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21 November 2020

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Fred

Just picked up a prescritption for an opthalmic anti-biotic. $257. Oh, wait, there's a coupon! $35. Which says to me this is a $35 medication. The other med, which has been around for decades, $16.50. I'm sure this would be $10 with the Orange Man's plan. Under Obama it would be, hey, wait, why didn't Obama do something about this in his 8 years?

Deap

Cost of health care in Ameica is driven more by medical malpractice attorneys than anything else. Bring in the same medical malpractice protections found in those other "economically advanced countries" at the same time.

Trial lawyers fund the Democrat party at least in my state.

Which is why we have never really seen effective medical malpractice reform and doctors continue to practice "defensive medicine", claiming they don't sue you for what you do, they sue you for what you don't do. So do everything whether the patient needs it or not or whether there is any evidence of it efficacy or value, as long as it is paid for by OPM.

And that is why American health care costs are the highest in the world, yet health outcomes rank near the bottom of "economically advanced countries."

Bring in the same medical malpractice protections, if you want to conform US cost to other nations. It is a start in the right direction if one is serious about lowering health care costs.

And this is an important psychological cost Americans need to be willing to pay. If part of US medical care means being able to sue the bastards if/when anything goes wrong, then this might not be the right choice.

We too often do as a nation worship being victims and making someone else pay; rather than acknowledge the inherent fragility of life and the risks already built into the journey of life.

Gimme a drug with no known utility or efficacy and I will sue the pants off you if it harms me in any way I can get a jury to accept ....is no way to build a "universal health care system" on the taxpayers dime.

Deap

Fred, DH is a retired ophthalmologist and when traveling in Mauritius a few years back needed to pick up some anti-biotic drops for me to use for my eye infection.

He was able to do this as a reciprocal physician courtesy in Mauritius - RX grade product and it probably cost $15 or so. It worked the way it was supposed to work and infection soon cleared up.

His son in law recently had to use antibiotic eye drops and DH was shocked how much they cost now in the US, somewhere in the hundred or so dollars. And there in hangs the tale.

Take home message: there is no upper limit to the costs of "universal health care" in the US unless we ration it. Who is ready for that battle?

If we buy "socialist Scandinavia's" universal health care model, we have to buy the whole practice which includes rationing, death panels and restricted medical malpractice provisions. Unlimited free stuff for everyone on demand is not "health care"; it is one more blank check written to Democrat special interest groups.

walrus

Healthcare in the USA is just disgusting as to cost. You pay 17%+ GDP for a rotten corrupt system. Most developed countries have excellent systems for around 8% GDP.

last night I heard from an acquaintance who was hospitalised in the US. She had travel health insurance so was OK. However there was another guy in the ward who had some condition in his limbs. - he was bargaining with the hospital staff to try to save an arm and a leg - he didn’t have enough money to save both. The hospital told him to choose which to save. Disgusting.

You have been duped into worrying about how to pay for healthcare when you should be querying it’s insane cost.

walrus

Example of insane, corrupt medical costs:

ACL reconstruction.

Australia - $8650, out of pocket $600 maximum.

https://www.medibank.com.au/health-support/hospital-assist/costs/acl-repair/

USA - $14800

https://www.healthgrades.com/right-care/acl-surgery/how-much-does-acl-surgery-cost

....the Democrats won’t fix this either.

Eric Newhill

Pharma makes their profit in the US because insurance finances the cost. They let their surplus go cheap- just marginal profit at best - in other countries that have price controls.

In some ways, the other countries are screwing the US consumer. At least that's one way to look at it.

Biden will undo this as soon as he hits the whitehouse.

Deep, it isn'y malpractice that causes high costs in the US. It's because we have the best and the most and we develop a lot of new stuff - the Cadillac SUV as opposed to the the tiny under-powered Euro-econo-car - and insurance finances the consumption of all that new stuff. Some of it adds a lot of value. Much adds only marginal benefit and that benefit is less than the cost, but US consumers want every last iota of care. Try taking it away via rationing like other countries. Americans squeal like stuck pigs and that's when they start looking to sue ("you coulda done more to keep dear old mom alive!")

james

those "who liken it to socialism" reminds me of the labelling against those trying to shut down any progressive change toward israel as "anti-semitism"...eventually these cheap and meaningless labels are seen as irrelevant.. ordinary people start ignoring them more and more..

@ eric newhill... i think it is big pharma that is screwing the US consumer... blaming it on other countries is nuts as i see it.. the usa is so in bed with corporations - big pharma included, the public doesn't appear to know where to start to get out of this downward spiral.. the usa is also in bed with wall st and the insurance industry you mention.. ordinary people suffer no matter how you splice it..

upstater

Why did the president wait until November 2020 to issue this policy?

This could have been accomplished 46 months ago. SAD!

Deap

Eric, US trauma care is probably second to none. The big money comes from fleecing the millons of worried-well; an entirely different segment of the "health care" market dynamics.

walrus

Eric Newhill, your argument is utter BS. I was CEO of a University commercialisation company and sat on the Board of drug development start ups. You do not have a cadillac health system, for the poor they get fed s@@t as evidenced by your infant mortality and life expectancy comparisons. As for death panels and rationing, total BS.

Furthermore, Europe and Australia are not “marginal cost dumping grounds” for drugs.

Most drugs cost pennies per dose to produce. The costs you see are FDA approvals costs and marketing. A drug company I know used to pick up doctors by helicopter and fly them to exquisite restaurants for lunch - this gives you an idea how profitable drug supply is in Australia even at the lower prices we pay.

Furthermore most drug discoveries are made in university labs then put into startups and only get to big pharma after ten million or more of risk capital has been spent on phase I and II trials.

Big pharma are a f@#$ing racket. I’ve dealt with them, including the slimiest - purdue pharma - who gave you oxycontin.

ked

he’s into vengeance, for sure. & even the slightest slights, perceived or real, will do. he lives in a reality of his own devise.

“I have not spoken with the president-elect,” Blackburn said.”
Later Friday night, a spokesperson for Blackburn said the comment was a mistake and that Blackburn had “been very clear” on her position about the election outcome.

https://www.rawstory.com/2020/11/de-niro-calls-out-trump-as-mobster-and-republicans-understand-why/

Mark

hope this helps,have personal example with not tolerating statin drug,but unable to get the psck9 alternative covered by insurance.am in awe of the companies that are able to develop these wonder drugs and do not want to stifle development.thx

William RAISER

I appreciate your blog. It seems to stand alone as a source of real news about the on-going coup-d'état occurring in the US. Thanks.

Eric Newhill

Walrus,
Apples to oranges. In the US you'd have the latest models of scopes and computer imaging, etc. and the surgery would be done sooner. Is that worth an extra $6,200? I don't know; probably not, but I really don't know because I've never had one knee done in the US and the other done in Australia by the got system. Apparently Aussies say "yes, it's worth it". 50% of healthcare down under is paid for by privately purchased insurance that is exempt from the govt controls.

Sometimes the US delivers demonstrably better care; albeit at a higher price. We already discussed mastectomies. You agreed that in Australia they cut off the breast and that's it. In the US breast reconstruction ( a $15K to $20K value) is considered by all major insurance companies to be part of the mastectomy service.

Alexandria

The "Orangeman" is, as usual, a day late and a dollar short. If he had made it a priority on Day 1 to help the people who actually put him in the White House with, for example, infrastructure, including starting work on the wall on Day 1, and lowering prescription drug prices, instead of a tax cut for the 1%, moving the U.S. Embassy to Jerusalem and the preoccupation with repeal and replace the ACA (with what pray tell?), he'd be gearing up for an inauguration and a second term.

turcopolier

Bob R.

Would you have voted for him if he had done those things?

turcopolier

William Raiser

Apparently the coup has been on-going for a while. The dimensions of it are as yet not discernible.

Eric Newhill

Walrus,
One more point - what the provider (hospital/doctor) bills is not what is paid by insurance. We normally pay only a % of billed. I just looked something up and can tell you that providers are not be reimbursed $14,800 for ACL surgery. In fact, they are being paid about the same as what they are paid down under. Now if a US person did not have insurance, then they would pay the full $14,800 - although maybe they could negotiate. Providers regularly bill some extraordinary amount. That is their way of negotiating with insurance. Here's what it really cost us boohoo you don't pay us enough.

Eric Newhill

Deep,
I earned a masters degree studying healthcare economics, passed actuarial exams and have worked for major health care insurance companies studying cost drivers for the purpose of predicting future costs/pricing premiums, contracting with providers, etc, but, especially, looking for ways to lower costs. If we can lower cost while maintaining access to quality care, we are more competitive. I've been doing this for 20 years. I've worked my way to a senior management position with one of the big companies. I confess that Rx is not my area of expertise. I of course use Rx figures in my analysis, but I lack a thorough knowledge of the business underpinnings. The Rx guys are a separate cloistered team and they tend to keep their insider insights on a need to know basis.

This is a very complicated subject and soundbites don't do it service. I will say that focussing on big corporations is not totally fair. Doctors, hospitals and suppliers of medical tech (including drugs) are fierce competitors seeking to maximize profits. An insurance company must provide an adequate network of providers (e.g. a members must have access to hospitals, family medicine, primary care and all kinds of specialists). There are state laws governing all of that. That gives the providers a bargaining position. We need them. Providers form cartels to ensure that none breaks ranks and begins a trend of negotiating for reimbursement rates that are viewed as unfavorable to the others. Providers also demand that they have the latest and greatest technology. That costs money. That cost gets passed along in billing and reimbursement.

Obesity and associated life style choices in the US is responsible for around 25% of total healthcare expenditures. Think about that. We have members (patients) who individually cost us - the insurance company and ultimately other members (in their premiums) - hundreds of $thousands and even $millions every year. We cover every last possible approach to keep them alive.

I wish I had more insiders info on Rx. All I know is that I have consistently been told over the tears that US insurance de facto finances development by agreeing to reimburse at a high rate. That allows Pharma to recuperate all of the R&D, FDA testing, marketing, etc. Pharma knows that insurance will pay. If insurance doesn't agree to pay, we start seeing stories about dear old mom, the poor widow, who died because insurance wouldn't cover the drug that would have saved her life. Like I said, it's complicated. The cost of a jet trip to a fancy hotel is a meaningless drop in the ocean costs. Perspective is important.

leith

Alexandria - Bingo! I'm stealing your comment to put on twitter if you have no objections.

Fred

Deap,

Mauritius is an island off the East Coast of Africa and is a long way from a lot of places but you were there and couldn't get basic meds without an retired doctor interceding for you? Will wonders never cease. Ofloxacin is a basic opthalmic anti-biotic, it's $16, less on Chewy since pets get eye infections too.

Upstater,

I remember when Obama fixed health care so well prescription costs came down. Oh, wait, never mind.

blue peacock

Too little, too late, IMO. But good nevertheless! Why should pharmaceuticals be given protection from competition? If they can sell the same drug for one-tenth the price in another country why shouldn't an importer take advantage of the price arbitrage?

My cousin is a physician in Tennessee. He and some of his other doctor partners began a private practice in the 90s. Their town consolidated to two major hospital systems. One of them approached them a few years ago with a buyout that did not provide them the valuation that they had built. The offer was simple. Either accept our low-ball offer or stop sending your patients to our hospital system. This is an example of cartel behavior.

Healthcare is no different than most other market segments where market concentration has grown over the past 40+ years to the point that a few dominant players remain in most market categories. They rule the roost!

walrus

Eric Newhill, you are completely wrong in your characterisation of the healthcare in other countries being second rate compared to America.

We have plenty of state of the art equipment and state of the art doctors. So does the rest of the world. We are not Cuba.

As for your comments on breast cancer you are misinformed or just plain crazy.

My wife was diagnosed with it five years ago. Within three days she had a top surgeon and oncologist as consultants. She was going to need surgery. A week later she was invited to join an international clinical trial.of a new drug. She underwent about five months of chemo -which is now done before surgery. She had a mastectomy, radiation, breast reconstruction, counselling that is ongoing. The drug she was treated with worked and scoured the cancer out of her lymph nodes, you will read about it eventually.

In my wife’s case and my late partners case, I specifically asked the specialists if better treatment was available in the US or Europe - being prepared to pay a million if necessary, and got the same answer:”no”.

We have a vaccine manufacturing facility in Melbourne and are about to spend $800 million on a second one. We are already starting on production of the Oxford/zeneca vaccine, an Australian Mrna vaccine and goodness knows what else.

You have been brainwashed by American pharma. Your price/value proposition for American healthcare is rancid.

Leith

Or he could have done what Granny Nancy and the House Dems have wanted to do for years, which McConnell and the big pharma lobbyists have repeatedly blocked:

1] Give Medicare the power to negotiate directly with the drug companies.

2] Make the lower drug prices negotiated by Medicare available to Americans with private insurance, not just Medicare beneficiaries.

3] Stop drug companies ripping off Americans while charging other countries less for the same drug..

4] Create an out-of-pocket limit on prescription drug costs for Medicare beneficiaries.

5] Reinvest in innovation and the search for new cures and treatments, using some of the savings from lowering the unjustified drug prices that are bankrolling Big Pharma’s stock-buybacks to reinvest billions of dollars in the search for new breakthrough treatments and cures at the National Institutes of Health.

Eric Newhill

Walrus,
Here's a link to your system on the topic of breast reconstruction -https://www.canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/comparison-public-versus-private-breast-reconstruction-surgery

Maybe they pay for it, maybe they won't, maybe they pay for some of it...it's up to the govt. to review on a case by case basis.

As for your gaslighting, I suppose I could use the search engine to find your comment from a couple years ago wherein you told me that your partner had a mastectomy and the reconstruction wasn't covered. I'm too lazy at the moment and don't care enough, frankly. We both know what you said. Unless you have gotten to that age where you don't recall. I'm going to write it off as that and let it go.

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