That $56,000 Drug? Blame Medicare(nytimes.com)
nytimes.com
That $56,000 Drug? Blame Medicare
https://www.nytimes.com/2021/08/20/business/drug-cost-medicare-alzheimers.html
132 comments
Company hires lobbyists to ensure Medicare isn't allowed to negotiate drug prices, then convinces the public it's Medicare's fault. I can't believe we're still falling for this shit.
I truly don't understand this reasoning. If lobbyists buy politicians, the sell out are the politicians, and then healthcare administration must be taken away from government..
The only reason government politicians are worth buying out is that the power of government is the only check to even larger power accumulations. If you eliminate government then that capital power just does directly does what it wants with no transparency of even a politicians bought vote.
I love it when Americans theorize and hypothesize acting like healthcare isn't a solved problem anywhere else in the world.
The American healthcare system is exceptionally bad when you compare it against the United States' relative wealth, for sure; the rest of the world hasn't solved healthcare, though.
Even if you zoom in on the few countries most people are talking about when they say "the rest of the world," there's still a tons of issues present, a lot of which are directly a result of the system that they chose to utilize. This is an issue with a lot of nuance and I wish people wouldn't make such reductive statements like this.
Even if you zoom in on the few countries most people are talking about when they say "the rest of the world," there's still a tons of issues present, a lot of which are directly a result of the system that they chose to utilize. This is an issue with a lot of nuance and I wish people wouldn't make such reductive statements like this.
As long as those issues don't include people going broke because of a snake bite (and they don't) I'd say they pretty much did solve it.
When you can't get the latest cancer drugs because your gov't can't/won't pay for it, is it still solved?
This is somewhat of a straw man fallacy often cited by proponents of profit centric healthcare. In reality it happens relatively rarely and is usually linked to the effectiveness of that treatment. In the UK, a typical example of state provided healthcare, some extremely expensive treatments which can only increase life expectancy for a few weeks or months are not approved as there is little benefit. But not every health insurance policy in the US will cover this treatment, especially without some copay. On the other hand, a treatment was recently approved for use which costs £1.795 million per patient. The cost to the patient for that treatment is zero.
I find this argument not only provably less relevant than the poster thinks is is, but also it's not much different from dying as you can't afford to pay even the copay for your cancer treatment. The USA can't even sort out decent healthcare for children, who haven't yet had the opportunity to get a job to pay for their healthcare.
No healthcare system is perfect but that's not a reason to not seek something better, fairer and more efficient.
I find this argument not only provably less relevant than the poster thinks is is, but also it's not much different from dying as you can't afford to pay even the copay for your cancer treatment. The USA can't even sort out decent healthcare for children, who haven't yet had the opportunity to get a job to pay for their healthcare.
No healthcare system is perfect but that's not a reason to not seek something better, fairer and more efficient.
It's happens more often than you think. In single payer system, those therapies aren't even discussed with the patient since the physician knows if it's not paid for by the gov't it's effectively out of reach.
Sure, the US system isn't perfect by any means, but one reason why it's so expensive is they throw everything plus the kitchen sink at patients. And this is even for Medicaid which covers the poorest Americans.
Having lived in 4 different country with 4 different healthcare systems, if I got diagnosed with a serious cancer you can damn well be sure I'll get treated in the US. I have a friend who got diagnosed with breast cancer who did the same, moved back to the US and with ACA subsidies was getting the latest therapies with a monthly premium of $200. And the drugs she received weren't even paid for in her home country.
Sure, the US system isn't perfect by any means, but one reason why it's so expensive is they throw everything plus the kitchen sink at patients. And this is even for Medicaid which covers the poorest Americans.
Having lived in 4 different country with 4 different healthcare systems, if I got diagnosed with a serious cancer you can damn well be sure I'll get treated in the US. I have a friend who got diagnosed with breast cancer who did the same, moved back to the US and with ACA subsidies was getting the latest therapies with a monthly premium of $200. And the drugs she received weren't even paid for in her home country.
>>In single payer system, those therapies aren't even discussed with the patient since the physician knows if it's not paid for by the gov't it's effectively out of reach.
I genuienly don't think that's as common as you think it is.
Anecdote time: when my dad was diagnosed with GIST in Poland(you know, not a very wealthy country), his prognosis was about 6-12 months if lucky. But the doctors at the oncology unit knew that the drug Glivec was being approved against GIST but not yet refunded by the Polish healthcare system. They basically applied and got approved to fund his therapy along with 5 other people(GIST was and remains super rare). The national healthcare system paid for his treatment with Glivec for the next 8 years(until he died), despite the huge cost of the medication.
Like, maybe he was lucky. But again, I think you are misrepresenting the system by saying "doctors won't even try". Sure, maybe some won't. Some will. I've heard similar stories from US where doctors won't order certain medically necessary treatment because they know insurers won't pay for it - it doesn't mean anything in isolation.
I genuienly don't think that's as common as you think it is.
Anecdote time: when my dad was diagnosed with GIST in Poland(you know, not a very wealthy country), his prognosis was about 6-12 months if lucky. But the doctors at the oncology unit knew that the drug Glivec was being approved against GIST but not yet refunded by the Polish healthcare system. They basically applied and got approved to fund his therapy along with 5 other people(GIST was and remains super rare). The national healthcare system paid for his treatment with Glivec for the next 8 years(until he died), despite the huge cost of the medication.
Like, maybe he was lucky. But again, I think you are misrepresenting the system by saying "doctors won't even try". Sure, maybe some won't. Some will. I've heard similar stories from US where doctors won't order certain medically necessary treatment because they know insurers won't pay for it - it doesn't mean anything in isolation.
I have no idea what the timing was but Gleevec was first approved in the US 20 years ago. It was an old drug by the early 2010’s.
And that’s what I’ve observed. Yes, in universal systems you’ll get cancer care, but you’ll get the standard of care from 5-10 years ago. All the while cancer can has advanced by leaps and bounds.
And that’s what I’ve observed. Yes, in universal systems you’ll get cancer care, but you’ll get the standard of care from 5-10 years ago. All the while cancer can has advanced by leaps and bounds.
Well, maybe. In my dad's case he started treatment in 2003, so I don't think it was that long after the first approval in the US.
That's due to ACA, which is only about 7 years old and has an uncertain future. The cancer survival rates are a few percentage points better in the US than many other countries, but this is not uniform and still depends upon your level of insurance. If you are uninsured or underinsured your survival rate is significantly less than if you are fully insured.
The "everything plus the kitchen sink" approach isn't ideal in all scenarios and the US healthcare system has a high level of overtreatment, often with potentially harmful interventions. It also pushes up the cost for everyone.
However there are economic models that provide for a high level of universal healthcare equal to what the US has now and also cost less than the US spends right now. The difference is that is moves from a combination of clear personal cost and obfuscated public costs, to purely public costs and many in the US seem opposed to that relatively minor shift. It also means the politicians are even more responsible for their society's healthcare and I imagine many of them don't want that responsibility.
The "everything plus the kitchen sink" approach isn't ideal in all scenarios and the US healthcare system has a high level of overtreatment, often with potentially harmful interventions. It also pushes up the cost for everyone.
However there are economic models that provide for a high level of universal healthcare equal to what the US has now and also cost less than the US spends right now. The difference is that is moves from a combination of clear personal cost and obfuscated public costs, to purely public costs and many in the US seem opposed to that relatively minor shift. It also means the politicians are even more responsible for their society's healthcare and I imagine many of them don't want that responsibility.
If you review data, the US indeed has higher cancer survival rates. But they’re marginally higher while overall US life expectancy is lower. That means basically that all-other-causes of shortened lifespan are higher in the US.
https://worldpopulationreview.com/country-rankings/cancer-su...
https://ourworldindata.org/grapher/life-expectancy-vs-gdp-pe...
https://worldpopulationreview.com/country-rankings/cancer-su...
https://ourworldindata.org/grapher/life-expectancy-vs-gdp-pe...
Is there any data that links cancer survival to where that treatment was developed?
I’m genuinely curious and realize this is one of those topics that is easy to come across as combative, but please know that’s not my intent.
The reason I ask is that I think roughly 40% of healthcare R&D globally is funded by the U.S. For its size, the U.S. scores relatively high on the access and quality dimensions, but as has been discussed is quite bad at cost. I wonder if the US has optimized for quality and access at the expense of cost.
I have also heard from those in the field that the US effectively subsidizes other countries costs through their R&D and price policies. E.g., other countries may have tight drug price controls and the only way pharma is willing to invest in R&D is because they can make up those profits in America.
It really makes me think all this discussion about one country’s healthcare vs another is myopic. Just like many other aspects of economics, healthcare to a certain extent is a global system.
I’m genuinely curious and realize this is one of those topics that is easy to come across as combative, but please know that’s not my intent.
The reason I ask is that I think roughly 40% of healthcare R&D globally is funded by the U.S. For its size, the U.S. scores relatively high on the access and quality dimensions, but as has been discussed is quite bad at cost. I wonder if the US has optimized for quality and access at the expense of cost.
I have also heard from those in the field that the US effectively subsidizes other countries costs through their R&D and price policies. E.g., other countries may have tight drug price controls and the only way pharma is willing to invest in R&D is because they can make up those profits in America.
It really makes me think all this discussion about one country’s healthcare vs another is myopic. Just like many other aspects of economics, healthcare to a certain extent is a global system.
What was the plot of Breaking Bad again? Guess Heinsberg just wanted the latest cancer drug.
I think that you're not looking closely enough at the underlying issues of these systems if your only metric is people don't go broke from a snake bite, or more broadly, they don't pay immediate upfront costs for their healthcare, even though a whole lot of these places do have upfront costs as well.
The healthcare industry has a lot of working parts, all of which require scrutiny, even in these mythical places of which you aspire American healthcare to look like. There's genuinely negative outcomes as a result of the policy decisions everywhere, too.
The healthcare industry has a lot of working parts, all of which require scrutiny, even in these mythical places of which you aspire American healthcare to look like. There's genuinely negative outcomes as a result of the policy decisions everywhere, too.
It's so strange when Canadian and European dignitaries fly to the US for important procedures when they've already solved healthcare [0].
[0] https://www.sfgate.com/opinion/openforum/article/Why-Canadia...
[0] https://www.sfgate.com/opinion/openforum/article/Why-Canadia...
Why is that strange? Universal Health care doesn’t mean you don’t have options if you can pay or is that a sign of failure to you? Also the article mentions that 700k Canadians are waiting for health care (it doesn’t mention how long they have to wait). The US has 40M people not getting healthcare at all. I’d rather wait a bit than not getting it at all.
The point is that no one has solved healthcare, contrary to the OP's point. It is certainly more equitable in places like Canada, but of a lower quality at the high end in virtually every country compared to the US, and it often takes months to see a specialist (but everyone gets a chance, if they don't have an urgent condition, that is).
America's healthcare system is terrible, but socializing it like other countries have done isn't going to solve the problem (root causes include a massive shortage of doctors, a norm of bundling insurance with employment, lack of pricing transparency, partially socialized healthcare, as described in the article, and a system in which it costs a billion dollars to get a drug approved).
America's healthcare system is terrible, but socializing it like other countries have done isn't going to solve the problem (root causes include a massive shortage of doctors, a norm of bundling insurance with employment, lack of pricing transparency, partially socialized healthcare, as described in the article, and a system in which it costs a billion dollars to get a drug approved).
> Takes months to see a specialist?
Even having an insurance can mean that it will take months to see a specialist.
And universal healthcare doesn't have to mean that there shouldn’t be any private health care. The Nordic countries have solved it this way.
Even having an insurance can mean that it will take months to see a specialist.
And universal healthcare doesn't have to mean that there shouldn’t be any private health care. The Nordic countries have solved it this way.
It's not strange at all, the US has the best healthcare system in the world ... that money can buy, so it's a huge benefit to the elites with f*ck you money who want the best care at any cost.
Europe hasn't solved healthcare at all, there's plenty of issues ongoing and developing but the average joe need not worry of going broke due to medical bills so he can focus his life on other things.
Europe hasn't solved healthcare at all, there's plenty of issues ongoing and developing but the average joe need not worry of going broke due to medical bills so he can focus his life on other things.
[deleted]
Hold your horses.
Problems of national health systems in other countries are not "globally" visible like insane bills for Americans.
Just go and read up how many British people are nagging about NHS. I expect that there is shitload of corruption in health care in other countries as well but I don't read or speak German or French.
In Poland I heard about case of a doctor that died from overwork, she just collapsed because she was working 3 shifts for a month or something. Don't get me started on emergency crews that are treated like dirt and hired on as B2B contractors.
Well I am not going to get a bill that will ruin me financially but I might end up with no professional health care to help me when I am in trouble because they don't get paid enough and are worked to the ground.
Problems of national health systems in other countries are not "globally" visible like insane bills for Americans.
Just go and read up how many British people are nagging about NHS. I expect that there is shitload of corruption in health care in other countries as well but I don't read or speak German or French.
In Poland I heard about case of a doctor that died from overwork, she just collapsed because she was working 3 shifts for a month or something. Don't get me started on emergency crews that are treated like dirt and hired on as B2B contractors.
Well I am not going to get a bill that will ruin me financially but I might end up with no professional health care to help me when I am in trouble because they don't get paid enough and are worked to the ground.
> Just go and read up how many British people are nagging about NHS.
Us British people are nagging about the NHS because we've had 10+ years of a wannabe-GOP running it into the ground in order to stealth-privatise it and bung billions into theirs and their corrupt chums' pockets.
We love the NHS. We don't love austerity and corruption.
Us British people are nagging about the NHS because we've had 10+ years of a wannabe-GOP running it into the ground in order to stealth-privatise it and bung billions into theirs and their corrupt chums' pockets.
We love the NHS. We don't love austerity and corruption.
This is a consequence of the NHS existing, though. It's one of the genuinely big downsides to having public healthcare where quality of care will coincide with the controlling government's support and/or aptitude for governing it.
Private healthcare also suffers from poor governance (it's one of the big factors in why the United States' healthcare system is so expensive) but its effects aren't quite as drastic.
Private healthcare also suffers from poor governance (it's one of the big factors in why the United States' healthcare system is so expensive) but its effects aren't quite as drastic.
The broadest general measures of gdp per capita spent on healthcare as well as life expectancy would indicate that not only does the US pay over double per capita of what every other modern nation pays, it also has 2-5 year lagging life expectancy (not to mention the only modern nation with flat or declining life expectancy).
As an aside, the NHS is indeed flirting with instability right now, but that is due to multiple Tory governments arguably putting policies in place to destabilize and privatize the NHS in the long term. It’s as bizarre as Brexit to me that the British voters are going with it. But there it is.
As an aside, the NHS is indeed flirting with instability right now, but that is due to multiple Tory governments arguably putting policies in place to destabilize and privatize the NHS in the long term. It’s as bizarre as Brexit to me that the British voters are going with it. But there it is.
So private health like in the US that is not tied to any government would fix that? ;)
I don't see that argument as refutation of my argument :)
Because party you don't support is running the system does not mean that when party you support it will get better. I don't believe any party has that much influence over what is happening in health care anyway or is able to fix it.
I don't see that argument as refutation of my argument :)
Because party you don't support is running the system does not mean that when party you support it will get better. I don't believe any party has that much influence over what is happening in health care anyway or is able to fix it.
For France, the root cause for the lack of specialist in some zones is actually not that they aren't paid enough (a generalist, for instance, seem to have it's lower bracket above the median income for a family, and an average that is at 3-5 times it. Sadly, jobs such as nurse have bad pays though...), but more a part of the french medicine school: the "numerus closus". At the end of the first year, students take an exam week, and only the N first students are allowed to pass, with N being a preselected constant for that year. Not everyone is allowed to try again too. This has been criticized for some time and if I remember well was recently removed, but the cynic part of me tell me that they would have no issues crafting an exam specially to have roughly N students pass...
The real blocking point is the internship in the 5th year. There is not enough physician to train our intern at public hospital. So with the end of the numerus closus and some new decision about internship, you can now have 2 interns per surgeons, effectively trading formation quality and old physicians sanity for numbers.
[deleted]
I think it's a counter-productive line of reasoning. That drug doesn't cost $50K+ anywhere else in the world. Hypotheticals are all well and good, but let's stay grounded in reality as well.
When you have so many facts demonstrating that government-funded medicine works just fine everywhere else, the only hypothetical worth considering is whether it would work here too.
When you have so many facts demonstrating that government-funded medicine works just fine everywhere else, the only hypothetical worth considering is whether it would work here too.
> That drug doesn't cost $50K+ anywhere else in the world
The rest of your point notwithstanding, this is a statement whose explanation could almost be its own converse -- companies can afford to profitably sell a drug for less than $50k elsewhere in the world because they're allowed to milk the USA money cow (i.e., marginal costs are low, fixed costs are high, and there exists a guaranteed market to cover the fixed costs). Without further evidence that the fixed costs could be covered as well it's entirely plausible that the proposed alternative (that the drug company would exist, make the drug, and sell it for a reasonable price worldwide without further subsidies/intervention) would never come to be.
Such evidence probably exists, but an argument whose truth depends wholly on orthogonal statements isn't worth repeating.
The rest of your point notwithstanding, this is a statement whose explanation could almost be its own converse -- companies can afford to profitably sell a drug for less than $50k elsewhere in the world because they're allowed to milk the USA money cow (i.e., marginal costs are low, fixed costs are high, and there exists a guaranteed market to cover the fixed costs). Without further evidence that the fixed costs could be covered as well it's entirely plausible that the proposed alternative (that the drug company would exist, make the drug, and sell it for a reasonable price worldwide without further subsidies/intervention) would never come to be.
Such evidence probably exists, but an argument whose truth depends wholly on orthogonal statements isn't worth repeating.
I hear this argument all the time but are there any drugs that are only profitable due to the price gouging going on in the US?
Because it seems to me that the price difference is so large, sometimes by a factor of 10 or more, that it doesn’t seem worth it to bother going through the approval process in any other country and yet pharmaceutical companies do so. So the NPV must be positive even when the price is lower.
I also think if there were drugs that only exist because of high US drug prices that we would hear about them. Proponents of the exorbitant prices would be yelling from the rooftops about some specific miracle compound that was only possible to develop because of their tireless work at finding new and exiting ways to price gouge.
Instead all I hear are these hand wavy arguments about research costs and whatnot. Where’s the beef?
Because it seems to me that the price difference is so large, sometimes by a factor of 10 or more, that it doesn’t seem worth it to bother going through the approval process in any other country and yet pharmaceutical companies do so. So the NPV must be positive even when the price is lower.
I also think if there were drugs that only exist because of high US drug prices that we would hear about them. Proponents of the exorbitant prices would be yelling from the rooftops about some specific miracle compound that was only possible to develop because of their tireless work at finding new and exiting ways to price gouge.
Instead all I hear are these hand wavy arguments about research costs and whatnot. Where’s the beef?
> Because it seems to me that the price difference is so large, sometimes by a factor of 10 or more
The approval process is O(1%) of the total cost of development.
> I also think if there were drugs that only exist because of high US drug prices that we would hear about them
Maybe. I've grown wary of reading too much into the relative popularity of different phrases and arguments; it turns out people are complicated and prone to prioritizing points you might not care about, and even when those arguments are being made they often get lost in the noise of 8B other people.
Humira probably isn't a bad example in any case (though without being inside a company it's hard to know for sure since you don't know if, e.g., they would have prioritized international approvals and sales if the US market couldn't be lucrative). Total international sales only eclipsed total R&D in the last few years, despite the drug having been around for a couple decades. I personally think the current level of price gouging for Humira in the US is excessive, but AbbVie would also have had to take a loss on it for nearly 20yrs without some level of price gouging somewhere.
The approval process is O(1%) of the total cost of development.
> I also think if there were drugs that only exist because of high US drug prices that we would hear about them
Maybe. I've grown wary of reading too much into the relative popularity of different phrases and arguments; it turns out people are complicated and prone to prioritizing points you might not care about, and even when those arguments are being made they often get lost in the noise of 8B other people.
Humira probably isn't a bad example in any case (though without being inside a company it's hard to know for sure since you don't know if, e.g., they would have prioritized international approvals and sales if the US market couldn't be lucrative). Total international sales only eclipsed total R&D in the last few years, despite the drug having been around for a couple decades. I personally think the current level of price gouging for Humira in the US is excessive, but AbbVie would also have had to take a loss on it for nearly 20yrs without some level of price gouging somewhere.
You can do this math yourself. The average drug costs about $1.3B to develop [1]. What's the profit margin per dose in your country of choice, times the number of expected doses before the patent runs out? I can pretty much guarantee the total of that is nowhere near [1], let alone high enough to satisfy shareholder expectations. The unfortunate truth is that drugs are expensive to develop, and the US market subsidizes them for the rest of the world.
[1] https://www.biopharmadive.com/news/new-drug-cost-research-de...
[1] https://www.biopharmadive.com/news/new-drug-cost-research-de...
Well conveniently there are 1.3 billion people in the OECD countries. A $1 per person tax burden for each new drug sounds downright reasonable.
Replying to myself since apparently people don't like financial facts. If you read Pfizer's 10-K for 2019 (chosen for pre-pandemic numbers), the US accounted for 45% of their gross revenue compared to Western Europe's ~15%. If you discounted the US down to a similar per-person revenue level as Europe, the company would fluctuate between profitability and non-profitability quarter to quarter.
I genuinely don't know what people want here - drugs aren't magically summoned into existence for free. If you want new drugs, someone has to cover the cost and the prices that the non-US world pays aren't nearly high enough to do that. You could lower the prices for Americans, but only if you simultaneously increase the prices for everyone else, too.
I genuinely don't know what people want here - drugs aren't magically summoned into existence for free. If you want new drugs, someone has to cover the cost and the prices that the non-US world pays aren't nearly high enough to do that. You could lower the prices for Americans, but only if you simultaneously increase the prices for everyone else, too.
This is always such a weird defense to me. It's crazy to me to think that we won't provide universal healthcare to our own citizens but some seem to think we're altruistic enough to enable socialized medicine for the rest of the first world.
It's not a defense against universal healthcare. Rather, it points out that the mechanism for universal healthcare _might_ have to just be taxes or state-owned R&D rather than legislating that drugs have to be cheap.
> Altruistic enough to...
There's no altruism involved. US consumers are willing to pay those prices (inelastic demand), and companies are able to charge them (lack of competition, legal barriers). Predicated on that fact, marginally it's also profitable to manufacture for other countries as well, but if the rest of the world didn't exist you'd still expect to see the current behavior.
> Altruistic enough to...
There's no altruism involved. US consumers are willing to pay those prices (inelastic demand), and companies are able to charge them (lack of competition, legal barriers). Predicated on that fact, marginally it's also profitable to manufacture for other countries as well, but if the rest of the world didn't exist you'd still expect to see the current behavior.
This argument would be more convincing if drug companies didn’t spend more on marketing in the US than they do for R&D.
[deleted]
But this is an example of that big governemnt doing exactly the opposite and using its power to sell out.
So the transparency of free market negotiations is inferior to the transparency of corrupt taxpayer sponsored price fixing?
There is no free market without some government keeping it to some measure of free. If no one enforces property rights then the strongest just takes property from anyone with no consent.
No, we need a functional government free of bribes, not a society run by money which places the value of a life at roughly $0.
You need to punish gov from taking bribes to get there.
Getting rid of medicare could fix this price gouging, but not price gouging in medicine in gneeral. Look at insulin: The efficient market response to jacked up insulin prices is...um...mercy kill your diabetic relatives and procreate new ones in their stead. Yeah, no thanks.
The only solution is public healthcare and unfucked voting systems. Say it to yourself until you get it.
The only solution is public healthcare and unfucked voting systems. Say it to yourself until you get it.
Or perhaps allow competition and not government granted monopolies through patents and approvals?
Did you read my insulin example? The patents expired, at least.
Don't get me wrong, markers are good for some things, but healthcare is not among them.
Don't get me wrong, markers are good for some things, but healthcare is not among them.
I disagree with both majority and minority rule, but regarding
> unfucked voting systems
What system would you propose?
Considering our voting systems have only tended more toward 'fucked' over time, how do you propose we ever get to 'unfucked' voting systems when we are held fast by 'fucked' ones?
> unfucked voting systems
What system would you propose?
Considering our voting systems have only tended more toward 'fucked' over time, how do you propose we ever get to 'unfucked' voting systems when we are held fast by 'fucked' ones?
Full on proportional representation in both houses would do the trick. You get the occasional year of formation negotiations but it would solve so many problems in the US.
The senators are supposed to represent states - their direct election has been a major source of government growth and waste.
I think you can get medicare for all even with this current shit voting system. Just will take annoyingly long. The better voting is still really important but for this issue less essential. Well done healthcare (and really, the bar is low) will also create more interest in building better institutions in general and so may help electoral reform.
Looks to me like our voting systems work fine. Our campaign finance systems however...
First past the post is a terrible voting system. It forces two main parties, and doesn't represent anyone whose candidate didn't win in their locality.
Representative ( or mixed representative with preferential, where you vote for a party list and for a person specifically who gets ahead) is much better, and would certainly alleviate many of the US political system's issues ( like the immediate politicisation of every issue among party lines)
Representative ( or mixed representative with preferential, where you vote for a party list and for a person specifically who gets ahead) is much better, and would certainly alleviate many of the US political system's issues ( like the immediate politicisation of every issue among party lines)
That plan also has bad incentives, the third option is best, try to remove money from politics. Ensure medicare laws are made for the good of the people.
The problem isn't money in politics. It's politicians with absolutely no knowledge about economics. Healthcare system became an entangled mess of the private and public sector in the first place because the government tried to implement a price floor on salaries, no lobbying required.
Even the most unscrupulous of politicians should recognize that a few thousand dollars in campaign contributions and front row tickets to a college football game isn't a fair trade for handing pharmaceutical companies a blank check from an account with effectively infinite money. What happens is that the lobbyist butters the politician up and sounds smart, so the politician just listens to whatever the lobbyist is saying.
Even the most unscrupulous of politicians should recognize that a few thousand dollars in campaign contributions and front row tickets to a college football game isn't a fair trade for handing pharmaceutical companies a blank check from an account with effectively infinite money. What happens is that the lobbyist butters the politician up and sounds smart, so the politician just listens to whatever the lobbyist is saying.
How? A politician is never tied to a medical result, or even "the good of the people". A politicians first priority is winning an election, not having administrative capabilities.
tommymachine(1)
Medicare is a cash cow for businesses. Anyone that tries to fix it is going to discover what it’s like to be part of a smear campaign.
the problem is that something as critical as people's health is allowed to exist as a commodity on the free market. when your life is at stake, there's no price that remains in the way. so these companies gouge out the consumer, pray on their fears. the last thing we need is to allow the free market to control health care even more than it already has.
Yet we somehow have food, water, and electricity. The problem isn't that its essential, it's that we grant monopolies, limit competition, and overall break any systemic feedback loops.
_you_ might have food, yet
over 10% of american citizens do not (https://www.feedingamerica.org/hunger-in-america/the-united-...). the later two categories you mentioned are classified as public utilities by the federal government (water and electricity).
the vibrancy of the health care in the United States is not the issue. by all economic measures, the health care market is incredibly vibrant and profitable. there are numerous companies that exist in each state, and dozens of options to choose from nationally. the problem is that there is a market for medical supplies which the government does not strictly limit and control, and multiple perverse profit layers which should not exist. your health care provider is not incentivized to help you, only exploit as much cash out of healthy people as possible while ensuring their "losses" (paying for those who are ill) are minimized. under a free market health care system where the goal is profit, this will always be the case
the vibrancy of the health care in the United States is not the issue. by all economic measures, the health care market is incredibly vibrant and profitable. there are numerous companies that exist in each state, and dozens of options to choose from nationally. the problem is that there is a market for medical supplies which the government does not strictly limit and control, and multiple perverse profit layers which should not exist. your health care provider is not incentivized to help you, only exploit as much cash out of healthy people as possible while ensuring their "losses" (paying for those who are ill) are minimized. under a free market health care system where the goal is profit, this will always be the case
Ideally that should be illegal and we shouldn't tolerate naked political corruption and bribery.
You can't take the oversight away from government, that's fundamentally what it does. You can't expect them to stand by forever when the private situation is a disaster that gets people killed either, like Purdue and their opiates.
So you hold both parties accountable. Neither is being held at gunpoint here - both are mutually consenting to an exchange, and thus both are responsible for the consequences thereof.
The tax payer is being held at gunpoint by the government: he must pay for this exchange involuntarily.
The private enterprise does not hold that privilege.
Or we prevent politicians from being bought out. Otherwise this can apply to anything and everything as it already does. Farm policies that help bust small farmers in favor of corporate farmers as an example. Then what we end up with is no government (which is fine with me but detestable by many) and local organizing.
I hope I'm alive to see the day voters scrutinize politicians whom take lobbiest contributions.
There are websites that lay it all out, but not many people bother to do our homework, including myself.
I have heard the insurance industry lobbiests, and not just medical insurance, pretty much control my state (California).
There are websites that lay it all out, but not many people bother to do our homework, including myself.
I have heard the insurance industry lobbiests, and not just medical insurance, pretty much control my state (California).
Me too. But people are too busy caring whether or not a D or R is present next to the name and what social policies are pushed. Who cares about economic policy when I really just want others to be forced to live with the morals I have? And in some cases, some voters do see those corporations and wealthy as people who should lead society. Like they they will actually admit it, but it can be seen from actions and comments.
Yes, this is a general argument against government. Government always tends towards corruption, so allowing it the total control of anything ends badly.
And places without strong government also tend towards corruption.
There was an interesting article on HN yesterday about the failure of nation building in Afganistan https://news.ycombinator.com/item?id=28271799
There was an interesting article on HN yesterday about the failure of nation building in Afganistan https://news.ycombinator.com/item?id=28271799
Allowing total control of anything with no input from those affected ends badly. It is independent of if that concentration takes the form of a corrupted government or capital accumulation or a warlord.
Of those only a democratic government at least has the theory of responding to those governed. Either forms tend to be a hierarchical application of power with few checks.
Of those only a democratic government at least has the theory of responding to those governed. Either forms tend to be a hierarchical application of power with few checks.
"Blame Medicare."
No, no I don't think I will.
Most shameless propaganda headline since "Don't blame Blackrock for the housing crisis, blame your neighbors."
No, no I don't think I will.
Most shameless propaganda headline since "Don't blame Blackrock for the housing crisis, blame your neighbors."
I don't see how that last statement isn't true. Blackrock isn't putting guns to people's heads nor is it abusing eminent domain to get these houses.
Yes, let's just pretend that the whole context in which they're operating is entirely dependent of their lobbying efforts, connections to the government and Federal Reserve, etc
How do those factors affect the seller's due diligence? I'll agree with the potential conflict of interest, but conflict of interest on its own doesn't stop anyone else from buying homes for their own purposes, even those among the highest levels of government. Unless such a sale is accomplished through an abuse of eminent domain or fraudulent representation, any transactions ought to be between buyer, seller, and contractually relevant parties.
And as side note, lobbying is not a bad word. Anyone who vouches for, or on behalf of one's interests before government is a lobbyist by definition. That goes for John Q Public as much as it does for Blackrock.
And as side note, lobbying is not a bad word. Anyone who vouches for, or on behalf of one's interests before government is a lobbyist by definition. That goes for John Q Public as much as it does for Blackrock.
There is nothing with business protecting their interests with lobbysts or without.
Only people who you could blame are lawmakers. They are the people with real power and your interest representatives.
Only people who you could blame are lawmakers. They are the people with real power and your interest representatives.
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The NHS manages to negotiate some of the best drug prices in the world. I bet drug companies just love the opposite of Medicare and nationalised health. As I understand it other countries have an agency that stops drugs coming into the market if their cost doesn’t justify their improvement in outcomes. America just lets all drugs that are safe come onto the market at any price. https://www.vox.com/platform/amp/science-and-health/2016/11/...
Australia allows drugs on the market if they pass the TGA (our FDA) approval process.
Our PBS, the Pharmaceutical Benefits Scheme, which subsidizes drugs, is similar to the UK's NICE, which evaluates drugs to compare their price to the effectiveness in terms of QALY (Quality Adjusted Life Years) and other metrics.
The PBS then negotiates with the drug manufacturer, who either meet the government's price, or don't. If they don't, then the drug is not subsidized. So it's in the manufacturer's interest to get a large purchaser to buy the drug.
Our PBS, the Pharmaceutical Benefits Scheme, which subsidizes drugs, is similar to the UK's NICE, which evaluates drugs to compare their price to the effectiveness in terms of QALY (Quality Adjusted Life Years) and other metrics.
The PBS then negotiates with the drug manufacturer, who either meet the government's price, or don't. If they don't, then the drug is not subsidized. So it's in the manufacturer's interest to get a large purchaser to buy the drug.
> What price might you charge if the major purchaser for your drug has committed to pay whatever “other customers” pay? Biogen, the drug’s manufacturer, came up with a price of $56,000 per year.
So then I should be blaming the people setting the high price, as they're choosing to do this.
So then I should be blaming the people setting the high price, as they're choosing to do this.
Yeah such garbage logic, the company is clearly exploiting here
Because the rules set forth by the law have created an incentive to set the price that maximizes their profit. They have a customer who has to buy their product no matter what, and as a corporation beholden to shareholders they have a legal duty to maximize returns. I agree that it's a terrible system that incentivizes corporations into exploitative practices, but we can't really do anything about it without changing the rules they have to operate under.
That's a misunderstanding that I see a lot, they do not have a legal duty to maximize returns to shareholders.
Not the source I usually use for this but,
https://www.nytimes.com/roomfordebate/2015/04/16/what-are-co...
Not the source I usually use for this but,
https://www.nytimes.com/roomfordebate/2015/04/16/what-are-co...
I mean, you could give lectures and try to convince the CEOs to give up free money, or you could set up a system of rules that actually incentivizes reasonable drug prices. I can tell you which is going to work better.
> and as a corporation beholden to shareholders they have a legal duty to maximize returns
I never understood this point. If there is a legal requirement to maximize profit, CEOs should be legally required to have low compensations so as to maximize profit. But that is not the case. Why "maximize profit" does not apply to wasteful hyper paid CEOs?
Worse even. Most companies reduce profits by moving them to other countries with lower taxes. Would not that be against the law?
I never understood this point. If there is a legal requirement to maximize profit, CEOs should be legally required to have low compensations so as to maximize profit. But that is not the case. Why "maximize profit" does not apply to wasteful hyper paid CEOs?
Worse even. Most companies reduce profits by moving them to other countries with lower taxes. Would not that be against the law?
Just because someone is incentivized to do something, it doesn't mean they're absolved of all responsibility or blame when they do that thing.
Of course it doesn't. But a lot of the time, those people will not care whether you blame them or not. They'll just keep doing it. If there's a loophole, some unscrupulous person or company will always exploit it. Go ahead and blame them. When you've gotten that out of your system, change the law.
> they have a legal duty to maximize returns
They have a fiduciary duty to shareholders. That just means they have to act honestly, fairly, and always in the best interest of the shareholders. That's not at all the same thing as a duty to "maximize returns".
They have a fiduciary duty to shareholders. That just means they have to act honestly, fairly, and always in the best interest of the shareholders. That's not at all the same thing as a duty to "maximize returns".
We all, including politicians, threw their hands up when Skirelli got greedy.
SEC went after him for show.
Not one law was enacted to prevent another greedy entity from doing the same thing.
(I don't even blame the guy. Everything he did with that drug was legal. I do blame politicians whom did nothing to stop the greed afterwards. I really think most of these old coots on both sides actually believe totally free market medicine will save them one day from old age.)
SEC went after him for show.
Not one law was enacted to prevent another greedy entity from doing the same thing.
(I don't even blame the guy. Everything he did with that drug was legal. I do blame politicians whom did nothing to stop the greed afterwards. I really think most of these old coots on both sides actually believe totally free market medicine will save them one day from old age.)
If you don't like a price of the product doesn't work, the best remedy is to not buy it. We need to change policy so Medicare doesn't have to buy it. This would fix the problem many drugs, not one.
Most corporate entities have a fiduciary duty to maximize their shareholders’ returns. If your solution to a problem is “companies just need to stop trying to make money”, then you’re probably going to be disappointed.
Do they really though?
https://medium.com/bull-market/there-is-no-effective-fiducia...
https://medium.com/bull-market/there-is-no-effective-fiducia...
The board dictates what the company does and share holders can vote the board out if they don't like what they are doing no? Most boards are interested only in money but that reflects the share holders and board more than some sacred pursuit of corps.
Public companies that don’t maximize profits will usually be targeted by activists who will replace the board and management with people who will max profits.
Say a company exists that doesn’t aggressively pursue profits. It makes $1/year and is worth $10 per share. If it started maxing profits it could make $2/year and be worth $20/share. An activist can come in and continue to pay well above market price, knowing that once he acquires enough shares, he’ll replace the board and raise the value of the shares.
The simple logic is that almost every public company will eventually evolve to maximize profit regardless of what other social mission they advertise. The sole exception is if a founder retains control of a very large proportion of voting stock.
Say a company exists that doesn’t aggressively pursue profits. It makes $1/year and is worth $10 per share. If it started maxing profits it could make $2/year and be worth $20/share. An activist can come in and continue to pay well above market price, knowing that once he acquires enough shares, he’ll replace the board and raise the value of the shares.
The simple logic is that almost every public company will eventually evolve to maximize profit regardless of what other social mission they advertise. The sole exception is if a founder retains control of a very large proportion of voting stock.
> Medicare bases its payments for physician-administered drugs on their average private market price.
Medicare is driving up prices by… paying market rate?
This reasoning seems to imply that Medicare somehow has the ability to time travel backwards and influence the choices of drug companies and private insurance to inflate prices which they then agree to pay. It literally implies that Medicare reacting to private market is exactly the same thing as controlling the private market. This strikes me as completely incomprehensible at best and a nakedly bad faith attack on Medicare at worst
Medicare is driving up prices by… paying market rate?
This reasoning seems to imply that Medicare somehow has the ability to time travel backwards and influence the choices of drug companies and private insurance to inflate prices which they then agree to pay. It literally implies that Medicare reacting to private market is exactly the same thing as controlling the private market. This strikes me as completely incomprehensible at best and a nakedly bad faith attack on Medicare at worst
I am not an American but I think you have it back to front. It seems because they know the biggest customer (medicare) will have to pay what smaller customers pay, they simply charge huge amounts to the smaller customers.
From an economics perspective the demand curve is inelastic. Medicare will pay whatever the price is as long as there is one other buyer paying that price.
From an economics perspective the demand curve is inelastic. Medicare will pay whatever the price is as long as there is one other buyer paying that price.
Of course drug companies consider the buyers of their product when setting prices. I also don't think the article is suggesting abolishing Medicare just changing it's process to buying drugs.
In other countries, the cost/benefits analysis would be done and you'd just not get the drug until it's cheaper.
In the US, healthcare is addicted to new technologies even if they improve outcomes by 0.01% while being 10x more expensive.
In the US, healthcare is addicted to new technologies even if they improve outcomes by 0.01% while being 10x more expensive.
The statistics do not show that we improve outcomes even though we spend more.
Almost every metric for the quality of healthcare outcomes in the US is worse than most european countries. For example, if you sort the under 5 mortality rate [0], you'll see that the United States comes in 47th, after Cuba, Russia, Qatar, and basically all of western europe.
If you check life expectancy, you'll find similar subpar numbers. Ditto for infant mortality.
You can easily argue that life expectancy is partly lifestyle based (the fast food industry killing us rather than healthcare), but for infant mortality and under-5 mortality, those numbers should track quite well with the quality of our medical system I think. And those numbers, well, our medical system is obviously doing quite poorly compared to other countries that spend far less.
[0]: https://en.wikipedia.org/wiki/List_of_countries_by_infant_an...
Almost every metric for the quality of healthcare outcomes in the US is worse than most european countries. For example, if you sort the under 5 mortality rate [0], you'll see that the United States comes in 47th, after Cuba, Russia, Qatar, and basically all of western europe.
If you check life expectancy, you'll find similar subpar numbers. Ditto for infant mortality.
You can easily argue that life expectancy is partly lifestyle based (the fast food industry killing us rather than healthcare), but for infant mortality and under-5 mortality, those numbers should track quite well with the quality of our medical system I think. And those numbers, well, our medical system is obviously doing quite poorly compared to other countries that spend far less.
[0]: https://en.wikipedia.org/wiki/List_of_countries_by_infant_an...
Even if they don't improve outcomes at all.
https://www.nytimes.com/2021/07/19/health/alzheimers-drug-ad...
https://www.nytimes.com/2021/07/19/health/alzheimers-drug-ad...
Within biopharma, certain therapeutics have no hope of being sufficiently successful without Medicare. (The American taxpayer subsidises sales to support the massive expected profits.1) It is part of the marketing strategy, and thus the drug delivery strategy, that these drugs be eligible for Medicare. For example, let's say the drug is to be administered by the patient at home, unlike the drug in the article. The drug delivery strategy would be a system that qualifies for coverage under Part B. Medicare coverage is essential.
1 Personal opinion: This may be a recurring pattern we can see in other industries, too. Look for a situation where the customer cannot afford the product so the seller relies on the government, i.e., the taxpayer, to help the customer pay. One recent example is the steady rise in university tuition, student lending and now the student debt crisis.
1 Personal opinion: This may be a recurring pattern we can see in other industries, too. Look for a situation where the customer cannot afford the product so the seller relies on the government, i.e., the taxpayer, to help the customer pay. One recent example is the steady rise in university tuition, student lending and now the student debt crisis.
This headline is exhibit A of how the NYT is our Pravda, the propaganda arm for the .0001%.
This is an opinion piece, not the views of the editors. They also have many opinions pieces in favor of universal healthcare and other ways to lower drug prices besides abolishing Medicare if you do some googling.
I am reading the article using the NYT android app, and "opinion" is not mentioned anywhere, I copied the url and checked it on a browser, there is no opinion tag, and the url had no /opinion/ segment. So, I don't think this one is an opinion piece.
It's some column they're calling "Economic Views" with the description saying it's "A column that explores life through an economic lens with leading economists and writers." They probably should put that it's an opinion on the top of the article just to be clear upfront.
Click-bait headline.
It doesn't say Medicare has decided to cover it yet, it's under review.
And only some privately administered Medicare plans have decided to cover it.
Some hospital systems are doubting the efficacy and refuse to administer it.
No doubt, it's a huge market. But the fact that it's a monthly infusion makes it a tough proposition.
Sovaldi was a miracle drug, priced like a Bentley. This drug is no miracle drug, but they priced it like one.
It doesn't say Medicare has decided to cover it yet, it's under review.
And only some privately administered Medicare plans have decided to cover it.
Some hospital systems are doubting the efficacy and refuse to administer it.
No doubt, it's a huge market. But the fact that it's a monthly infusion makes it a tough proposition.
Sovaldi was a miracle drug, priced like a Bentley. This drug is no miracle drug, but they priced it like one.
> the exorbitant cost of drugs that need to be administered by physicians
Can someone with more familiarity explain why some drugs need to be “administered by physicians”? Why can’t patients self administer or why can’t a less expensive job role be imagined for a simple 5 minute visit for drugs administered in an outpatient setting?
Also, for regular drugs and prescriptions, why are doctors involved at all and why does the FDA regulate access to them, creating time and cost barriers? I feel like much of the time, my physician or a physician’s assistant aren’t providing any useful diagnosis or guidance toward a prescription that I couldn’t have figured out myself. The gatekeeping almost always is frustrating because I get no value out of them. I’m especially annoyed since some of the drugs I’ve been prescribed aren’t even controlled in the EU but are in the US.
Can someone with more familiarity explain why some drugs need to be “administered by physicians”? Why can’t patients self administer or why can’t a less expensive job role be imagined for a simple 5 minute visit for drugs administered in an outpatient setting?
Also, for regular drugs and prescriptions, why are doctors involved at all and why does the FDA regulate access to them, creating time and cost barriers? I feel like much of the time, my physician or a physician’s assistant aren’t providing any useful diagnosis or guidance toward a prescription that I couldn’t have figured out myself. The gatekeeping almost always is frustrating because I get no value out of them. I’m especially annoyed since some of the drugs I’ve been prescribed aren’t even controlled in the EU but are in the US.
The model you describe does exist, pharmacies with an onduty pharmacist are allowed to prescribe a wide and large range of prescription-only drugs in Thailand, cost is competitive - if you take the generics the brief consultation and antibiotic's can be as little as $1 total. This includes large chain pharmacies like Boots and Watsons, waiting for the onduty pharmacist at smaller independent might not be so strict/official and better for certain hmm..
> Can someone with more familiarity explain why some drugs need to be “administered by physicians”?
There is no need, this is purely regulatory capture at work.
> Why can’t patients self administer
Probably because it's expensive to make and the potential for abuse is very high.
> why can’t a less expensive job role be imagined for a simple 5 minute visit for drugs administered in an outpatient setting?
We do have a "less expensive" job role. There are nurse practitioners who could be doing the vast majority of work that we have doctors doing right now with significantly less training with basically no downsides other than to doctors, whose value would plummet. Granted, doctors in the United States are probably way overcompensated as a result of the regulations in place. In Great Britain, being a physician isn't nearly as lucrative (though it's also less time consuming/expensive to become one).
> Also, for regular drugs and prescriptions, why are doctors involved at all and why does the FDA regulate access to them, creating time and cost barriers?
Probably to prevent public health crises like the opium epidemic, though, you'll notice, this happened despite the best efforts of the government to prevent it. Gating access to drugs is largely to prevent abuse, though maybe there should be reform with regards to how we control access to these. Should I need to go to a doctor or could I just get a recommendation from a Pharmacist? Maybe we could designate a class of drugs acceptable for Nurse practitioners to prescribe. Maybe most drugs should just be available over the counter? The way we categorize drugs is probably too restrictive, though it isn't the primary reason drug prices are driven up.
> I feel like much of the time, my physician or a physician’s assistant aren’t providing any useful diagnosis or guidance toward a prescription that I couldn’t have figured out myself. The gatekeeping almost always is frustrating because I get no value out of them.
Any time a doctor comes to a different conclusion from me, despite me knowing my own body better than she does and doing plenty of my own research, obviously I'm going to be frustrated. I might even be right. But that doesn't mean that I'm generally going to be right more often than they are. I think you're probably overestimating your own abilities while discrediting the capabilities of your doctors here because doctors don't always do what you want.
There is no need, this is purely regulatory capture at work.
> Why can’t patients self administer
Probably because it's expensive to make and the potential for abuse is very high.
> why can’t a less expensive job role be imagined for a simple 5 minute visit for drugs administered in an outpatient setting?
We do have a "less expensive" job role. There are nurse practitioners who could be doing the vast majority of work that we have doctors doing right now with significantly less training with basically no downsides other than to doctors, whose value would plummet. Granted, doctors in the United States are probably way overcompensated as a result of the regulations in place. In Great Britain, being a physician isn't nearly as lucrative (though it's also less time consuming/expensive to become one).
> Also, for regular drugs and prescriptions, why are doctors involved at all and why does the FDA regulate access to them, creating time and cost barriers?
Probably to prevent public health crises like the opium epidemic, though, you'll notice, this happened despite the best efforts of the government to prevent it. Gating access to drugs is largely to prevent abuse, though maybe there should be reform with regards to how we control access to these. Should I need to go to a doctor or could I just get a recommendation from a Pharmacist? Maybe we could designate a class of drugs acceptable for Nurse practitioners to prescribe. Maybe most drugs should just be available over the counter? The way we categorize drugs is probably too restrictive, though it isn't the primary reason drug prices are driven up.
> I feel like much of the time, my physician or a physician’s assistant aren’t providing any useful diagnosis or guidance toward a prescription that I couldn’t have figured out myself. The gatekeeping almost always is frustrating because I get no value out of them.
Any time a doctor comes to a different conclusion from me, despite me knowing my own body better than she does and doing plenty of my own research, obviously I'm going to be frustrated. I might even be right. But that doesn't mean that I'm generally going to be right more often than they are. I think you're probably overestimating your own abilities while discrediting the capabilities of your doctors here because doctors don't always do what you want.
One of the other mysteries for me is why simple office visits with limited time with a professional still cost hundreds. I acknowledge nurse practitioners exist but it doesn’t seem to have helped pricing much from where I’m standing. I still see mysterious codes billed and exorbitant expenses, often for only 15 minutes of time with a FNP, and usually after lengthy wait times at my expense.
Theoretically requiring a physician acts as a check against misuse of the medicine or allows for more control over reactions to the medication. There are drugs that would likely not be approved without some restriction on administration.
This particular drug is Intravenous Infusion Therapy. It's IV fluid and it takes up to 1 hour. And it's administered by nurses trained on IV, not physicians. It can be done at Infusion therapy centers.
How can doctors in the US afford helicopters and yachts?
How can data scientists and devops engineers afford real estate in California and early retirement?
Genuine question: if drug pricing was altered resulting in much lower prices, would the same research and development still occur?
Would people be willing to pool capital to pursue FDA approval?
Would other countries still get low prices?
This isn't an argument for anything so I don't need rhetorical unrelated comparisons, I’m wondering if this has been evaluated and studied, or maybe if there were case studies from prior time periods or other countries
Would people be willing to pool capital to pursue FDA approval?
Would other countries still get low prices?
This isn't an argument for anything so I don't need rhetorical unrelated comparisons, I’m wondering if this has been evaluated and studied, or maybe if there were case studies from prior time periods or other countries
Can someone explain to me why I should care about drug prices when they're covered by medicare (as a private person and an American, which I am not, thus asking).
As an Austrian I don't know what my meds cost. I pay a flat fee of 6 Euros per package at the drugstore if I have a prescription. And I can't get my main ones without one.
As an Austrian I don't know what my meds cost. I pay a flat fee of 6 Euros per package at the drugstore if I have a prescription. And I can't get my main ones without one.
Because someone still has to pay for the drugs through tax and/or subsidized through paycheck (if you have private insurance).
You might pay 6 euros per package, but that could be a 50 euro drug. The 44 euro difference is being made up through your nationalized healthcare.
If by and large, most of the drugs are reasonably priced, then a flat fee structure of 6 euros is possible, because it's small enough sum that it could easily be paid by other people who is paying into the pool, but not using the healthcare service.
In fact, up until 15-20 years ago, it was common for American health plans to have flat fee of $5-$10 for most drugs.
That went straight out the window with emergence of more expensive medications that costs tens of thousands of dollars per patient per year, which completely skewed the average price of medications, and flat fee of $5-10 became unsustainable.
Nowadays, $25-30 is the norm depending on your plan, and if your plan covers it. $50-100 is common if you insist on taking medications for which there are cheaper alternatives.
You might pay 6 euros per package, but that could be a 50 euro drug. The 44 euro difference is being made up through your nationalized healthcare.
If by and large, most of the drugs are reasonably priced, then a flat fee structure of 6 euros is possible, because it's small enough sum that it could easily be paid by other people who is paying into the pool, but not using the healthcare service.
In fact, up until 15-20 years ago, it was common for American health plans to have flat fee of $5-$10 for most drugs.
That went straight out the window with emergence of more expensive medications that costs tens of thousands of dollars per patient per year, which completely skewed the average price of medications, and flat fee of $5-10 became unsustainable.
Nowadays, $25-30 is the norm depending on your plan, and if your plan covers it. $50-100 is common if you insist on taking medications for which there are cheaper alternatives.
Because you pay one way or another, via taxes in Austria, or via insurance deductions in other countries, or sometimes a combination of both. With the tax route their is also austerity, we won't buy that park for children cos paying for a single customer of biogen for twelve months has removed that opportunity (these decisions are obviously at aggregate scale). Tldr you pay way more than six euros unless it's just a nonpatent generic antibiotic or fever medicine
I'm actually not as mad about them blaming medicare, as much as I'am mad about them blaming something that isn't the cause of the problem (UK, Canada, Australia, hello?) this is to distract people from the real cause (deregulation), so that the problem stays.
Umm.. Medicare already announced they are doing a National Coverage Determination (NCD) to determine if they will pay for it and for whom.
And yes, Medicare can negotiate drug prices through Part D or take discounts by fiat through Part B.
And yes, Medicare can negotiate drug prices through Part D or take discounts by fiat through Part B.
Are you sure Medicare negotiating drug price through Part D?
I know the bill has been out there forever, but it's far from being enacted.
https://www.congress.gov/bill/117th-congress/house-bill/3
I know the bill has been out there forever, but it's far from being enacted.
https://www.congress.gov/bill/117th-congress/house-bill/3
Part D drugs are administered through private insurers and they do negotiate on drug prices, then compete for patients with lower premiums.
Blame the complete and total lack of any competition as well. To this day hospitals often outright refuse to quote the pricing of treatments and drugs, drugs can't be re-imported from cheaper locales (such as India or even Canada), and if one happens to be uninsured, hospital prices are truly eye watering even though you're paying cash, and hospital would not get anywhere near as much if you went through insurance. One would hope the _realistic_ solutions to all of this are blindingly obvious, and yet...
Big Pharma is so deeply entrenched that Trump couldn't even make any headway with "favored nations" domestic pricing that he proposed. It makes sense: I, a freelancer, for instance, can't charge my larger clients more because of such a clause.
And whatever drugs he did make cheaper (insulin, epi pens), Biden restored the pricing on almost immediately after taking office. Read the fact checks, they bury this particular lede really, really well, so you'll have to read very carefully, much like I used to read Pravda when I was a kid in the USSR.
Big Pharma is so deeply entrenched that Trump couldn't even make any headway with "favored nations" domestic pricing that he proposed. It makes sense: I, a freelancer, for instance, can't charge my larger clients more because of such a clause.
And whatever drugs he did make cheaper (insulin, epi pens), Biden restored the pricing on almost immediately after taking office. Read the fact checks, they bury this particular lede really, really well, so you'll have to read very carefully, much like I used to read Pravda when I was a kid in the USSR.
You have to be extra gullible to fall for this