Author Topic: What comes after the ACA?  (Read 382476 times)

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2650 on: June 12, 2017, 08:56:32 PM »
You have a captive set of consumers who will die without what you're peddling. Add in an extra layer of profit (insurers) and it becomes even more exploitive.

So people and businesses in the medical field should not be allowed to make a profit?

What about manufacturers of medical equipment, like MRI machines?   People will die without those.

Ambulance manufacturers?

Airlines and helicopters which do life flights or carry donor organs?

What about the company who provides the basic or prepared food to the hospitals?  Should they also be non profit?

Actually what about farmers in general?  People will die without what they are peddling.   Evil for them to make a profit (not many probably do anyway).

TrudgingAlong

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Re: What comes after the ACA?
« Reply #2651 on: June 12, 2017, 11:04:52 PM »
Not saying no profit, but there should be limits on how much someone can be fleeced. Epi-pens being a great example. Just because you can charge something doesn't mean you should. I really have no good solutions as I will freely admit I don't understand all of it, but if love to see some of the fat removed. Insurers feel like fat to me, at least on a non-catastrophic level. I'd much rather know the costs going in and paying my doctor directly instead of forty middle men. That feels like a pipe dream here, through.

So, yes, I admit I feel no sadness for insurers who are not getting amazing profits. I don't think this should be an industry where people go to get rich. But they can, because someone will always pay when life is on the line.

chasesfish

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Re: What comes after the ACA?
« Reply #2652 on: June 13, 2017, 05:39:57 AM »
Not saying no profit, but there should be limits on how much someone can be fleeced. Epi-pens being a great example. Just because you can charge something doesn't mean you should. I really have no good solutions as I will freely admit I don't understand all of it, but if love to see some of the fat removed. Insurers feel like fat to me, at least on a non-catastrophic level. I'd much rather know the costs going in and paying my doctor directly instead of forty middle men. That feels like a pipe dream here, through.

So, yes, I admit I feel no sadness for insurers who are not getting amazing profits. I don't think this should be an industry where people go to get rich. But they can, because someone will always pay when life is on the line.

Just require that the private pay patients can't be billed any higher than 5% above the lowest contracted insurance rate.  That would solve a lot of the catastrophes of the uninsured.   We get a bill for 3x the actual cost of service and then need a Big 4 insurer or medicare/medicaid to get the real price.
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BookValue

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Re: What comes after the ACA?
« Reply #2653 on: June 13, 2017, 05:58:13 AM »
What about manufacturers of medical equipment, like MRI machines?   People will die without those.

MRI is an interesting example, because as a country we are paying far more for the machines than somewhere like Japan, where the cost for an MRI is 1/10 what it is here. Yet the manufacturers are still willing and able to sell machines for such a low cost, somehow....
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Gin1984

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Re: What comes after the ACA?
« Reply #2654 on: June 13, 2017, 06:52:06 AM »
Not saying no profit, but there should be limits on how much someone can be fleeced. Epi-pens being a great example. Just because you can charge something doesn't mean you should. I really have no good solutions as I will freely admit I don't understand all of it, but if love to see some of the fat removed. Insurers feel like fat to me, at least on a non-catastrophic level. I'd much rather know the costs going in and paying my doctor directly instead of forty middle men. That feels like a pipe dream here, through.

So, yes, I admit I feel no sadness for insurers who are not getting amazing profits. I don't think this should be an industry where people go to get rich. But they can, because someone will always pay when life is on the line.
Here is an example.  I just had to get an insulin pen.  Now, I am ok with the companies getting a profit, however, the pen without insurance costs a little over $100 and can only be used for two weeks even though there is still meds in them (so planned to cause people to need more than the medication they actually use and I know this because another brand does set it up so you can use it for longer).  However, when I look at the same medication but on direct vet med sites, it is only $50.  My insurance negotiated it down to $60/pen, but still $10 more than what they sell on vet sites.  Why is that?  Because people need it to live and therefore they can charge anything they want.  And that, I have a problem with.  And consequences, if you can be a reasonable human being, then your choices get curtailed.  Aka, I am fine with the government determining the profit for you, if you are an asshole.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2655 on: June 13, 2017, 07:29:00 AM »
Here is an example.  I just had to get an insulin pen.  Now, I am ok with the companies getting a profit, however, the pen without insurance costs a little over $100 and can only be used for two weeks even though there is still meds in them (so planned to cause people to need more than the medication they actually use and I know this because another brand does set it up so you can use it for longer).  However, when I look at the same medication but on direct vet med sites, it is only $50.  My insurance negotiated it down to $60/pen, but still $10 more than what they sell on vet sites.  Why is that?  Because people need it to live and therefore they can charge anything they want.  And that, I have a problem with.  And consequences, if you can be a reasonable human being, then your choices get curtailed.  Aka, I am fine with the government determining the profit for you, if you are an asshole.

Comparing vet drugs to human drugs is silly.   It is like saying "See, Apple provides schools with computers for free so why does my Macbook Air cost $2000?"

The government could control things more I guess.  Housing is sort of needed for people to live.  Housing in parts of California is very expensive.  Perhaps the government should step in and regulate the price homes can be sold?   I see a lot of greedy people selling their homes for millions of dollars making gross profit.

Gin1984

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Re: What comes after the ACA?
« Reply #2656 on: June 13, 2017, 07:36:35 AM »
Here is an example.  I just had to get an insulin pen.  Now, I am ok with the companies getting a profit, however, the pen without insurance costs a little over $100 and can only be used for two weeks even though there is still meds in them (so planned to cause people to need more than the medication they actually use and I know this because another brand does set it up so you can use it for longer).  However, when I look at the same medication but on direct vet med sites, it is only $50.  My insurance negotiated it down to $60/pen, but still $10 more than what they sell on vet sites.  Why is that?  Because people need it to live and therefore they can charge anything they want.  And that, I have a problem with.  And consequences, if you can be a reasonable human being, then your choices get curtailed.  Aka, I am fine with the government determining the profit for you, if you are an asshole.

Comparing vet drugs to human drugs is silly.   It is like saying "See, Apple provides schools with computers for free so why does my Macbook Air cost $2000?"

The government could control things more I guess.  Housing is sort of needed for people to live.  Housing in parts of California is very expensive.  Perhaps the government should step in and regulate the price homes can be sold?   I see a lot of greedy people selling their homes for millions of dollars making gross profit.
Actually it is not silly.  They are the same medication, made with the same restrictions and oversite, on the same equipment, by the same people.  And both are sold for profit.
Your example was of a company doing a donation.  Mine is of selling it to two different companies.  To actually be equivalent to my example it would have to be apple sold some Macs at one store for $2000 and the identical Macs for $1000 at a different store and only certain people could use either store.

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boarder42

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Re: What comes after the ACA?
« Reply #2657 on: June 13, 2017, 08:01:32 AM »
Here is an example.  I just had to get an insulin pen.  Now, I am ok with the companies getting a profit, however, the pen without insurance costs a little over $100 and can only be used for two weeks even though there is still meds in them (so planned to cause people to need more than the medication they actually use and I know this because another brand does set it up so you can use it for longer).  However, when I look at the same medication but on direct vet med sites, it is only $50.  My insurance negotiated it down to $60/pen, but still $10 more than what they sell on vet sites.  Why is that?  Because people need it to live and therefore they can charge anything they want.  And that, I have a problem with.  And consequences, if you can be a reasonable human being, then your choices get curtailed.  Aka, I am fine with the government determining the profit for you, if you are an asshole.

Comparing vet drugs to human drugs is silly.   It is like saying "See, Apple provides schools with computers for free so why does my Macbook Air cost $2000?"

The government could control things more I guess.  Housing is sort of needed for people to live.  Housing in parts of California is very expensive.  Perhaps the government should step in and regulate the price homes can be sold?   I see a lot of greedy people selling their homes for millions of dollars making gross profit.
Actually it is not silly.  They are the same medication, made with the same restrictions and oversite, on the same equipment, by the same people.  And both are sold for profit.
Your example was of a company doing a donation.  Mine is of selling it to two different companies.  To actually be equivalent to my example it would have to be apple sold some Macs at one store for $2000 and the identical Macs for $1000 at a different store and only certain people could use either store.

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agreed same analogy can be applied to the epipens ... have you seen what other countrys pay compared to the US.  either we are subsidising the world Pharma market or we're getting gouged b/c of the ridiculous insurance/payment systems in the US.
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Midwest

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Re: What comes after the ACA?
« Reply #2658 on: June 13, 2017, 08:01:52 AM »
Here is an example.  I just had to get an insulin pen.  Now, I am ok with the companies getting a profit, however, the pen without insurance costs a little over $100 and can only be used for two weeks even though there is still meds in them (so planned to cause people to need more than the medication they actually use and I know this because another brand does set it up so you can use it for longer).  However, when I look at the same medication but on direct vet med sites, it is only $50.  My insurance negotiated it down to $60/pen, but still $10 more than what they sell on vet sites.  Why is that?  Because people need it to live and therefore they can charge anything they want.  And that, I have a problem with.  And consequences, if you can be a reasonable human being, then your choices get curtailed.  Aka, I am fine with the government determining the profit for you, if you are an asshole.

Comparing vet drugs to human drugs is silly.   It is like saying "See, Apple provides schools with computers for free so why does my Macbook Air cost $2000?"

The government could control things more I guess.  Housing is sort of needed for people to live.  Housing in parts of California is very expensive.  Perhaps the government should step in and regulate the price homes can be sold?   I see a lot of greedy people selling their homes for millions of dollars making gross profit.

What about generic drug prices - http://www.health.harvard.edu/blog/why-many-generic-drugs-are-becoming-so-expensive-201510228480 or the epi-pen issue?

I understand high drug prices on new drugs, but older generics?

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2659 on: June 13, 2017, 08:13:50 AM »
agreed same analogy can be applied to the epipens ... have you seen what other countrys pay compared to the US.  either we are subsidising the world Pharma market or we're getting gouged b/c of the ridiculous insurance/payment systems in the US.

We are subsidizing the world Pharma market to some extent, exactly the same as you subsidize the school system who gets free Apple computers when you buy a $2000 Macbook.

A country like India, where the per capita income is around $1600 a year, they cannot afford to pay $50,000 for a life saving drug, or even $5,000.   Thus the drug companies drastically lower the price there, almost like charity.   They make it up in other rich countries, just like Apple makes up for the free computers they give away by selling Macbooks for $2000 to rich people.

It still costs about $2B to as much as $4B to bring a drug to market.   If you subtract the possible initial government grant research on those drugs then it costs $1,990,000,000 to $3,990,000,000 or so to bring a drug to market (this is including the rolled in costs of failed drug trials, which is totally fair from an investment standpoint).

I am not sure, but I feel like the dog and cat market for drugs is a lot like the third world country market.   People are not going to pay $50,000 to treat a dog or cat, so the drugs are provided at a massive charity discount.   It could also be that dogs and cats don't sue the drug companies for multi million dollar lawsuits.

Midwest

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Re: What comes after the ACA?
« Reply #2660 on: June 13, 2017, 08:23:27 AM »
agreed same analogy can be applied to the epipens ... have you seen what other countrys pay compared to the US.  either we are subsidising the world Pharma market or we're getting gouged b/c of the ridiculous insurance/payment systems in the US.

We are subsidizing the world Pharma market to some extent, exactly the same as you subsidize the school system who gets free Apple computers when you buy a $2000 Macbook.

A country like India, where the per capita income is around $1600 a year, they cannot afford to pay $50,000 for a life saving drug, or even $5,000.   Thus the drug companies drastically lower the price there, almost like charity.   They make it up in other rich countries, just like Apple makes up for the free computers they give away by selling Macbooks for $2000 to rich people.

It still costs about $2B to as much as $4B to bring a drug to market.   If you subtract the possible initial government grant research on those drugs then it costs $1,990,000,000 to $3,990,000,000 or so to bring a drug to market (this is including the rolled in costs of failed drug trials, which is totally fair from an investment standpoint).

I am not sure, but I feel like the dog and cat market for drugs is a lot like the third world country market.   People are not going to pay $50,000 to treat a dog or cat, so the drugs are provided at a massive charity discount.   It could also be that dogs and cats don't sue the drug companies for multi million dollar lawsuits.

If the pricing subsidy is only benefiting the 3rd world, why are some drugs in Canada so much cheaper than the US?

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2661 on: June 13, 2017, 08:26:17 AM »

If the pricing subsidy is only benefiting the 3rd world, why are some drugs in Canada so much cheaper than the US?

Why is gasoline so much higher in Canada than in the USA?

Midwest

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Re: What comes after the ACA?
« Reply #2662 on: June 13, 2017, 08:30:54 AM »

If the pricing subsidy is only benefiting the 3rd world, why are some drugs in Canada so much cheaper than the US?

Why is gasoline so much higher in Canada than in the USA?

Taxes?  https://taxfoundation.org/how-high-are-other-nations-gas-taxes/

I don't know if that's all of it, but it seems to account for about $0.75 per gallon.

the_fixer

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Re: What comes after the ACA?
« Reply #2663 on: June 13, 2017, 08:31:55 AM »
For most Americans (literally most, as in more than half) the ACA has either lowered their healthcare costs or given them access to healthcare where they previously had none.

You have mentioned before how great the ACA is where you live, possibly your perception and your opinion of how great the ACA is has been skewed by that fact. Not everyone has the same access, options or has been impacted in the same positive way and their opinion / dislike is based on their experience.

I personally do not know one person that has lower insurance rates or costs due to the ACA.  Their rates have gone up significantly and their deductibles have gone up, they have lost the ability to see the same doctor, they have had to move from insurance company to insurance company as the companies enter and exit the exchanges.

Just because it is utopia for you does not mean it is has been good for everyone.

What is an acceptable % for people that have been positively impacted VS negatively impacted to call it a success?

Dabnasty

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Re: What comes after the ACA?
« Reply #2664 on: June 13, 2017, 08:33:43 AM »

If the pricing subsidy is only benefiting the 3rd world, why are some drugs in Canada so much cheaper than the US?

Why is gasoline so much higher in Canada than in the USA?

Taxes?  https://taxfoundation.org/how-high-are-other-nations-gas-taxes/

I don't know if that's all of it, but it seems to account for about $0.75 per gallon.
And what does the price of gas have to do with this discussion?

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2665 on: June 13, 2017, 08:40:38 AM »

If the pricing subsidy is only benefiting the 3rd world, why are some drugs in Canada so much cheaper than the US?

Why is gasoline so much higher in Canada than in the USA?

Taxes?  https://taxfoundation.org/how-high-are-other-nations-gas-taxes/

I don't know if that's all of it, but it seems to account for about $0.75 per gallon.
And what does the price of gas have to do with this discussion?

We were just trying to figure out why things can cost different amounts in different countries.  Why everything doesn't cost the same amount everywhere in the world.

Dabnasty

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Re: What comes after the ACA?
« Reply #2666 on: June 13, 2017, 08:52:24 AM »

If the pricing subsidy is only benefiting the 3rd world, why are some drugs in Canada so much cheaper than the US?

Why is gasoline so much higher in Canada than in the USA?

Taxes?  https://taxfoundation.org/how-high-are-other-nations-gas-taxes/

I don't know if that's all of it, but it seems to account for about $0.75 per gallon.
And what does the price of gas have to do with this discussion?

We were just trying to figure out why things can cost different amounts in different countries.  Why everything doesn't cost the same amount everywhere in the world.
No we weren't. Midwest was questioning your reasoning that developed countries pay more to subsidize less developed countries because Canada is also a developed country. I think that's an important question. Gasoline is a commodity and they pay more due to taxes.

Now that's not to say that I completely disagree that we subsidize, but my understanding is that drug companies can still be profitable selling at greatly reduced rates whether in developing countries or in Canada because many of the drugs are cheap to produce once they are established. So we aren't paying $19 for a $10 drug so someone else can have it for $1 but rather we pay $19 for a $1 drug and they pay the going rate of $1. The excess goes to research and/or greedy people.

I think the question that needs to be answered is where does the money go and what is the honest price that would cover production, R&D, and a reasonable profit.
« Last Edit: June 13, 2017, 08:53:58 AM by Dabnasty »

EnjoyIt

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Re: What comes after the ACA?
« Reply #2667 on: June 13, 2017, 08:59:49 AM »
For most Americans (literally most, as in more than half) the ACA has either lowered their healthcare costs or given them access to healthcare where they previously had none.

You have mentioned before how great the ACA is where you live, possibly your perception and your opinion of how great the ACA is has been skewed by that fact. Not everyone has the same access, options or has been impacted in the same positive way and their opinion / dislike is based on their experience.

I personally do not know one person that has lower insurance rates or costs due to the ACA.  Their rates have gone up significantly and their deductibles have gone up, they have lost the ability to see the same doctor, they have had to move from insurance company to insurance company as the companies enter and exit the exchanges.

Just because it is utopia for you does not mean it is has been good for everyone.

What is an acceptable % for people that have been positively impacted VS negatively impacted to call it a success?

Sol and others have been so blinded by the positives of the ACA they aren't even willing to acknowledge the negatives. What is worse when you spend years preaching those benefits it becomes very difficult for the psyche to admit that maybe you were not 100% right. These people will go on to ignore facts and make convoluted examples such as thinking every person in the US can become mustachiane overnight and get ACA subsidies. It is a perfect example of cognitive dissonance.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2668 on: June 13, 2017, 09:07:52 AM »
... but if love to see some of the fat removed. Insurers feel like fat to me, at least on a non-catastrophic level. I'd much rather know the costs going in and paying my doctor directly instead of forty middle men. That feels like a pipe dream here, through. . .

I think you have some of the answer. Remove insurance and its bureaucracy from low cost health expenditures is the first start. No reason to have an insurance company (government or private) bump of the cost of simple doctors visits and medication refills. Dealing with government or private insurance is a very costly ordeal. Allow complete price transparency and then have insurance for true catastrophic events.

We need to stop thinking insurance=healthcare. They are not the same thing.

OurTown

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Re: What comes after the ACA?
« Reply #2669 on: June 13, 2017, 09:11:25 AM »
Why don't we just have a universal Medicare? 

Midwest

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Re: What comes after the ACA?
« Reply #2670 on: June 13, 2017, 09:12:28 AM »
... but if love to see some of the fat removed. Insurers feel like fat to me, at least on a non-catastrophic level. I'd much rather know the costs going in and paying my doctor directly instead of forty middle men. That feels like a pipe dream here, through. . .

I think you have some of the answer. Remove insurance and its bureaucracy from low cost health expenditures is the first start. No reason to have an insurance company (government or private) bump of the cost of simple doctors visits and medication refills. Dealing with government or private insurance is a very costly ordeal. Allow complete price transparency and then have insurance for true catastrophic events.

We need to stop thinking insurance=healthcare. They are not the same thing.

Isn't an HSA the beginnings of that concept?  Improve upon that with education and price transparency.

Gin1984

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Re: What comes after the ACA?
« Reply #2671 on: June 13, 2017, 09:18:00 AM »

If the pricing subsidy is only benefiting the 3rd world, why are some drugs in Canada so much cheaper than the US?

Why is gasoline so much higher in Canada than in the USA?

Taxes?  https://taxfoundation.org/how-high-are-other-nations-gas-taxes/

I don't know if that's all of it, but it seems to account for about $0.75 per gallon.
And what does the price of gas have to do with this discussion?

We were just trying to figure out why things can cost different amounts in different countries.  Why everything doesn't cost the same amount everywhere in the world.
No we weren't. Midwest was questioning your reasoning that developed countries pay more to subsidize less developed countries because Canada is also a developed country. I think that's an important question. Gasoline is a commodity and they pay more due to taxes.

Now that's not to say that I completely disagree that we subsidize, but my understanding is that drug companies can still be profitable selling at greatly reduced rates whether in developing countries or in Canada because many of the drugs are cheap to produce once they are established. So we aren't paying $19 for a $10 drug so someone else can have it for $1 but rather we pay $19 for a $1 drug and they pay the going rate of $1. The excess goes to research and/or greedy people.

I think the question that needs to be answered is where does the money go and what is the honest price that would cover production, R&D, and a reasonable profit.
Which is why I compared the cost of the drug when given to humans vs animals.  The most expensive part of a drug trial (and most likely to fail) is mouse studies and that is the same for both animal and human.  Then they move up.  The cost is not much different between the two, the only real difference is that people WILL die without some of these medications so the drug companies know they can price it whatever they want.  The vet price is a profitable price that includes R&D.  This is my field, I've worked on the mouse portion of a drug trial.  That is why I brought it up.

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Gin1984

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Re: What comes after the ACA?
« Reply #2672 on: June 13, 2017, 09:19:00 AM »
For most Americans (literally most, as in more than half) the ACA has either lowered their healthcare costs or given them access to healthcare where they previously had none.

You have mentioned before how great the ACA is where you live, possibly your perception and your opinion of how great the ACA is has been skewed by that fact. Not everyone has the same access, options or has been impacted in the same positive way and their opinion / dislike is based on their experience.

I personally do not know one person that has lower insurance rates or costs due to the ACA.  Their rates have gone up significantly and their deductibles have gone up, they have lost the ability to see the same doctor, they have had to move from insurance company to insurance company as the companies enter and exit the exchanges.

Just because it is utopia for you does not mean it is has been good for everyone.

What is an acceptable % for people that have been positively impacted VS negatively impacted to call it a success?
How many people will die without ACA?  How many will die if we keep it? 

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sol

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Re: What comes after the ACA?
« Reply #2673 on: June 13, 2017, 09:19:32 AM »
Sol and others have been so blinded by the positives of the ACA they aren't even willing to acknowledge the negatives. What is worse when you spend years preaching those benefits it becomes very difficult for the psyche to admit that maybe you were not 100% right. These people will go on to ignore facts and make convoluted examples such as thinking every person in the US can become mustachiane overnight and get ACA subsidies. It is a perfect example of cognitive dissonance.

That was both personally insulting and demonstrably untrue.  Want to try again?

Hopefully, you're just having a rough day and got a little out of hand.  I've come to expect better from you.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2674 on: June 13, 2017, 09:54:39 AM »

Which is why I compared the cost of the drug when given to humans vs animals.  The most expensive part of a drug trial (and most likely to fail) is mouse studies and that is the same for both animal and human.  Then they move up.  The cost is not much different between the two, the only real difference is that people WILL die without some of these medications so the drug companies know they can price it whatever they want.  The vet price is a profitable price that includes R&D.  This is my field, I've worked on the mouse portion of a drug trial.  That is why I brought it up.

I really do not believe that mouse studies are the most expensive part of a drug trial.  Can you back that up with any proof?


Gin1984

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Re: What comes after the ACA?
« Reply #2675 on: June 13, 2017, 09:56:29 AM »

Which is why I compared the cost of the drug when given to humans vs animals.  The most expensive part of a drug trial (and most likely to fail) is mouse studies and that is the same for both animal and human.  Then they move up.  The cost is not much different between the two, the only real difference is that people WILL die without some of these medications so the drug companies know they can price it whatever they want.  The vet price is a profitable price that includes R&D.  This is my field, I've worked on the mouse portion of a drug trial.  That is why I brought it up.

I really do not believe that mouse studies are the most expensive part of a drug trial.  Can you back that up with any proof?
That is the part that fails the most, so if you look at overall research costs, not the one drug that did make it to market but the 9 that failed and get wrapped in the total cost of the profitable drug, it is considered the most expensive. 
What kind of proof would you like for this?

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2676 on: June 13, 2017, 10:11:03 AM »
That is the part that fails the most, so if you look at overall research costs, not the one drug that did make it to market but the 9 that failed and get wrapped in the total cost of the profitable drug, it is considered the most expensive. 
What kind of proof would you like for this?

I did a little search and came up with this study:  http://csdd.tufts.edu/files/uploads/Tufts_CSDD_briefing_on_RD_cost_study_-_Nov_18,_2014..pdf

It has the claim that the average cost to bring a drug to market (2014) is about $2.6B including the costs of failed pre-human (animal or mouse) and clinical (phase I to III) trials.

On page 21 they break down the out of pocket and capitalized costs to this:

$430m, $1098m for mouse studies

$965m, $1460m for human studies

It would seem to indicate the animal testing is quite a bit less than the human testing, even accounting for failures that don't make it to human trials.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2677 on: June 13, 2017, 11:02:29 AM »
Sol and others have been so blinded by the positives of the ACA they aren't even willing to acknowledge the negatives. What is worse when you spend years preaching those benefits it becomes very difficult for the psyche to admit that maybe you were not 100% right. These people will go on to ignore facts and make convoluted examples such as thinking every person in the US can become mustachiane overnight and get ACA subsidies. It is a perfect example of cognitive dissonance.

That was both personally insulting and demonstrably untrue.  Want to try again?

Hopefully, you're just having a rough day and got a little out of hand.  I've come to expect better from you.

Sol,
I will admit that of recent I have picked on your comments. I do so because I interpret you to be intelligent with honorable and moral intentions. My hope is to show that not everything is as black and white as you present.  This fluidness allows for better negotiation with those who may disagree with you. By understanding what principles your opponent is being driven by, you can make adjustments in your own argument and potentially allow them to see more broadly and make concessions with their hard stances.

You state "demonstrably not true"  A few posts above I demonstrate that it is true. I explain how many middle class Americans have been harmed by the ACA making healthcare much more unaffordable to them.  You completely ignore that statement telling me they should just be more mustachian to qualify for subsidies when we both know that such a transition is unfathomable to most Americans. Another example is telling me that Republicans take money from rich corporations completely ignoring the fact that democrats do the exact same thing.  You also said
Quote
[regarding poor republican voters] They're like 1850s plantation slaves pressed into service to hunt down runaway slaves with the argument that runaways make it harder for the slaves left behind.
You are comparing poor republican voters to slaves which is an insult to slavery.

I understand why you do this.  It is your moral compass that makes you want the best for the most amount of people.  It is very honorable, but it also blinds you from seeing all sides of the equation.

The reality is:
1) Despite the massive benefits of the ACA, the law has harmed a large percentage of middle class tax payers.  The law has not only made healthcare more unaffordable to those people, it also made it very cumbersome being forced to change health plans and doctors on a yearly basis. Also just because a group of people has health insurance does not mean they can still afford the deductibles and a significant portion of the newly insured find their subsidized insurance not that helpful. These people want the ACA amended or dismantled.
2) Politics is dirty and corrupt. Both democrat and republican politicians are mostly scum who care more about being reelected and satisfying their lobbyists as opposed to doing what is right for the American people. Republicans do it in the guise of cutting taxes, cutting the deficit, and improving the American way of life. Democrats do it in the guise of social justice, environmental benefits, and improving the lives of those less fortunate.
3) Not everyone who votes republican is a racist idiot redneck. There are many intelligent hard working middle class Americans who pay taxes and are constantly squeezed by the government. They find their cost of living going up, their taxes going up, and their disposable income dwindling. They chose to vote republican last year.  It doesn't mean they are stupid or racist.  It just means they became fed up with our political system that the last 8 years has given and want change.  Maybe in 3-7 years those same people will vote democrat after seeing no benefit from the current regime.  But the reality is that they are not racist morons.

Sol, Cognitive dissonance is a normal part of human thinking.  Everyone gets this when their strong beliefs are questioned. Who knows, maybe I am the one with cognitive dissonance discussing this subject with you. Although difficult to accept, maybe with the right arguments I can see that in myself. I will try and be open to that thought.

TrudgingAlong

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Re: What comes after the ACA?
« Reply #2678 on: June 13, 2017, 11:17:32 AM »

We are subsidizing the world Pharma market to some extent, exactly the same as you subsidize the school system who gets free Apple computers when you buy a $2000 Macbook.

A country like India, where the per capita income is around $1600 a year, they cannot afford to pay $50,000 for a life saving drug, or even $5,000.   Thus the drug companies drastically lower the price there, almost like charity.   They make it up in other rich countries, just like Apple makes up for the free computers they give away by selling Macbooks for $2000 to rich people.


The US is rich, yes, but let's be honest here: how many Americans can actually afford to drop 50k yearly on a lifesaving drug? I sure as hell can't, and our family's income is not particularly low. That would also be on top of any other healthcare we'd receive. So, this means you are arguing for the top 1% to subsidize the entire third world, plus everyone else in developed countries that can't afford this? What sense is there in this? I'm going to take a Republican stance on this and say this isn't fair or how it should work at all.

Also, government grants and charities that fund research are not being accounted for in this argument. If we all help crowdsource a needed drug, why must also pay a company massive profit for it? The main thing a company gets from a drug they develop is people need it and will for a long time. They get exclusive rights for a time, then generics should be a free for all. I don't know how to level the playing field, but it should be much more level than it is.

Gin1984

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Re: What comes after the ACA?
« Reply #2679 on: June 13, 2017, 11:20:12 AM »
That is the part that fails the most, so if you look at overall research costs, not the one drug that did make it to market but the 9 that failed and get wrapped in the total cost of the profitable drug, it is considered the most expensive. 
What kind of proof would you like for this?

I did a little search and came up with this study:  http://csdd.tufts.edu/files/uploads/Tufts_CSDD_briefing_on_RD_cost_study_-_Nov_18,_2014..pdf

It has the claim that the average cost to bring a drug to market (2014) is about $2.6B including the costs of failed pre-human (animal or mouse) and clinical (phase I to III) trials.

On page 21 they break down the out of pocket and capitalized costs to this:

$430m, $1098m for mouse studies

$965m, $1460m for human studies

It would seem to indicate the animal testing is quite a bit less than the human testing, even accounting for failures that don't make it to human trials.
Human testing has four phases, pre-clinical has one.  Pre-clinical work costs more than the individual phases, I'm sorry I was not more clear.  But vet research would have the same additional phase but for more animals.  Individually each animal type would be less, but overall, I believe they are comparable.
If you take yourself to slide, not pg, 19, it says 30% of costs are pre-human which means the numbers on slide 21 may need some elaboration (likely the rest of the presentation we don't have access to.

Gin1984

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Re: What comes after the ACA?
« Reply #2680 on: June 13, 2017, 11:21:30 AM »

We are subsidizing the world Pharma market to some extent, exactly the same as you subsidize the school system who gets free Apple computers when you buy a $2000 Macbook.

A country like India, where the per capita income is around $1600 a year, they cannot afford to pay $50,000 for a life saving drug, or even $5,000.   Thus the drug companies drastically lower the price there, almost like charity.   They make it up in other rich countries, just like Apple makes up for the free computers they give away by selling Macbooks for $2000 to rich people.


The US is rich, yes, but let's be honest here: how many Americans can actually afford to drop 50k yearly on a lifesaving drug? I sure as hell can't, and our family's income is not particularly low. That would also be on top of any other healthcare we'd receive. So, this means you are arguing for the top 1% to subsidize the entire third world, plus everyone else in developed countries that can't afford this? What sense is there in this? I'm going to take a Republican stance on this and say this isn't fair or how it should work at all.

Also, government grants and charities that fund research are not being accounted for in this argument. If we all help crowdsource a needed drug, why must also pay a company massive profit for it? The main thing a company gets from a drug they develop is people need it and will for a long time. They get exclusive rights for a time, then generics should be a free for all. I don't know how to level the playing field, but it should be much more level than it is.
We do already do this.  Many researchers do work using NIH funding and then if the drug could be sold then the drug companies come in. 

gaja

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Re: What comes after the ACA?
« Reply #2681 on: June 13, 2017, 11:44:23 AM »

We are subsidizing the world Pharma market to some extent, exactly the same as you subsidize the school system who gets free Apple computers when you buy a $2000 Macbook.

A country like India, where the per capita income is around $1600 a year, they cannot afford to pay $50,000 for a life saving drug, or even $5,000.   Thus the drug companies drastically lower the price there, almost like charity.   They make it up in other rich countries, just like Apple makes up for the free computers they give away by selling Macbooks for $2000 to rich people.


The US is rich, yes, but let's be honest here: how many Americans can actually afford to drop 50k yearly on a lifesaving drug? I sure as hell can't, and our family's income is not particularly low. That would also be on top of any other healthcare we'd receive. So, this means you are arguing for the top 1% to subsidize the entire third world, plus everyone else in developed countries that can't afford this? What sense is there in this? I'm going to take a Republican stance on this and say this isn't fair or how it should work at all.

Also, government grants and charities that fund research are not being accounted for in this argument. If we all help crowdsource a needed drug, why must also pay a company massive profit for it? The main thing a company gets from a drug they develop is people need it and will for a long time. They get exclusive rights for a time, then generics should be a free for all. I don't know how to level the playing field, but it should be much more level than it is.

It looks like you can get epipens for around $200 in the US: https://www.goodrx.com/epipen. In Norway, the price before government subsidies is $118. Most of your companies should cover more people than the 5 million who live in Norway, so it can't be about buying in bulk. If this is your way of helping us out; the per capita GDP of the US is 57436, while Norway's is 69231. So... I guess it is working? Thank you?
Travelling southern Norway, Iceland and the Faroes in an electric car: http://travelelectric.blogspot.no/

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2682 on: June 13, 2017, 11:55:23 AM »
Also, government grants and charities that fund research are not being accounted for in this argument. If we all help crowdsource a needed drug, why must also pay a company massive profit for it? The main thing a company gets from a drug they develop is people need it and will for a long time. They get exclusive rights for a time, then generics should be a free for all. I don't know how to level the playing field, but it should be much more level than it is.
We do already do this.  Many researchers do work using NIH funding and then if the drug could be sold then the drug companies come in.
[/quote]

As Gin1984 pointed out above, and I can agree with, human clinical trials (all combined) are as much as 70% of the cost of bringing a drug to market.   Almost or absolutely zero of the NIH funding goes toward paying for these human clinical trials.  That money goes to grants and universities which sometimes come up with the initial molecules (they come up with a lot of molecules and most are useless).

If we ignore the cost of pre-clinical animal trials, a lot of which are undertaken AFTER the drug has been "stolen" from the University where it was paid for by government or charity, then there is still 70% of the cost of a drug born by the company bringing it to market (it is a lot higher than that in reality but we can use 70%).

70% of 2B to 4B is still a lot of money.   And this is a limited market, because when the drug goes generic, it is not always the company who originally invested in the drug who gets to make the profits from the generic version.   Also, did you know that the original company can still be sued if someone takes the generic version and has a side effect?  Isn't that fun?

None of this is touching the subject of investors paying for that 70% of a drug cost.  They don't want to be paid back just at face value.   This is a high risk business where companies lose billions of investor dollars all the time.   A company needs to make a lot more than $2B on a $2B drug to keep investors interested in investing in new drug pipelines.

How would you like it if you were not allowed to make money on your rental property?   If someone pointed out that the mortgage + insurance is $X and so you should not be charging $X + $Y even though the market would bear that?   And yes I do realize there are rent controlled areas of the country but I bet the landlords don't really enjoy that.

Gin1984

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Re: What comes after the ACA?
« Reply #2683 on: June 13, 2017, 12:01:12 PM »
Also, government grants and charities that fund research are not being accounted for in this argument. If we all help crowdsource a needed drug, why must also pay a company massive profit for it? The main thing a company gets from a drug they develop is people need it and will for a long time. They get exclusive rights for a time, then generics should be a free for all. I don't know how to level the playing field, but it should be much more level than it is.
We do already do this.  Many researchers do work using NIH funding and then if the drug could be sold then the drug companies come in.

As Gin1984 pointed out above, and I can agree with, human clinical trials (all combined) are as much as 70% of the cost of bringing a drug to market.   Almost or absolutely zero of the NIH funding goes toward paying for these human clinical trials.  That money goes to grants and universities which sometimes come up with the initial molecules (they come up with a lot of molecules and most are useless).

If we ignore the cost of pre-clinical animal trials, a lot of which are undertaken AFTER the drug has been "stolen" from the University where it was paid for by government or charity, then there is still 70% of the cost of a drug born by the company bringing it to market (it is a lot higher than that in reality but we can use 70%).

70% of 2B to 4B is still a lot of money.   And this is a limited market, because when the drug goes generic, it is not always the company who originally invested in the drug who gets to make the profits from the generic version.   Also, did you know that the original company can still be sued if someone takes the generic version and has a side effect?  Isn't that fun?

None of this is touching the subject of investors paying for that 70% of a drug cost.  They don't want to be paid back just at face value.   This is a high risk business where companies lose billions of investor dollars all the time.   A company needs to make a lot more than $2B on a $2B drug to keep investors interested in investing in new drug pipelines.

How would you like it if you were not allowed to make money on your rental property?   If someone pointed out that the mortgage + insurance is $X and so you should not be charging $X + $Y even though the market would bear that?   And yes I do realize there are rent controlled areas of the country but I bet the landlords don't really enjoy that.
[/quote]
You may want to look at who posts what.  Using my own statement to argue seems a bit silly because obviously, I don't think that my two statements are conflicting.  First, we do subsidize the drugs by funding a large portion of the basic research.  Then yes the drug companies do their own.  Which I fully agree they should make a profit on, the problem is when they are making an excess profit on drugs that people require to live.  And when there is the same drug that they are selling for half the cost and STILL making a profit in the same place. 
And I lived places with rent control, people were still buying and renting out because they were making enough that it was worth while.  Just like there are drug development companies in other countries that obviously their investors find worthy to invest in. 

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2684 on: June 13, 2017, 12:06:33 PM »
It looks like you can get epipens for around $200 in the US: https://www.goodrx.com/epipen. In Norway, the price before government subsidies is $118. Most of your companies should cover more people than the 5 million who live in Norway, so it can't be about buying in bulk. If this is your way of helping us out; the per capita GDP of the US is 57436, while Norway's is 69231. So... I guess it is working? Thank you?

I think this is more of a trade related issue.   Say the cost+profit of an epipen was $159.   In a totally fair world Norway and the USA would both pay $159.   But Norway has a government that can do what it wants.   Norway tells the USA company that it won't pay more than $118.   The USA does not have any real restrictions on what the company can sell the drug for, so they charge $200 to make up the difference Norway short changed them.

If the USA really wanted to make things fair, it would place a tariff on pickled herring imports from Norway and use this money to offset the higher cost of epipen in the USA.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2685 on: June 13, 2017, 12:16:24 PM »
You may want to look at who posts what.  Using my own statement to argue seems a bit silly because obviously, I don't think that my two statements are conflicting.  First, we do subsidize the drugs by funding a large portion of the basic research.  Then yes the drug companies do their own.  Which I fully agree they should make a profit on, the problem is when they are making an excess profit on drugs that people require to live.  And when there is the same drug that they are selling for half the cost and STILL making a profit in the same place. 
And I lived places with rent control, people were still buying and renting out because they were making enough that it was worth while.  Just like there are drug development companies in other countries that obviously their investors find worthy to invest in.

Sorry multiple quote confusion.

I guess we are stuck on what is an excess profit.  It is reality that there is price gouging and collusion in the drug pharma market but there are many better investments out there than drug companies, so how do you keep investors interested while still keeping prices low?

Really why should someone have invested in Merck for the past decade over Apple or Amazon?   Altruistic reasons maybe?

What if we made all drug companies in the USA government controlled?   The taxpayer could fund the billions of dollars in programs (probably a lot more than that with usual government efficiencies).  The taxpayer could then get really cheap drugs.   If the USA wanted, they could provide these same drugs to the rest of the world for low cost.   We would still be in the same boat that we are subsidizing the rest of the world, but at least we would be more upfront about it.

gaja

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Re: What comes after the ACA?
« Reply #2686 on: June 13, 2017, 12:21:10 PM »
It looks like you can get epipens for around $200 in the US: https://www.goodrx.com/epipen. In Norway, the price before government subsidies is $118. Most of your companies should cover more people than the 5 million who live in Norway, so it can't be about buying in bulk. If this is your way of helping us out; the per capita GDP of the US is 57436, while Norway's is 69231. So... I guess it is working? Thank you?

I think this is more of a trade related issue.   Say the cost+profit of an epipen was $159.   In a totally fair world Norway and the USA would both pay $159.   But Norway has a government that can do what it wants.   Norway tells the USA company that it won't pay more than $118.   The USA does not have any real restrictions on what the company can sell the drug for, so they charge $200 to make up the difference Norway short changed them.

If the USA really wanted to make things fair, it would place a tariff on pickled herring imports from Norway and use this money to offset the higher cost of epipen in the USA.

Nothing forces that company to sell drugs to anyone. If they agree on the price negotiated in Norway (or any of the other countries where they sell them more cheaply than in the US), it is because they are still making a profit. Why on earth would they sell with a loss to one rich country and earn it back from a different rich country, when they could just say no to country number one and still make the profit from country number two? I get that there is some sort of humanitarian aid going on in some countries, but noone in their sound mind thinks that way while doing business in the UK, Canada, or the Nordic countries. Your argument makes no sense. Unless you are suggesting that Norway is somehow strongarming the drug company into selling to us at below market price? "Sell us your medicine or we will force feed you pickled herring and throw snow balls in your face?"
Travelling southern Norway, Iceland and the Faroes in an electric car: http://travelelectric.blogspot.no/

Midwest

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Re: What comes after the ACA?
« Reply #2687 on: June 13, 2017, 12:22:12 PM »
You may want to look at who posts what.  Using my own statement to argue seems a bit silly because obviously, I don't think that my two statements are conflicting.  First, we do subsidize the drugs by funding a large portion of the basic research.  Then yes the drug companies do their own.  Which I fully agree they should make a profit on, the problem is when they are making an excess profit on drugs that people require to live.  And when there is the same drug that they are selling for half the cost and STILL making a profit in the same place. 
And I lived places with rent control, people were still buying and renting out because they were making enough that it was worth while.  Just like there are drug development companies in other countries that obviously their investors find worthy to invest in.

Sorry multiple quote confusion.

I guess we are stuck on what is an excess profit.  It is reality that there is price gouging and collusion in the drug pharma market but there are many better investments out there than drug companies, so how do you keep investors interested while still keeping prices low?

Really why should someone have invested in Merck for the past decade over Apple or Amazon?   Altruistic reasons maybe?

What if we made all drug companies in the USA government controlled?   The taxpayer could fund the billions of dollars in programs (probably a lot more than that with usual government efficiencies).  The taxpayer could then get really cheap drugs.   If the USA wanted, they could provide these same drugs to the rest of the world for low cost.   We would still be in the same boat that we are subsidizing the rest of the world, but at least we would be more upfront about it.

Does the US produce a significant majority of new life improving/saving drugs?  If that's true and if other developed countries are being subsidized through our high prices, maybe it's time to correct that.

Midwest

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Re: What comes after the ACA?
« Reply #2688 on: June 13, 2017, 12:28:36 PM »

We are subsidizing the world Pharma market to some extent, exactly the same as you subsidize the school system who gets free Apple computers when you buy a $2000 Macbook.

A country like India, where the per capita income is around $1600 a year, they cannot afford to pay $50,000 for a life saving drug, or even $5,000.   Thus the drug companies drastically lower the price there, almost like charity.   They make it up in other rich countries, just like Apple makes up for the free computers they give away by selling Macbooks for $2000 to rich people.


The US is rich, yes, but let's be honest here: how many Americans can actually afford to drop 50k yearly on a lifesaving drug? I sure as hell can't, and our family's income is not particularly low. That would also be on top of any other healthcare we'd receive. So, this means you are arguing for the top 1% to subsidize the entire third world, plus everyone else in developed countries that can't afford this? What sense is there in this? I'm going to take a Republican stance on this and say this isn't fair or how it should work at all.

Also, government grants and charities that fund research are not being accounted for in this argument. If we all help crowdsource a needed drug, why must also pay a company massive profit for it? The main thing a company gets from a drug they develop is people need it and will for a long time. They get exclusive rights for a time, then generics should be a free for all. I don't know how to level the playing field, but it should be much more level than it is.

It looks like you can get epipens for around $200 in the US: https://www.goodrx.com/epipen. In Norway, the price before government subsidies is $118. Most of your companies should cover more people than the 5 million who live in Norway, so it can't be about buying in bulk. If this is your way of helping us out; the per capita GDP of the US is 57436, while Norway's is 69231. So... I guess it is working? Thank you?

Norway is a small country and heavily dependent on oil and gas.  That certainly contributes to the GDP in Norway.  If oil and gas were to go away or decrease in importance, I suspect Norway's GDP would, unfortunately, fall rather steeply.

EPI-Pens are an messed up situation.  We are not contributing to your wellness there.  We simply have a greedy daughter of a politician leading the company who is bilking insurance and the taxpayers.

gaja

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Re: What comes after the ACA?
« Reply #2689 on: June 13, 2017, 12:39:44 PM »

We are subsidizing the world Pharma market to some extent, exactly the same as you subsidize the school system who gets free Apple computers when you buy a $2000 Macbook.

A country like India, where the per capita income is around $1600 a year, they cannot afford to pay $50,000 for a life saving drug, or even $5,000.   Thus the drug companies drastically lower the price there, almost like charity.   They make it up in other rich countries, just like Apple makes up for the free computers they give away by selling Macbooks for $2000 to rich people.


The US is rich, yes, but let's be honest here: how many Americans can actually afford to drop 50k yearly on a lifesaving drug? I sure as hell can't, and our family's income is not particularly low. That would also be on top of any other healthcare we'd receive. So, this means you are arguing for the top 1% to subsidize the entire third world, plus everyone else in developed countries that can't afford this? What sense is there in this? I'm going to take a Republican stance on this and say this isn't fair or how it should work at all.

Also, government grants and charities that fund research are not being accounted for in this argument. If we all help crowdsource a needed drug, why must also pay a company massive profit for it? The main thing a company gets from a drug they develop is people need it and will for a long time. They get exclusive rights for a time, then generics should be a free for all. I don't know how to level the playing field, but it should be much more level than it is.

It looks like you can get epipens for around $200 in the US: https://www.goodrx.com/epipen. In Norway, the price before government subsidies is $118. Most of your companies should cover more people than the 5 million who live in Norway, so it can't be about buying in bulk. If this is your way of helping us out; the per capita GDP of the US is 57436, while Norway's is 69231. So... I guess it is working? Thank you?

Norway is a small country and heavily dependent on oil and gas.  That certainly contributes to the GDP in Norway.  If oil and gas were to go away or decrease in importance, I suspect Norway's GDP would, unfortunately, fall rather steeply.

EPI-Pens are an messed up situation.  We are not contributing to your wellness there.  We simply have a greedy daughter of a politician leading the company who is bilking insurance and the taxpayers.
How is Norway's size and oil industry relevant to us paying less for drugs than you? If anything, it should be good excuses to hike the prices. We can afford it, and we don't really have a lot of market power. And anyone who has ever met a Nordic citizen at a market will know about our abyssmal negotation skills.

Epipens are an easy example to compare, because there are so few producers it is always comparing apples to apples. That greedy daughter of a politician would never sell something at below cost, even to a charming Norwegian, so we can be quite sure she is making money both at $118 and $220. Why do you think you should pay a higher price than the rest of the world?
Travelling southern Norway, Iceland and the Faroes in an electric car: http://travelelectric.blogspot.no/

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2690 on: June 13, 2017, 12:44:06 PM »
Nothing forces that company to sell drugs to anyone. If they agree on the price negotiated in Norway (or any of the other countries where they sell them more cheaply than in the US), it is because they are still making a profit. Why on earth would they sell with a loss to one rich country and earn it back from a different rich country, when they could just say no to country number one and still make the profit from country number two? I get that there is some sort of humanitarian aid going on in some countries, but noone in their sound mind thinks that way while doing business in the UK, Canada, or the Nordic countries. Your argument makes no sense. Unless you are suggesting that Norway is somehow strongarming the drug company into selling to us at below market price? "Sell us your medicine or we will force feed you pickled herring and throw snow balls in your face?"

It is a bit more complicated but I think the company does still make a profit selling cheaper to Norway than the USA but that profit is not as much as they would like.   It may be that a company still chooses to sell there because a small profit is better than no profit or they are worried if they did not provide the drug to Norway it might choose to copy and produce the drug itself, citing national health security reasons for violating the international patent (this has happened before in other countries).

If we go back to the rent control example and imagine a landlord who owned rentals in several states, he might still decide there is enough profit to rent his houses in the rent controlled area but he still charges the higher market rate in the other areas that are not rent controlled.   He probably is not going to say "well gee, I make a few dollars on this rent controlled place so I will just charge that same rate everywhere else"

gaja

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Re: What comes after the ACA?
« Reply #2691 on: June 13, 2017, 12:58:52 PM »
Nothing forces that company to sell drugs to anyone. If they agree on the price negotiated in Norway (or any of the other countries where they sell them more cheaply than in the US), it is because they are still making a profit. Why on earth would they sell with a loss to one rich country and earn it back from a different rich country, when they could just say no to country number one and still make the profit from country number two? I get that there is some sort of humanitarian aid going on in some countries, but noone in their sound mind thinks that way while doing business in the UK, Canada, or the Nordic countries. Your argument makes no sense. Unless you are suggesting that Norway is somehow strongarming the drug company into selling to us at below market price? "Sell us your medicine or we will force feed you pickled herring and throw snow balls in your face?"

It is a bit more complicated but I think the company does still make a profit selling cheaper to Norway than the USA but that profit is not as much as they would like.   It may be that a company still chooses to sell there because a small profit is better than no profit or they are worried if they did not provide the drug to Norway it might choose to copy and produce the drug itself, citing national health security reasons for violating the international patent (this has happened before in other countries).

If we go back to the rent control example and imagine a landlord who owned rentals in several states, he might still decide there is enough profit to rent his houses in the rent controlled area but he still charges the higher market rate in the other areas that are not rent controlled.   He probably is not going to say "well gee, I make a few dollars on this rent controlled place so I will just charge that same rate everywhere else"

I think this is more like buying a car: We both want to buy the same brand of car, and go to the same dealership. I spend some time negotiating a good price, you agree to the sticker price. When you find out I paid less you grumble a bit about it being unfair, but say "someone has to pay for the costs of developing that car, running the auto factory, and the seller's pay check". I go smilingly home and put the extra money in my index fund (https://www.nbim.no/en/).

Again: when you see other countries are paying less - why are you comfortable paying the higher prices?
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Midwest

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Re: What comes after the ACA?
« Reply #2692 on: June 13, 2017, 12:59:38 PM »

It looks like you can get epipens for around $200 in the US: https://www.goodrx.com/epipen. In Norway, the price before government subsidies is $118. Most of your companies should cover more people than the 5 million who live in Norway, so it can't be about buying in bulk. If this is your way of helping us out; the per capita GDP of the US is 57436, while Norway's is 69231. So... I guess it is working? Thank you?

Norway is a small country and heavily dependent on oil and gas.  That certainly contributes to the GDP in Norway.  If oil and gas were to go away or decrease in importance, I suspect Norway's GDP would, unfortunately, fall rather steeply.

EPI-Pens are an messed up situation.  We are not contributing to your wellness there.  We simply have a greedy daughter of a politician leading the company who is bilking insurance and the taxpayers.
How is Norway's size and oil industry relevant to us paying less for drugs than you? If anything, it should be good excuses to hike the prices. We can afford it, and we don't really have a lot of market power. And anyone who has ever met a Nordic citizen at a market will know about our abyssmal negotation skills.

You stated your GDP per capita was higher than the US.  I misinterpreted your statement to imply that had something to do with lower drug costs (including epipen).  Apologies.

Epipens are an easy example to compare, because there are so few producers it is always comparing apples to apples. That greedy daughter of a politician would never sell something at below cost, even to a charming Norwegian, so we can be quite sure she is making money both at $118 and $220. Why do you think you should pay a higher price than the rest of the world?

Epi-pen prices have exploded in the US over the past few years.  During testimony, the CEO misrepresented causes and profit margins.  I don't think the world should be paying a higher price on this item as it represents everything that's wrong with the US drug industry.   Here's an article on the saga - http://www.reuters.com/article/us-health-epipen-costs-idUSKBN16Y24O

On the other hand, developing new drugs and technologies is expensive and drugmakers need to be compensated for that.  There was little innovation in epi-pen, however, just blatant opportunism and fraud. 

If US is paying high prices on new drugs so the rest of the world can benefit, then we should work on pushing some of that burden outside the US.  Things like EPI-Pen and doxycycline price increases, on the other hand, are un-ethical.

radram

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Re: What comes after the ACA?
« Reply #2693 on: June 13, 2017, 01:23:02 PM »

1) Despite the massive benefits of the ACA, the law has harmed a large percentage of middle class tax payers.  The law has not only made healthcare more unaffordable to those people, it also made it very cumbersome being forced to change health plans and doctors on a yearly basis. Also just because a group of people has health insurance does not mean they can still afford the deductibles and a significant portion of the newly insured find their subsidized insurance not that helpful. These people want the ACA amended or dismantled.

I do not believe one can fairly attribute changing doctors solely to the changes in the ACA.

I remember several times in my career when it was announced that my company was changing insurance. Sometimes my doctors were in the new group, sometimes they were not. I even remember one time our employer even announced at the time of the changes that they checked, and something like 90% of the billed doctors the past year were in the new plan. That was nice of them to do, but that was definitely a rarity.

Changing insurance has been "a thing" for decades. Before ACA it was simply a financial decision made by your employer to stay competitive. Now it's just Obama's fault.
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NESailor

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Re: What comes after the ACA?
« Reply #2694 on: June 13, 2017, 01:54:16 PM »


The reality is:
1) Despite the massive benefits of the ACA, the law has harmed a large percentage of middle class tax payers.  The law has not only made healthcare more unaffordable to those people, it also made it very cumbersome being forced to change health plans and doctors on a yearly basis. Also just because a group of people has health insurance does not mean they can still afford the deductibles and a significant portion of the newly insured find their subsidized insurance not that helpful. These people want the ACA amended or dismantled.
2) Politics is dirty and corrupt. Both democrat and republican politicians are mostly scum who care more about being reelected and satisfying their lobbyists as opposed to doing what is right for the American people. Republicans do it in the guise of cutting taxes, cutting the deficit, and improving the American way of life. Democrats do it in the guise of social justice, environmental benefits, and improving the lives of those less fortunate.
3) Not everyone who votes republican is a racist idiot redneck. There are many intelligent hard working middle class Americans who pay taxes and are constantly squeezed by the government. They find their cost of living going up, their taxes going up, and their disposable income dwindling. They chose to vote republican last year.  It doesn't mean they are stupid or racist.  It just means they became fed up with our political system that the last 8 years has given and want change.  Maybe in 3-7 years those same people will vote democrat after seeing no benefit from the current regime.  But the reality is that they are not racist morons.

Sol, Cognitive dissonance is a normal part of human thinking.  Everyone gets this when their strong beliefs are questioned. Who knows, maybe I am the one with cognitive dissonance discussing this subject with you. Although difficult to accept, maybe with the right arguments I can see that in myself. I will try and be open to that thought.

Hi EnjoyIt!

#1 - Not sure whether we can really tell how many are better off vs. worse off.  Many may feel that they are worse off when in fact their policy is more comprehensive and more robust...they just don't know it (no lifetime caps etc.).  I do agree, however, it should be amended/fixed/whatever.   Our setup is garbage, as we've covered over 55 pages by now.
#2 - spot on.
#3 - Cost of living going up, squeezed by the government...puh lease! We have an entire community of people here who can clearly demonstrate that cost of living is NOT in fact going up that drastically.  The government also isn't really squeezing anyone particularly hard either.  The poor already don't pay all that much in taxes.  The middle class don't have to, if they don't want to.  And the truly wealthy (because this community right here already has many very wealthy members) can easily afford to pay what they pay...and then some.  I'm in the top few % by income for my age group.  Even if my income tax burden DOUBLED next year - I'd still be doing great...with NO impact on my quality of life. 

So I don't accept any of the bitching about taxes being too high.  The argument that AHCA repeals a tax hike from 8 years ago is ridiculous.  20 years ago rates were higher, why not use 20 years ago as a baseline?  Or how about 30 years ago?  Or 40 years ago?  I know why - because somehow we've concluded that taxes are evil and we're overtaxed...when in fact we pay less and less of our incomes for an ever expanding government.  I'm fine either way.  Cut my taxes or cut spending.  But don't ask for a goddamn increase in military spending and then tell me that everyone at my level of wealth and above is suffering some undue tax burden (this is not directed at you...this is in the general direction of a plain vanilla republican politician...whose platform is just that - more military, less taxes for me).  Those who claim that are full of shit and greedy.

dividendman

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Re: What comes after the ACA?
« Reply #2695 on: June 13, 2017, 03:07:19 PM »
I agree, the cost of living hasn't gone up much, and the government hasn't had much impact on it.

The cost of dying however, that is getting nuts.

Bateaux

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Re: What comes after the ACA?
« Reply #2696 on: June 13, 2017, 06:50:40 PM »
/\ /\ /\   Well said NE SAILOR.   
“Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.”
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JumpInTheFIRE

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Re: What comes after the ACA?
« Reply #2697 on: June 13, 2017, 09:57:20 PM »

Sorry multiple quote confusion.

I guess we are stuck on what is an excess profit.  It is reality that there is price gouging and collusion in the drug pharma market but there are many better investments out there than drug companies, so how do you keep investors interested while still keeping prices low?

Really why should someone have invested in Merck for the past decade over Apple or Amazon?   Altruistic reasons maybe?

What if we made all drug companies in the USA government controlled?   The taxpayer could fund the billions of dollars in programs (probably a lot more than that with usual government efficiencies).  The taxpayer could then get really cheap drugs.   If the USA wanted, they could provide these same drugs to the rest of the world for low cost.   We would still be in the same boat that we are subsidizing the rest of the world, but at least we would be more upfront about it.

Pharmaceutical companies make some of the highest margins of any industry (citation http://www.bbc.com/news/business-28212223), rivaled only by banks.  They invest the money to create new drugs because they have a shitload of money and want even more money.  They hold such immense political power that the last time Republicans passed major health legislation (Medicare part D) the law specifically prohibited Medicare from negotiating with the pharma companies for better prices on drugs. 

There are similar bullshit sweetheart laws all across the whole healthcare industry, bought and paid for by the lobbyists.  There is no need for insurance companies, they only add a middleman that wants a sizable cut to the equation.  The ONLY way to lower healthcare costs is to go to a single payer system without the negotiation restrictions that congress is prone to passing.   A single payer system immediately reduces costs by 15-20% (average profit margin of health insurance companies) and with the negotiating power of the entire US population behind it we could bring the pharma companies profit margins back down to earth. 

TrudgingAlong

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Re: What comes after the ACA?
« Reply #2698 on: June 13, 2017, 11:01:26 PM »
Yep, this is where my thinking goes. ^

beltim

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Re: What comes after the ACA?
« Reply #2699 on: June 14, 2017, 12:37:22 AM »
The ONLY way to lower healthcare costs is to go to a single payer system without the negotiation restrictions that congress is prone to passing.   A single payer system immediately reduces costs by 15-20% (average profit margin of health insurance companies) and with the negotiating power of the entire US population behind it we could bring the pharma companies profit margins back down to earth.

This is just wrong.  Yes, single payer with sensible negotiating power would reduce costs, but the average profit margin of health insurance companies is nowhere near what you said.    In fact, the average is just 3.3%.  Private insurance companies also have higher administrative costs than Medicare/Medicaid, but much of that is just efficiency of scale.

The fact is, there are a bunch of ways to lower health care costs.  Single payer is one, but it's far from the only one.  And playing boogeyman with pharmaceutical companies and health insurance companies distracts from the actual source of high medical costs.
« Last Edit: June 14, 2017, 12:44:28 AM by beltim »