price fixing is unlikely to lead to a better outcome.
Because of how hamstrung Medicare and Medicaid are - with laws restricting them from leveraging their size properly in negotiations, Medicare and Medicaid combined cost US taxpayers as much per taxpayer as the NHS costs per UK taxpayer.
The big difference, of course, being that this buys us universal coverage in the UK, while Medicaid and Medicare only covers a portion of the US population. So the cost per recipient of care is many times higher.
Then a whole lot of Americans have to pay again in private insurance to actually get cover.
So for a start, Americans ought to campaign to unshackle Medicare. Remove the regulations preventing it from leveraging its size fully and make it subject to pressure to be cost effective, and put the savings into expanding coverage, and you'd already be a huge step closer to solving the problem.
EDIT: This is an interesting read: https://www.commonwealthfund.org/publications/explainer/2021... " As proposed in H.R. 3, drug pricing negotiation would reduce federal spending by $456 billion and increase revenues by $45 billion over 10 years." -- this is a plan that still puts lots of restrictions on how hard Medicare can negotiate. Also: https://www.kff.org/medicare/issue-brief/whats-the-latest-on...
Activists never demand cheaper (or more transparent) health care. They demand state to pay for it!
...it's cheaper that way. That's-- that's why they say that. You can keep repeating yourself, but tell me, what makes almost every other first-world country better at this than the States? How is it that we can pay so much less and have, in aggregate, better health outcomes? It's a mystery!
My country has public health insurance, but gov also works hard to keep costs down. If we paid for drugs like this, the public system would bankrupt.
Expecting sick people or their relatives to navigate that kind of bureaucracy to get the care they need and/or avoid dire financial straits just seems insane to me
This is not the America I raised a hand to.
(Bankruptcy can only be used every 10 years.)
Not so long ago I had seen a documentary about how American diabetics couldn't afford insulin and had to purchase their insulin pens in Canada. It's quite a shame for a first-world country with one of the highest per-capita income to have people give up healthcare because it's simply too expensive
Imagine a charter bus that takes a full load of people once per month from the US to Canada from regionally close cities (e.g. Chicago, Cleveland, Seattle, and New York) for insulin and other critical but expensive prescription drugs. The bus takes them to a pharmacy, everyone unloads and picks up their prescriptions, then loads back into the bus. Everything is called in, pre-arranged with the pharmacy for a streamlined operation.
It's a really stupid situation and possible solution that shouldn't be viable. Unfortunately, it probably could be done.
So I think doing so as a foreigner shouldn't be a problem provided you can speak French or English depending on the practitioner.
Presumably they just don't want the hassle of figuring out regulations or dealing with stuff confiscated at borders.
For drugs that are legal to import into the US surely there must be online pharmacies willing to deliver, though.
Several reasons this terrible system continues to exist but it essentially boils down to entrenchment.
- The private healthcare industry pays politicians to maintain the status quo. The alternative government run solution does not.
- The private healthcare industry creates propaganda and pays the media to spread it. An improved government run solution does not.
- Many Americans have decent coverage from their employer. For them, it’s not worth upending the system for what might be moderate gains. More over, propaganda has made them expect worse coverage from any alternatives.
- ACA gave many without employer coverage a good enough solution. It’s still expensive as fuck but it subdued enough voters.
So, after considering voters who are happy enough with the devil they know, you don’t have enough votes left to overturn the system.
I never understood why there are no independent national health insurers (read Allianz for example) providing health care for self employed people like in Europe.
Edit: A classic by John Mackey (Whole Foods Inc.) but still valid: https://www.wsj.com/articles/SB10001424052970204251404574342...
Quote: „Repeal government mandates regarding what insurance companies must cover.“
The issue in the US is that the system is hugely inefficient compared to the models in Europe. There is an absolutely massive administrative layer between care providers and payers, price negotiations aren't transparent or efficient, the whole system is hugely complex, and the vested interests are incentivized to keep it that way.
Shopping for plans on the marketplace is already terrible when they all cover the same stuff. It'll be way worse if I have to decide between terrible options for what's covered. Especially since we all know none of that is going to be clear or easily comparable, and certainly not pick the things you want covered.... It'll be like broken bones are in the package that excludes cysts, and brain cancer coverage is not available with any other cancers, and to get coverage for any sort of dermatology, you also need coverage for skiing and parachuting incidents.
As-is, I can take my list of prefered facilities, look and see who has them in network, and then add the premiums to the out of pocket max to find my rough worst case cost and pick the one with the least worst case cost and call it a day. This is usually also the one with the least premiums, so it's also the least cost if I don't visit the doctor at all.
Which is to say it's not just propaganda.
As for the VA system's woes, I would say: yeah, it's definitely possible to build a system that doesn't work well. But that doesn't mean we shouldn't be trying.
> Which is to say it's not just propaganda.
No public or private system anywhere in the world has a uniformly good track record.
The difference of course between Medicare and less popular plans like VA coverage and Medicaid is that people on Medicare have political power, veterans and the poor do not.
Nobody is arguing that you can run a healthcare system badly, but to only point out the worse case is not arguing in good faith.
It's not irrational for people to look at the risk of making a worse system and judge for themselves if they think it's a risk worth taking. Examining a worst case that's within the scope of possible outcomes is a reasonable part of a good-faith process.
That said, the person I responded to was to my reading optimizing for getting away from the private health care apparatus as much as possible. Medicare For All does not accomplish that.
The VA was under-budget even before the two wars started in 2002/2003.
Then the ruined bodies and psyches rolled in, and VA wasn't given additional funding to handle the aftermath.
It's pretty clear how that ends up. The wars above cost $Trillions but the aftermath costs a few more Trillions that VA and other agencies didn't have.
Here's a first step to solving the US problem: Remove the legal restrictions on Medicare preventing it from negotiating best possible prices, and reinvest whatever it manages to save on expanding coverage.
That I know of, the US has either 5 or 55, depending on how you count the Medicaid programs run by each state + DC in cooperation with the feds, socialized healthcare systems (Medicare, Medicaid (1 or 51), TriCare, VA, and the Puerto Rico public healthcare system.)
At 9 million covered beneficiaries, the VA system is smaller than Medicare, smaller than Medicaid, and even smaller than California's state Medicaid plan (Medi-Cal).
It’s kind of weird to pretend VA is the socialized healthcare system in the US. (Actually, you can argue that TriCare and VA aren't even true “socialized” systems but employment-based plans for current and former employees, for a subset of federal government employees.)
Pregnant women, indigent, long term disability, orphaned children, and others are programs w/in the Texas Medicaid programs, for example.
Negative gains I may say. In my experience of the Canadian healthcare and US healthcare systems, the latter, IF you are well insured, feels like a Rolls-Royce whIle the former is like driving a Lada in Pothole City.
I remember the first time I called my provider in the US to book an appointment with a dermatologist. She said "Wednesday", I said "What month?" I couldn't believe it was that same week. I used to wait 2-3 months in Canada. And I had to first get a reference from a ER/generalist doctor.
Also don't forget the US spends on medicare/medicaid/VA about the same % Canada spends on healthcare.
If you have good work based coverage, our care is excellent. Fast access, and low out of pocket costs.
I do want to improve it for everyone, but I have 0 complaints about my personal access to health care. I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
We have pretty long wait times in the US for elective surgeries as well. Not as bad as canada, but it can take a bit to get you scheduled for a hip or knee replacement.
The fact they pay less for some procedures is irrelevant
Many doctors either do not see or see limited numbers of patients on medicare. This means that wait time is longer for these folks.
You are arguing real hard/loud, but it doesn't sound like you have talked to actual doctors about the issue.
Do all doctors take it? No, but I feel like they are in the minority and frankly, if a doctor doesn't take it, I feel they are more motivated by money than caring for their patients.
There’s no way to pay for better/faster treatment if it’s publicly covered.
EDIT: Edited to clarify I'm speaking specifically about Canada as there is some confusion in the replies.
They do let you pay for a private hospital room though oddly enough.
This is an outright lie, here in Uruguay and in Chile both with social Healthcare you can enter onto different private plans and that will expedite surgeries, doctor meetings etc
It is something that depends on a country per country basis
Easy there, cowboy. Based on the conversation, I believe OP is still referring to Canada, not every country with socialized healthcare.
“Assuming CAN is like NZ…”
“It’s (Canada) not.”
I can't speak to the situation in Canada, but in the UK this is not true. You can get private insurance and go to private doctors.
The clinic then fucked up billing, overcharged us, and it took another few months for all of this to get sorted out.
The first part of this story isn't too different from the Canadian[1] system, the second is a pile of unnecessary stress added on top.
Between mine and my employer's share, our 2-adult health insurance costs ~$15,000/year, by the way. And what do we get for it? Months long waitlists and clowns that can't even get billing right the first few times.
This may indeed be the Rolls Royce of healthcare, in the sense that it costs a mountain of money, finds expensive ways to break down all the time, and spends half its time in the shop.
[1] Actually, each province in Canada is responsible for running a provincial healthcare system.
> The first part of this story isn't too different from the Canadian system, the second is a pile of unnecessary stress added on top.
IMO the cost in stress and time of the American system is under-appreciated. We pay way more than other advanced states and have to deal with a whole bunch of companies, all of which seem to be either incredibly incompetent or actively trying to screw us, every time we actually need healthcare, which is precisely when we really don't need more stress or to have extra demands on our time. It's awful.
I've been getting bloodwork done at my physician's office for two years and Labcorp started sending me bills again. Same insurance, but they just randomly stopped filing with them until I spent long enough on the phone for a few of my hairs to grey.
When I was younger, I got a nasty infection after my wisdom teeth were removed. The ER bill, which was close to $5k for a doctor to look at me for roughly 5 minutes and write me a prescription for antibiotics and some pain meds, bounced between health and dental insurance for months, both saying the other should pay for it, before they kicked the can to my parents.
My mom had connections in the hospital's administration, so she was able to get it coded properly for health insurance to pay it. But I am probably the only person in this thread who can say "my mom is on a first-name basis with the people who can get billing issues resolved by the next day." Everyone else gets to sit on the phone for hours trying to sort it out, hoping that insurance will show mercy or that the hospital will bother recoding, or at least give them a bill they can stomach.
You'll reach a lot more people without that kind of language. I for one almost instantly dismiss anyone who talks like that. I didn't even read the rest of your post.
The word "privileged"? That's apt. Most on HN are privileged.
Or is it the way that statement was posed as a question? It's probably not the most diplomatic way opening a post but it's far from being offensive.
I don't know why you're commenting, since you're not the original commenter, and your very comment shows how you already recognize the generic accusation-of-privilege to be the problem (and how the word privilege is heavily coded with political affiliations and a whole pile of antagonistic/moralizing dogma at this point). You already knew how and why it would be inflammatory.
You recognized the problem, and opted to try to reframe it in more favorable terms to deny the possibility for improvement.
If the original commenter wants to reach across that Red Tribe / Blue Tribe divider and have an actual discussion (or even convince a neutral 3rd party of their views), their first sentence (and general tone) is quite counter-productive, and you know this.
This is a multi-user forum not a peer2peer chat client.
> and your very comment shows how you already recognize the generic accusation-of-privilege to be the problem
No, I'm saying the accusation of privilege is correct and it's not a problem to point out to people on here that we are privileged. Because we are.
> You already knew how and why it would be inflammatory.
If you're in the top 10% and can't stand being called privileged then the problem isn't the tone of the accuser, it's the person receiving the comment. The sooner privileged people stop acting like the victims, the sooner we can start fixing the worlds actual problems.
> their first sentence (and general tone) is quite counter-productive, and you know this.
Actually I was arguing that it's not counter-productive. It was the point of their post and a point very much worth making.
I've seen both sides of the social scale and we are definitely not on the side that should be getting offended when people should "privilege" ;)
"Worse healthcare for you and your family because you are privileged" is not particularly compelling to the roughly half of Americans you are yelling at.
Maybe at your specific doctor. But there are many, you could try another?
This isn't sustainable for me in the long run and I'm definitely considering leaving the US because of it.
Mostly of the 'making fun' is due to the fact that millions of US citizens have no or little health care and choose not to have treatment because they can't afford it, are limited about what treatments they can have, or have it and are made homeless or live under huge debts.
Just about every country which has some kind of health care system also has private health care/insurance that means you don't have to wait for treatment or have more choice about what, when and where things happen. Because of the competition of the 'free' healthcare systems these policies are usually much, much cheaper that the US.
I work in a company that gives me private medical insurance (which means I might get treated a little early for a non urgent condition, perhaps in a swanky private hospital) but feel good that people that can't afford it won't die, and that I can quit my job and not worry about getting ill.
https://www.kff.org/coronavirus-covid-19/poll-finding/vaccin...
https://www.npr.org/2021/05/04/993270974/why-lagging-covid-v...
https://www.npr.org/sections/health-shots/2021/04/15/9874126...
“There is a deep group of rural american's who refuse health care, even when provided by their job at extremely low cost.”
Particularly the part about those with insurance not seeking care. The articles cited are concerning vaccine takeup rates, which reasonable people can differ.
The media, pundits, and politicians only focus on the sticker price, not what people are actually paying, which is often much lower. http://greyenlightenment.com/2021/10/17/why-healthcare-is-so...
We hear about patients being stuck with $6000 bill but did said patient actually pay 6k? Absolutely not, even if uninsured.
also they ignore the role of employer healthcare, or how the NHS is paid for by higher taxes, so Americans are effectively paying less for healthcare in this regard.
So much misinformation and misleading info in the healthcare debate, driven by partisan politics.
They paid $1500, then, while in any other country, it would have cost, maybe $50
Sadly this opinion underlies a lot of America's problems.
The top 50%ish get coverage through jobs that is mostly fine.
The bottom 25% get heavily subsidized plans (often free) from both state and federal programs.
There is a hole there in the middle, but it may be possible to tweak a few programs without throwing out everything. This is basically what ACA tried to do with the backing...
The US health care system is by the far the most complex of any nation state and punishes the losers the worst. It strikes me as something badly in need of disruption. And it's not like we're talking about removing private health care entirely -- if that's what you're scared about?
> And it's not like we're talking about removing private health care entirely -- if that's what you're scared about?
I'm personally concerned with the 50 Stalins sort of sentiment surrounding health care. We legislated the current system into existence and its outcomes are perfectly predictable. Why not fix the causes instead of trying to legislative more effects and doubling down on government interference yet again?
The problem isn't regulation. Many other countries are far more regulated in the health care industry and operate a private market just fine. In fact some might even argue that some of the problems with the current US model is a lack of regulation.
The problem I've observed isn't a lack of competition, it's that all of the competition play by the same broken rules. You basically have an industry where people need your service. It's not luxury, it is literally life and death in many cases. People have to use your service, whatever it costs. And you then allow those companies to regulate themselves, companies that will almost always put profit ahead of welfare. That is never going to turn out well. But because libertarianism is very much a core part of the American ideology, whenever the question of how to fix the problem arises you argue that the market needs to be deregulated further. Basically just doing more of the same, as if it will suddenly fix things despite decades of proof that it hasn't already.
Now I'm not going to pretend that other counties have a perfect system. But I do believe the only way you are going to get a health care system that works for everyone is for voters and politicians to want something that is, at least on the surface, very "un-American".
> I'm personally concerned with the 50 Stalins sort of sentiment surrounding health care.
And here lies the problem. People are so brainwashed into thinking any form of social health care is communism and bad. Quite frankly, it's ridiculously misinformed. In fact most of the rest of the developed world has a social health care system AND private health care, capitalism, etc too. On this particular occasion you can actually have your proverbial cake and eat it.
> Why not fix the causes instead of trying to legislative more effects and doubling down on government interference yet again?
Because you're fixing the wrong thing. You're looking at a broken faucet causing water to leak constantly, and instead of fixing that faucet you go and break more faucets thinking that should some how change the behaviour of the first faucet. Then when the flow of water gets too expensive you then start arguing that it's not the leaking faucets at fault, it's the water rates instead. If this weren't a political problem then I'm sure most on here would throw their hands up shouting "learn some basic root cause analysis!"
[1] https://www.pbs.org/newshour/health/these-3-charts-show-how-...
Are you factoring in premiums? Once you factor premiums from both sides (employer and employee), healthcare in the USA is far from low out-of-pocket. Good family coverage is on the order of $2,000 or so a month.
That's not even getting into the garbage plans offered at some places. I've had plans that covered visits to exactly one region hospital system, any other hospitals needed preauthorization, and even those had the potential for rejected claims.
Which brings up another often missed point. When dealing with the lower cost plans, there's a huge risk of having a claim denied. I know for a fact that at least one major insurance provider has a policy to deny every claim and make the hospital rejustify it. If the hospital fails to justify the claim (to the insurance company standards), either the hospital system has to eat the cost, or they bill the patient instead. This is used to get around those "out-of-pocket maximums" cheap insurance is sold on. So you may only have to pay the first $8,000 of the bill, but that only applies to the first $8,000 of what the insurance company agrees is covered.
My out of pocket + premium for my entire family is MUCH MUCH MUCH less than I save in taxes by being an American over European. Pretend health insurance is a "tax" and add it to your total tax rate. Now compare your total tax rate with someone in Germany/Sweden/Norway making similar pay. For most developer type jobs, I think you are going to find that even a $2,000 a month insurance plan a steal.
But the further you fall down the income ladder, the worse the American system is.
There’s also the moral cost of participating in and supporting a system extorting the less fortunate.
“Not my problem” is where we are divided - and pay an extraordinary price, becoming complicit in the extreme violence of poverty.
* There is a base rate of 14.6% from your gross that split between the employer and employee. The split is not important for our calculation as it will come out of the same budget an employer has for one employee I guess.
* Public insurance providers can demand an additional contribution that was on average additional 1.3 percentage points. The highest I could find is 2.5 percentage points extra.
* There is an upper limit. You only have to pay for your first 58050€ ($67564) a year. For everything you earn above that you do not pay more.
* Family members that do not work or do not earn more than 450€ per month are included for free
So that means from the money your employer has available to pay you a maximum of (14.6 + 2.5) * 58050 / 100 = 9927€ ($11556) a year or 827€ ($963) a month.
Regardless of your delusion, let's not forget the fact that most of those employer-provided policies come with a shitton of asterisks.
then you're stuck with your work. Because other work might not provide the same coverage. It's not too bad for programmers because they are spoilt for choice. For many other people it becomes servitude.
You have some outlier coverage if your story is factual.
The reason a doctors visit is 0-$20 and an ER is $500 is because the insurance company is trying to steer you towards the more cost efficient treatment place.
Yes you can go to the ER for a sprained ankle, but often you can wait until the next day and go to the doctor for better treatment for 1/10 the cost.
Incentivizing you to make more budget friendly choices if capitalism. We like capitalism here right?
I like to think we like objectivity.
Your analogy about ERs is based on situations that aren't emergencies, so I'm not really sure how to square that with reality.
Even following that analogy, you shouldn't delay medical attention to save money, and the insurance company shouldn't be dictating or steering any part of your medical treatment, period.
Incentives only work when you have good information and time to make decisions. When you're in an emergency situation, you can't hop on your phone and shop around for the best deals on trauma surgeons and ambulance rides, and frankly that shouldn't be the expectation.
One way to think about it is that there are low wait times on the US because nobody can afford the care. You can skip the queue because all the poor people are kicked out of line.
Our care might be excellent but the administrative burden is not.
> Fast access, and low out of pocket costs.
Have you ever had to challenge a bill? or find out that the provider you used sent your labs to another provider that was out of your network and now you owe the other provider full price?
> I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
And you don't need to mimic their process. You can have single payer and privatized medicine. If you're wealthy or a company wants to offer a premium insurance then so be it. There will be a market for those "speed lanes" if you want.
Even the low out of pocket costs are vanishing with the introduction of the newer high deductible healthcare plans.
I think something a lot of people don't realize is that their care plan is often dictated by the insurer and employer, not their doctor. Your employer and insurer negotiate annually on your coverage with little input from employees. What medicines and treatments are covered is dictated not by the doctor.
If you want to know what truly excellent health care is like, visit Mayo Clinic. Because of the concentration of doctors in one location, I saw around 12 doctors in a week. That would have taken a year or more through the regular medical system.
Where "excellent" includes shorter length of life, and over-testing, over-diagnosis, and over-treatment (each of which causes harm) because you've got to have something to show for all that insurance spending.
The cost have gone up a lot.
Currently, the industry is also facing a labor shortage, so this is making the scheduling even harder. A family member in high school was diagnosed with obstructive sleep apnea (affecting school performance! You only get 8 semesters to mess up!), and it has been (so far) 8 weeks and we still don't have a formal intake for medical equipment. We have a prescription. We just can't get the equipment supplier to process the prescription and send it to us. I ended up paying out of pocket (and doing some crazy shit) to get a machine and supplies. Note: this is with doing what is basically a part-time job squeaky-wheeling everyone I can to try to get things happening. It is the worst.
Blue collar medical workers are quitting in droves because the work sucks and it has garbage pay, and you see the executives making huge salaries. And you get yelled at by people like me trying to make the system move faster. I try to stay friendly, but... I have lost it a few times. Of the seven people in my family, five of us have chronic medical issues.
I was just talking the other day with a friend wishing there was a medical consultancy I could hire. I give them my health insurance info and family demographics and all of the healthcare shit we need done, and then they find the providers, make appointments, file reimbursements with insurance/hsa/fsa tell me how much to put in fsa/hsa each year, deal with the full time job of having a family that needs to deal with the totally bonkers american medical system. They get some commission of whatever comes back to me, and also just some baseline monthly payment for service. PLEASE GOD LET THIS BECOME A THING. Or, you know, a not insane medical system.
The idea of a same-week appointment, especially as a new patient, seems like fantasy to me.
https://www.bbc.com/news/uk-42950587
Hopefully you don’t end up with a medical condition that exhausts your PTO and you get kicked off insurance. My neighbor’s go fund me staved off foreclosure for 6 months when his wife had cancer.
Where I live, 95% of medical practices belong to 2 networks. Step two after consolidation is reduce costs. Long story short, if you don’t have cancer, you’re looking at 90+ days for an appointment.
Dermatologists are a little different in that they can make money selling bullshit spa services. So you may see more variance by region as being cut out of hospital networks isn’t as big of a deal.
My experience with a dermatologist (in the US) ended up being the same as you anticipated it being. Trying to book a new patient appointment myself I was getting quoted availability 2-3 months out.
I was able to get that sped up a bit by having my primary doctor refer me (which my insurance didn't require) and set up the appointment on my behalf. But even then, it ended up being almost 6 weeks out.
I've also had to book GI appointments in a few different locations, and have had some get me in within a week and others that had a multi-month wait.
And some insurance plans in the use are HMO plans[1], which generally have the requirement of going through your primary care doctor for everything and requiring a referral from them to see other physicians.
The biggest gripe I have about the US healthcare system is how impacted it is by employer decisions. Having decent coverage today doesn't mean the coverage will stay decent, even if you stay with the same employer. I've had awesome insurance unexpected swapped out for crap insurance due to an acquisition, had good plans that I took into account when determining whether to take a job disappear the year after during open enrollment season, had the "same" plan change year to year in subtle but impactful ways (like keeping per-person deductibles the same, but adding a condition to meet a minimum family-level deductible in addition to any individual before you actually hit the threshold).
[1] https://www.investopedia.com/terms/h/hmo.asp
And an industry - not a service - aiming to find and charge the highest prices in a market where the buyer cannot refuse the service.
We have the worst of both worlds.
1) The conservatives (political right) have eroded public health care any chance they can, such as through cutting budgets to any health-related service over the course of at least the last 20 years. They do this so that they can stand up in front of people and argue that “Wait times are long! If you let us implement private health care you could simply pay for better service!”
2) Even with the reduced budgets and constant attacks by conservatives, if I limp in to emerg with severe pains I’m getting looked at immediately and might be successfully out of surgery by the end of the hour. On a smaller note, I just had this convo this morning: “Can I book an appt to get my prescription refilled? I know the Dr has to talk to me before writing it” “For sure. I can get you in Nov 28th. Are you completely out?” “Yes I am, I miscalculated and I’m concerned.” “Ok, I’m putting you in for tomorrow afternoon. Does that work for you?”
Is it propoganda or lived experience? Everytime someone has come around saying they're going to fix my health insurance for me, it's ended up costing me more for the same service as before.
Come to think of it, I've yet to have an increase in positive experiences concerning my health insurance. Every doctor's visit feels like a new surprise lurking in the dark.
I have heard that European Healthcare, especially in places like Denmark, is top notch and somehow free of this evil: I would love to know how they achieved this.
If so, the cost of medicine is just borne elsewhere: the average tax wedge is 38% in France vs 18% in the USA for a married couple with 2 children:
https://www.oecd.org/tax/tax-policy/taxing-wages-france.pdf
Sales tax is also 20% vs less than 10% in all US states.
But even taking that into account, the US still pays more:
https://www.rand.org/news/press/2021/01/28.html
https://www.formulary.health.gov.on.ca/formulary/results.xht...
Indomethacin can be bought from four different companies at $C0.12 per tablet.
https://www.uofmhealth.org/health-library/te7832
The real crime is calling bribes “campaign contributions” and pretending that our politicians (of all parties) aren’t selling their votes to the highest bidder.
Both sides were really shady, with lots of evidence just disappearing. My opinion, as someone from a Soviet country with actual widespread voting fraud, is that the way your election went was a bit suspicious. It was weird in the same way we see when the side that's supposed to win stuffs ballots from dead people, people who didn't turn up, etc. The large sudden bump in votes for Biden also seems suspicious. The fact that Trump got a record number of votes during a pandemic in which his voters almost all voted in person and still lost, is a bit suspicious. The fact that you need to only rig a few counties with a few votes to secure the thin margin by which Biden won, is suspicious. Many things are weird and suspicious. It is possible actual well intentioned people rigged the election to "save America". Whether they did and if it was right, I cannot say, I am not an American, I cannot judge your country.
All that said, based on actual available evidence, I cannot conclude that the election was rigged. It was probably the most scrutinized election in recent memory, leading to us seeing a bunch of suspicious events that probably happen pretty often. Similar to how the 2000 election, Bush vs Gore, was a bit suspicious.
"suspicious" is used here for cognitive priming.
The government or a charity should fund another line, and should in general provide incentives to companies to not shut down existing approved lines if it would leave only one company standing.
If I was uninsured in the US for whatever reason and needed elective surgery for something with a short enough recovery period, I'd look up UK hospitals.
They're often similarly cheap enough to justify a flight and a hotel stay. Especially as many of them leverage excess capacity at NHS Trusts (some are even operated by NHS Trusts, as the trusts are allowed to offer private services within certain constraints)
I believe that this may be what pushes the American system to change.
I know of several not-rich people, sometimes who have decent or good insurance, who have chosen to go abroad for medical care. The care they get abroad is typically cheaper as well as better.
Given the amount of money the US spends on healthcare, this should rarely be true.
The insurance companies have set up a good gig for themselves, but I think that they may be feeding at the trough a bit too aggressively. When the economy has a big downturn, I think some hard questions will be asked.
[1] https://www.fahorro.com/indometacina-100-mg-15-supsension.ht...
> Indocin's list price (what uninsured patients would pay) was $198 for 30 suppositories in 2008.
I would not be surprised if they've hiked the list price a ton to game the insurance "what we'll pay" formulas and get more money from insurance companies. As trimbo notes [0], if everyone is paying list price then only 225 people are using this drug consistently. That seems unlikely.
[0]: https://news.ycombinator.com/item?id=28905920
So perhaps the drug companies are just responding to demand from their biggest customers.
Two companies reaching an agreement to supply products at reduced price, but not making the terms of that agreement available to a third entity (uninsured customers)?
As for "should it be illegal", most people seem to agree the healthcare industry should be regulated more tightly than commerce in general, but there's plenty of debate about exactly how far we should go.
Seems to be standard business. ONE of my prescriptions for rheumatoid arthritis costs roughly $5000/month without insurance. My insurance, plus additional assistance from the drug maker makes the medication "free" for me. It's clearly a giant, legal insurance scam.
This appears to suggest that there are people who take enormously expensive theraputic drugs who don't need them, and that Martin Shkreli gave away those enormously expensive therapeutic drugs away to those who actually did.
Whether propoganda, misinformation, or a bald-faced lie, that's not what happened. That never happens, and never will. Shame on you for implying that was the case.
He meant "needs it for free" not "needs the drug".
"‘My other piece of advice, Copperfield,’ said Mr. Micawber, ‘you know. Annual income twenty pounds, annual expenditure nineteen nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds nought and six, result misery."[0]
[0] David Copperfield, Charles Dickens
Even if a highlighted instance of predatory behaviour was papered over due to said highlight, and even if that papering-over resulted in greater drug availability at lower cost, I think that might have been a result of the spotlight, rather than proof positive that the behaviour isn't awful and doesn't hurt those unlucky enough to fall ill.
30 50mg capsules of Indomethacin (generic indocin) is $8.87 at Giant Eagle.
60 75mg capsules of Indomethacin ER (generic indocin sr) is $29.08 at Giant Eagle.
Who is paying that much for this drug?
I would say this system needs to change but considering the democrats can't even escape from a wet paper bag, i don't see that happening.
https://www.medpagetoday.com/rheumatology/generalrheumatolog...
Colchicine, the old gout drug often cited as a cheap anti-inflammatory, hasn't been such a good deal since FDA approval, a study showed.
The inflation- and rebate-adjusted Medicaid price per pill jumped from $0.24 in 2008 to $4.20 after the FDA officially approved a branded form, Colcrys, through the agency's Unapproved Drug Initiative pathway in 2009.
and
Accordingly, Medicaid spending on single-ingredient colchicine rose 2833%," they wrote, and "58% of this increase was attributable to price increases alone."
and
"Only a fraction of an investment was required for Colcrys, a product that has provided no increased value and an unnecessary, long-term cost burden to the health care system," argued B. Joseph Guglielmo, PharmD, of the University of California San Francisco, in an accompanying editorial. "The current study findings illustrate that we can never allow such an egregious case to take place again."
say what you will but this is just stupid american bullshit.
As a part of that process, they offered market exclusivity as an incentive for a company to spend the time and money to do so. As I said in another response, the filing fee alone is $1.6M. It's not as expensive as a full NDA approval, but it's not free.
And your article lays it all out.
"Their study used Medicaid and Medicare data files through 2017, when combined Medicaid and Medicare claims exceeded $340 million for colchicine.
"Colcrys's manufacturer, which conducted a 1-week trial (n=185), received 3 years' market exclusivity for treatment of acute gout, and the unapproved formulations were soon ordered off the market, resulting in a virtual monopoly," McCormick's group noted."
So the price goes up for 3 years and as a result you get a fully FDA approved drug? Not worth that trade off?
https://www.the-rheumatologist.org/article/the-unapproved-dr...
On Friday, Nov. 20, 2020, the U.S. Department of Health and Human Services (HHS) published a Notice through the Federal Register announcing the withdrawal of guidance documents that established the Unapproved Drugs Initiative. This Notice brings to an end a 14-year-old program that has been blamed for significantly contributing to the rising cost.
So... again, yes... greed.
In total, 34 previously unapproved drugs were addressed through the Unapproved Drugs Initiative. In a 2017 analysis, researchers found that 90% of those drugs were approved through the new drug application 505(b)(2) pathway.2 The 505(b)(2) pathway does not require new clinical trial evidence and can be based on literature reviews or bioequivalence studies alone. New market exclusivity for these drugs led to a median price increase of 37% (interquartile range [IQR] = 23–204%) within two years of approval. It also resulted in more supply shortages of these drugs after approval, and these shortages also lasted longer likely because of the exclusivity.
it's greed my friend.
You realize the application fee alone for 505(b)(2) is $1.6M?[1] It's not like someone just emails a few papers with an application form to the FDA and gets FDA approval.
[1]https://www.fda.gov/industry/fda-user-fee-programs/prescript...
https://www.goodrx.com/indocin?dosage=50mg&form=capsule&labe...
https://www.goodrx.com/indocin?dosage=50mg&form=suppository&...
Maybe the generic can't be sold as a suppository, and the suppository version works better?
https://www.buzzrx.com/indocin-coupon
For those comparing vs the us health system, include (a) working f/t with good employer benefits, (b) f/t with less benefits and (c) working part time. And remember to include cobra. And include the state/province/country where the comparison is being done. No absolutes here, either.
Active ingredients Indometacin 25 mg
Drug tariff price £1.36
Active ingredients Indometacin 50 mg
Drug tariff price £1.64
Annual sales for oral and suppository are around 2 mil/year. Barely worth the liability and ongoing regulatory cost.
Here's the tale: If you have obstruction of your bile ducts below the liver or gallbladder, usually gallstones or sometimes neoplasm, you need an endoscopic retrograde cholangiopancreatography (ERCP) for extraction or sampling.
ERCP is sticking a tube down the throat, stomach, small intestines into a tiny opening at the ampulla of Vater to access the bile ducts. Sometimes this process causes inflammation of the ampulla and associated ducts leading to blockage, and can lead to pancreatitis due to back flow and pressure, because the pancreas also excretes its digestive enzymes via the ampulla).
A few trials circa 2015 showed rectal indomethacin reduced the risk of post-ERCP pancreatitis, and eventually it made its way into the guidelines. It is the only proven preventative treatment, so they have a natural monopoly.
Hope that helps.
The drug was approved in 1965 and the company selling it holds no patents on indomethacin.
If I had to hazard a guess, it may be the market isn't attractive enough for competitors to establish a national supply chain. Or there's some sort of collusion at play.
To me this represents further evidence why public goods should be left out of the hands of private for profit organizations for whom disease is simply an externality to capitalize on.