$1,000 a pill. Worth it?

[anewmanx]

It worked because there's a bottomless wallet/benefactor across the pond.

If price controls went into effect, investors would pull money out of pharma companies so fast, you'd hear a giant sucking noise. I know I would....i'd put my investment money in something that would actually make me money and not satisfy some utopian free medicine wet dream.

I do have to admit that I find it very amusing that you refer to Europe as having a bottomless wallet when the United States leads the world in debt, budget deficit, and poor financial decisions. I happen to be an American, a retired soldier, and a believer in fiscal frugality (I.E. I don't use loans unless they are absolutely necessary, I don't use credit cards, I drive only used cars that I know how to repair, I pay cash for everything, I prepay medical bills, etc...) But, I believe that the current economic model being employed in the United States is tantamount to insanity. How is it other countries can have a budget surplus? Can you imagine, what if we actually had a surplus. What a crazy thought.

Long term I don't see things going well for our country, and I will likely retire abroad permanently after a few years of pharmacy work. I wouldn't have even chosen to go back to school if it weren't for my misgivings in the way money is handled in our country. Can I really count on my VA Compensation to come in for the rest of my life? What would I do if it stopped; I can't work as a soldier or correctional officer anymore, I'm too crippled.

The current state of affairs in the healthcare industry is one of my prime factors in the aforementioned consideration; and I have free healthcare through the VA and Tricare for my family (at no cost mind you.) Lovely little benefits of being crippled for your country. I think that the state of the healthcare industry is indicative of economic cancer; one that cannot be recovered from. It will eventually consume the paycheck of every person. It's already drying up the retirement funds of the elderly.

Case in point: My grandfather and grandmother has around 300,000 set aside for retirement/expenses, after raising 13 children and sending them all to college, back in the 1990's. My grandfather's stroke sucked up every bit of that money, without regard to the portion his insurance paid. This is the great healthcare system we have in America.

Last week here in Costa Rica. A wealthy uncle of my wife who pays his fare share (13% of net income) to the healthcare system here had a devastating heart attack. By the time someone found him he was already starting to have organ failure. He spent over a week in the hospital, had multiple surgeries, and is stuck peeing in a bag now. How much did this hospital trip cost him? NOTHING. How much will his recovery, therapy, and future expenses cost him? That 13% he pays every month.

Because the healthcare is available for next to free, he is able to pay for private care if he doesn't want to wait in long lines for public care. Cost? Maybe $80 a visit to a specialist, $40 to a gp, $20 a session for physical therapy, etc... Surgeries? Maybe $5-10k for a major abdominal surgery, $5-15k for heart surgery.

Could you imagine getting those kind of prices for private care in the states? Of course not, we don't have socialized medicine to mediate the costs and provide a viable option that forces medical care AND pharmaceuticals to be reasonable with their prices.

So, in my final statement, I don't think I'm some liberal wacko just because I believe in socialized medicine; nor do I consider it a liberal wet dream. It's the reality in the majority of the free world. I've experienced both systems, and I perceive one to be superior to the other. Especially considering the DROVES of other Americans I meet that are flying here just to get their medical care here.

Just last year I had a full tooth reconstruction with titanium inserts in my roots. Three sessions, over five hours of labor in the orthodontists chair. What did I pay? $300 cash. Cheaper than the deductible on my dental plan. The crown is an additional $100. Whoop dee do. You tell me which system is better.

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[Medstart108]

We differ on opinion regarding that. I don't believe in spending more than you make. That is the very definition of fiscal conservative. It took witnessing first hand how superior socialized medicine was to realize how idiotic our insurance/healthcare system in the United States is. Just to clarify, Obamacare is not socialized medicine. It is an insurance scheme and tax grab written by lobbyist that is destroying the country.

Yes, they do regulate how much a real estate agent can charge in commission. Same with mortgage brokers and the origination fee.

When you decide to keep costs low you either:

A: Spend a lot of government money paying the fees for the drugs
B: Don't provide the drug

Costa Rica isn't rich, i'd wager B is mostly the option.

It costs a crap ton of money to develop drugs because of all the safety measures that are involved.

 

[Medstart108]

I do have to admit that I find it very amusing that you refer to Europe as having a bottomless wallet when the United States leads the world in debt, budget deficit, and poor financial decisions. I happen to be an American, a retired soldier, and a believer in fiscal frugality (I.E. I don't use loans unless they are absolutely necessary, I don't use credit cards, I drive only used cars that I know how to repair, I pay cash for everything, I prepay medical bills, etc...) But, I believe that the current economic model being employed in the United States is tantamount to insanity. How is it other countries can have a budget surplus? Can you imagine, what if we actually had a surplus. What a crazy thought.

Long term I don't see things going well for our country, and I will likely retire abroad permanently after a few years of pharmacy work. I wouldn't have even chosen to go back to school if it weren't for my misgivings in the way money is handled in our country. Can I really count on my VA Compensation to come in for the rest of my life? What would I do if it stopped; I can't work as a soldier or correctional officer anymore, I'm too crippled.

The current state of affairs in the healthcare industry is one of my prime factors in the aforementioned consideration; and I have free healthcare through the VA and Tricare for my family (at no cost mind you.) Lovely little benefits of being crippled for your country. I think that the state of the healthcare industry is indicative of economic cancer; one that cannot be recovered from. It will eventually consume the paycheck of every person. It's already drying up the retirement funds of the elderly.

Case in point: My grandfather and grandmother has around 300,000 set aside for retirement/expenses, after raising 13 children and sending them all to college, back in the 1990's. My grandfather's stroke sucked up every bit of that money, without regard to the portion his insurance paid. This is the great healthcare system we have in America.

Last week here in Costa Rica. A wealthy uncle of my wife who pays his fare share (13% of net income) to the healthcare system here had a devastating heart attack. By the time someone found him he was already starting to have organ failure. He spent over a week in the hospital, had multiple surgeries, and is stuck peeing in a bag now. How much did this hospital trip cost him? NOTHING. How much will his recovery, therapy, and future expenses cost him? That 13% he pays every month.

Because the healthcare is available for next to free, he is able to pay for private care if he doesn't want to wait in long lines for public care. Cost? Maybe $80 a visit to a specialist, $40 to a gp, $20 a session for physical therapy, etc... Surgeries? Maybe $5-10k for a major abdominal surgery, $5-15k for heart surgery.

Could you imagine getting those kind of prices for private care in the states? Of course not, we don't have socialized medicine to mediate the costs and provide a viable option that forces medical care AND pharmaceuticals to be reasonable with their prices.

So, in my final statement, I don't think I'm some liberal wacko just because I believe in socialized medicine; nor do I consider it a liberal wet dream. It's the reality in the majority of the free world. I've experienced both systems, and I perceive one to be superior to the other. Especially considering the DROVES of other Americans I meet that are flying here just to get their medical care here.

Just last year I had a full tooth reconstruction with titanium inserts in my roots. Three sessions, over five hours of labor in the orthodontists chair. What did I pay? $300 cash. Cheaper than the deductible on my dental plan. The crown is an additional $100. Whoop dee do. You tell me which system is better.

Well if your grandfather had insurance or was on medicare he would have been covered. Also, your wealthy uncle had a heart attack, so he got back the taxes he put in. What happens to the wealthy guy who never has a heart attack and takes care of his body, he ends up subsidizing the poor guy who doesn't live a healthy life. I guess that is fine, but there are always sacrifices when you switch from a private system to a public system.

 

[anewmanx]

Well if your grandfather had insurance or was on medicare he would have been covered. Also, your wealthy uncle had a heart attack, so he got back the taxes he put in. What happens to the wealthy guy who never has a heart attack and takes care of his body, he ends up subsidizing the poor guy who doesn't live a healthy life. I guess that is fine, but there are always sacrifices when you switch from a private system to a public system.

My grandfather had really poorly chosen insurance, and couldn't get government insurance until he had expended all his assets.

As for the uncle, you're quite right. But then again, don't we do the same thing with car insurance? We are required to have that, and what if we never have an accident for 40 years? Didn't we just subsidize everyone else.

And yet no one complains about the car insurance being mandated and regulated.

 

[Medstart108]

My grandfather had really poorly chosen insurance, and couldn't get government insurance until he had expended all his assets.

As for the uncle, you're quite right. But then again, don't we do the same thing with car insurance? We are required to have that, and what if we never have an accident for 40 years? Didn't we just subsidize everyone else.

And yet no one complains about the car insurance being mandated and regulated.

You have a good point with the car insurance. I guess that is what Obamacare does, basically mandates insurance for everyone.

 

[anewmanx]

You have a good point with the car insurance. I guess that is what Obamacare does, basically mandates insurance for everyone.

Obamacare is meant to look like socialized medicine, but it's actually an insurance industry scheme. It forces people onto plans that are priced by private companies then the taxpayers shell out subsidies to cover it. Obamacare is not socialized medicine.

 

[VCU07]

Hep. C is the leading cause if liver cancer. Cost wise, 84k certainly > transplantation. In addition, drug companies spend billions on development of these drugs. Hep. C isn't main stream as say statin therapy. I have no issue with these companies trying to recoop their investments and make profit....that's business. This drugs cure rate and tolerability compared to the alternatives certainly make the price worth it IMO

 

[deleted480308]

Obamacare is meant to look like socialized medicine, but it's actually an insurance industry scheme. It forces people onto plans that are priced by private companies then the taxpayers shell out subsidies to cover it. Obamacare is not socialized medicine.

anything that forces taxpayers to "shell out subsidies" is socialized

 

[useruseruser]

Oh I read about this drug awhile ago I think from Yahoo..? It's SIGNIFICANTLY cheaper in other countries. It's really interesting. I'm glad such a drug has become available now though.

 

[sakigt]

people would just leave and I'd have no renters, just like if I charge too much for a pill no one will buy it....you've seen an economics textbook so I'm sure you understand this...

We should probably go ahead and get rid of that patent protection as well while were busy removing barriers to the free market............

I loved economics in school. Loved it. But the fact is for it to work people:

a) Have to have complete information. We cant even get GMOs on labels let alone the "true cost" of products we buy
b) Easy entry and exit into market. If you dont want the FDA watching over stuff this would be super easy. Fungus in my steroids. Simvastatin in my red yeast rice from GNC. Lets go for it.

So until those and all the other "assumptions" and probably others Ive forgotten are met posting a S&D curve is too oversimplistic and not applicable.

 

[anewmanx]

anything that forces taxpayers to "shell out subsidies" is socialized

Well, let's get a little deeper here. Taxpayers choose their elected officials, their elected officials decide how to spend the money, so no one is forcing them to shell anything out. We all make sacrifices to be a part of a society. If the sacrifices are insurmountable, we protest. If the protest is met with tyranny, we rebel. That is exactly how America was formed IIRC .

If you dislike the direction that the voters have chosen to go, don't blame an ubiquitous monsters called the "government" for spending the money you owe to it to partake in said economy. Rather, ascribe yourself to a government you find more palatable. Reality is that the 300 foot tall shadowed monster we call our government in the United States is the aborted fetus of the cultural freedom movement in the 60's and 70's. It is the will of the majority. How frightening is that?

But above all else, don't dare to say that taxpayers have been forced to subsidize. The majority has consistently chosen a welfare state; generation after generation for that matter.

Socialized medicine would be a system that benefits the society, is run by the society, and is excluded from non-societal entities such as private corporations. You cannot therefore claim that Obamacare is "socialized medicine." It is clearly anything BUT socialized medicine.

Yet, sadly, the aforementioned is the will of the people.

For this, my soul weeps.

 

[zelman]

I do have to admit that I find it very amusing that you refer to Europe as having a bottomless wallet when the United States leads the world in debt, budget deficit, and poor financial decisions. ...

You did catch that the USA is that wallet, right?

 

[PharmEcon]

The term "socialized medicine" doesn't really mean anything because so many different institutions and people define it differently (as you can tell by just reading this thread). Technically most forms of insurance, government-backed or not, revolve on the concept of shared risk pools.

 

[anewmanx]

You did catch that the USA is that wallet, right?

The US has moths in it's wallet. We're living off borrowed money from CHINA.

 

[anewmanx]

The term "socialized medicine" doesn't really mean anything because so many different institutions and people define it differently (as you can tell by just reading this thread). Technically most forms of insurance, government-backed or not, revolve on the concept of shared risk pools.

Astute observation.

 

[deleted480308]

But above all else, don't dare to say that taxpayers have been forced to subsidize. The majority has consistently chosen a welfare state; generation after generation for that matter.

The taxpayers are absolutely forced to subsidize...by the votes of those that don't contribute to the federal system because they pay no income tax.

It's not voluntary and you can't opt out.....the tax system in this nation is nothing more than theft from the producers.


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[anewmanx]

The taxpayers are absolutely forced to subsidize...by the votes of those that don't contribute to the federal system because they pay no income tax.

It's not voluntary and you can't opt out.....the tax system in this nation is nothing more than theft from the producers.


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Ah, taxation with very unfair representation.

Alright, I can agree with you on this. I find myself very dissatisfied with the current socioeconomic system in the United States and the direction being chosen by the sheeple. I also don't agree with property taxes; it creates a glorified serf system like the middle ages. No one really owns their property. Disgusting isn't it?

 

[deleted480308]

Ah, taxation with very unfair representation.

Alright, I can agree with you on this. I find myself very dissatisfied with the current socioeconomic system in the United States and the direction being chosen by the sheeple. I also don't agree with property taxes; it creates a glorified serf system like the middle ages. No one really owns their property. Disgusting isn't it?

Huzzah! We agree on something


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[anewmanx]

Huzzah! We agree on something


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I enjoyed the discourse. It's good to come to an accord!

 

[a runner]

Also, voluntary price regulation agreements have worked in the UK since 1957

http://www.abpi.org.uk/our-work/commercial/pprs/Pages/default.aspx

Why can't it work in the States?

Ok, I think this thread is about to go off into Obamacare territory, never to return. But before it does, do you understand the basis for why everyone is saying that the USA subsidizes the healthcare costs of other countries through its innovations, including the drug discovery and approval process?

Think about it, I mean really think about, because this is a really important point in this whole new drug discussion. What proportion of drug company profits are made from USA sales? I've seen figures estimating around 80-90% of profits are from the USA. Those profits are driving new development of drugs. If the USA were to impose price controls on drugs to eliminate most of the profit from USA sales, so that drug prices here in the USA were comparable to Europe and Canada and the rest of the world for that matter, then one of two things would happen:

1) none of that 80% of profits would be able to be reinvested into drug development, therefore, very few new drugs, or
2) the prices would have to be raised around the world to recoup this lost profit in the USA, making healthcare more expensive in those other countries and lowering costs in the USA, giving more parity between countries

This could apply to most medical innovations and technologies. We pay a premium here for exporting our innovations to the rest of the world at little to no profit. That is one of the reasons why you can get cheaper healthcare in Costa Rica and other places. I'm sure there are other factors, but that is likely one of the largest.

This is why it was such a big deal when those few Democratic senators wanted to add an amendment to Obamacare that would allow re-importation of drugs from other countries. That would have essentially killed drug company profits in the USA, thereby killing private company drug innovation. This would have pushed the pressure onto other countries to raise their drug prices to allow the re-start of drug innovation. Unfortunately (if you want USA healthcare prices to be lower and other countries to pay SOME of their fair share) it was killed by the rest of the liberals who realized this and want the "rich" USA to keep on subsidizing the rest of the world.

 

[anewmanx]

Ok, I think this thread is about to go off into Obamacare territory, never to return. But before it does, do you understand the basis for why everyone is saying that the USA subsidizes the healthcare costs of other countries through its innovations, including the drug discovery and approval process?

Think about it, I mean really think about, because this is a really important point in this whole new drug discussion. What proportion of drug company profits are made from USA sales? I've seen figures estimating around 80-90% of profits are from the USA. Those profits are driving new development of drugs. If the USA were to impose price controls on drugs to eliminate most of the profit from USA sales, so that drug prices here in the USA were comparable to Europe and Canada and the rest of the world for that matter, then one of two things would happen:

1) none of that 80% of profits would be able to be reinvested into drug development, therefore, very few new drugs, or
2) the prices would have to be raised around the world to recoup this lost profit in the USA, making healthcare more expensive in those other countries and lowering costs in the USA, giving more parity between countries

This could apply to most medical innovations and technologies. We pay a premium here for exporting our innovations to the rest of the world at little to no profit. That is one of the reasons why you can get cheaper healthcare in Costa Rica and other places. I'm sure there are other factors, but that is likely one of the largest.

This is why it was such a big deal when those few Democratic senators wanted to add an amendment to Obamacare that would allow re-importation of drugs from other countries. That would have essentially killed drug company profits in the USA, thereby killing private company drug innovation. This would have pushed the pressure onto other countries to raise their drug prices to allow the re-start of drug innovation. Unfortunately (if you want USA healthcare prices to be lower and other countries to pay SOME of their fair share) it was killed by the rest of the liberals who realized this and want the "rich" USA to keep on subsidizing the rest of the world.

I love how you put quotes around rich. It's true, we have opulent debt in the United States, but no real wealth.

Industries are industries. If price controls were in place the world over, with companies being guaranteed a profit margin, then the companies would be forced to create new drugs to expand their profitability. I think there are two sides to this coin.

 

[a runner]

I love how you put quotes around rich. It's true, we have opulent debt in the United States, but no real wealth.

Industries are industries. If price controls were in place the world over, with companies being guaranteed a profit margin, then the companies would be forced to create new drugs to expand their profitability. I think there are two sides to this coin.

IF price controls were consistently and equally in place around the world, then the profit would be controlled by the various governments. Whatever profits were allowed would be directly correlated to how much money would be able to be reinvested into subsequent drug development.

That would actually be a pretty fair way to do things. My point is that, as it stands now, we're pretty much the only country left with some vestige of freedom and capitalism that has refused drug price controls up to this point, making it so that all the costs fall on us. That is why people in other countries can get drugs for pennies on the dollar compared to here. Our stubborn refusal (some could argue this stubbornness is a good thing) on this point has led to the ability of other countries to take advantage of the American patient by putting all the costs of drug development and marketing, etc. squarely on their shoulders. Ideally I would like to see other countries stop cheating American patients, taxpayers, and inflation victims by removing their price controls, but barring that impossibility, price controls (or allowing re-importation) here would go a long way in shifting those costs more evenly across the world.

 

[PharmEcon]

I love how you put quotes around rich. It's true, we have opulent debt in the United States, but no real wealth.

Hardly. Debt doesn't equate to not having money or wealth. At the end of the day who else can borrow at the rates (let alone volume) the UST does? No one. We are fine.

As for the topic at hand (well at least part of it, you guys have hit on A LOT of stuff ), part of the reason h/c is so expensive IS because we subsidize the world in a lot of h/c innovation, but there are many, many other reasons which add to the cost substantially. And I don't think price controls are the silver bullet that some people think.

 

[anewmanx]

Hardly. Debt doesn't equate to not having money or wealth. At the end of the day who else can borrow at the rates (let alone volume) the UST does? No one. We are fine.

http://en.wikipedia.org/wiki/List_of_sovereign_states_by_current_account_balance

What little we have will be consumed by servicing said debt.

It's like a guy with a great credit score using his six figure salary to service the interest on millions in loans. What happens when he defaults? The assets are liquidated to repay the debts.

 

[PharmEcon]

http://en.wikipedia.org/wiki/List_of_sovereign_states_by_current_account_balance

What little we have will be consumed by servicing said debt.

It's like a guy with a great credit score using his six figure salary to service the interest on millions in loans. What happens when he defaults? The assets are liquidated to repay the debts.

And yet the market is fine with buying billions of dollars of 10-year treasuries at 2.5%, something that none of those other countries can say. That tells you about what the market thinks about the US's ability to pay up if it so chooses. Like I said debt doesn't equate with wealth (or the ability to pay). Where rates are now and have been the last few years, we probably should've borrowed and spent more on infrastructure.

 

[a runner]

As for the topic at hand (well at least part of it, you guys have hit on A LOT of stuff ), part of the reason h/c is so expensive IS because we subsidize the world in a lot of h/c innovation, but there are many, many other reasons which add to the cost substantially. And I don't think price controls are the silver bullet that some people think.

I agree there are many factors why overall healthcare costs are higher here. I mean drug costs are only ~10% of overall healthcare expenditures. But as to this thread and why drug costs are so much higher here than other countries, I really do think the price controls in other countries prevent the costs from being spread around equitably. If it weren't for their price controls (or alternately, if WE adopted our own price controls), our drug costs would drop substantially and be near the levels of other countries.

Then we wouldn't be talking about $1,000 pills. Of course if everyone has price controls, then there likely won't be as much profit to fuel new innovations like this new hep C drug in the first place, and nobody could complain about the price because the pill wouldn't even exist. The fact that we have this drug to complain about the price in the first place is a nice problem to have.

 

[Reirrac]

Let's play a game of discussion.

Factors for healthcare costs;
1. School loans accumulated by practicing professionals. Everyone can agree doctors, pharmacists, dentists and others have significant school loans they are obligated to pay back. Many plan to pay off over decades. Pay rates may put this into consideration.
2. Rent, wages and other overhead expenses involved in running a functional facility. It takes diverse specialists to run a sizable clinic or hospital.
3. Profit Margin. What's the point of running a business if you don't get a reasonable return on investment? Investors, entrepreneurs and other talent will look into other industries. There are non-profit organizations out there, but they are reliant on donations and other forms of financial support to sustain their operations. I'm not talking about just hospital, but also other business entities closely involved, like medical suppliers, insurance, drug development and etc.
4. Others I may have forgotten to mention.

Argument for price controls;
1. The patient can't afford to pay for whatever reason. Not being able to get surgery, transplants, drugs and other treatment means certain death. A lot of people have strong feelings about patients dying because they can't cough up the money.
2. Some people feel medical care is a right, not a privilege.
3. Others I may have forgotten to mention.

Argument against;
1. The money has to come from somewhere. One can only cut costs so far without making sacrifices including layoffs, longer shifts and other factors affecting quality. If not from the patient, then from the insurance or other payors, and if not from them, then from the taxpayers or charity. If that's not enough then quality will suffer. Really, you get what you pay for. Reminds me of how the human body adapts to fasting and starvation.
2. Economics mention how the government manipulating the market may have unintended consequences. What may happen is anyone's guess and entirely conjecture. I figure we may lose the best of our talent to whatever entity offers them a better paycheck, work conditions, benefits and vacation time.
3. There is a limit to how much we can act from "the goodness of our heart". We got bills to pay, families to feed, and have our own lives to live, in our own time, in our own life.
4. Etc

It's a complex problem, without a doubt. And there may be no simple solution.

 

[Robdawg678]

It may cost 84k per duration of treatment but we should compare it to the current therapy right? Peg Interferon + Ribavirin + Protease Inhibitors (for some) which doesn't have that great of a cure rate to begin with compared to this new Gilead drug. The current therapy is expensive too, if i'm not mistaken, around 50 to 60k?

I just sat in on a SC Medicaid P&T committee the other day and Gilead was there discussing the cost. Its actually comparable in cost to a treatment of Peg Interferon + Ribavirin.

 

[WVUPharm2007]

I do have to admit that I find it very amusing that you refer to Europe as having a bottomless wallet when the United States leads the world in debt, budget deficit, and poor financial decisions.

The GDP to debt ratio isn't that high at about 70% And we own most of it ourselves. And most of those countries in Europe have ratios higher than ours. Germany, UK, Italy, France, Japan, and on and on. And it gets lower every day. Thanks to natural inflation, all you really have to do is just keep debt stable and it eventually negates itself.

Read up on central banking and governmental debt.

 

[rxlea]

No more so than the person who comes to your counter looking for refills on their Lipitor and Humalog while munching on a double cheeseburger with bacon and slurping a Big Gulp.

I laughed.

 

[BidingMyTime]

@jafx I think you are confusing ethics and reality. While *ethically* you may be right that the company is "despicably" overcharging for their drug (I have no idea if they are or aren't, so I agree that you *may* be right), the *reality* is, nobody else was willing to do the research to develop that drug and sell it at a lower cost. For all we know, $86,000 is a lower cost than what a competitor research company may have charged if they had developed it first. So, whether the drug is overpriced or not, there is now an option (at least for some people) that did not previously exist (and we can all rest assured by looking at history that eventually the cost of this drug will come down.)

And this is where ethics gets debatable....which is more ethical, to put a price limit on the price drugs can sell for (which means this drug would never have existed...we know this since countries which strict price controls on drugs don't develop breakthrough drugs), or is it more ethical to not have price limits so a company will have an incentive to develop a drug and at least some people will have a longer life/better QOL than if the drug never existed? Of course, reality is, there are even more considerations (such as allocation of scare resources) than these 2, but for the sake of argument will pretend that all else is equal, in which case I would say that #2 option, letting a company charge whatever they want, so they will develop a drug that otherwise never would have existed is by far the more ethical option.

 

[BidingMyTime]

The US has moths in it's wallet. We're living off borrowed money from CHINA.

Wrong, we are living off of borrowed money from the FED (US central bank) which just prints money willy-nilly. The US truly does have a bottomless wallet in this regard.

 

[confettiflyer]

Oh the perks of having the world's reserve currency. Our debt isn't as big a problem as tea party crazies made it out to be. In fact, Krugman argued we should have done more if it given the greater risks of a deflationary economy vs inflation.

 

[deleted480308]

Oh the perks of having the world's reserve currency. Our debt isn't as big a problem as tea party crazies made it out to be. In fact, Krugman argued we should have done more if it given the greater risks of a deflationary economy vs inflation.

Ugh, krugman is a disaster


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[rph3664]

I used to live in a little town called Big Stone Gap. Nearly all of the rentals were owned by one family. People were poorly educated, and only had a small subset of jobs they could perform. It was a backwards area that everyone was afraid to move away from. That family price gouged. Few moved. What eventually happened? Everyone ended up on government assistance who was living in his apartments. The apartments degraded into slums, and good old Steve(the owner) got richer.

Theory doesn't always match up with reality. In this case, people can't simply "move away" from their Hep C.

You didn't live in Big Stone Gap, Virginia, did you? I have a delightful book written by a woman who moved there with her husband and opened a bookstore, not knowing anyone there or what they were getting themselves into. I could relate to her on many, many levels.


http://www.amazon.com/Little-Bookst...tle+bookstore+of+big+stone+gap+by+wendy+welch

 

[anewmanx]

You didn't live in Big Stone Gap, Virginia, did you? I have a delightful book written by a woman who moved there with her husband and opened a bookstore, not knowing anyone there or what they were getting themselves into. I could relate to her on many, many levels.


http://www.amazon.com/Little-Bookstore-Big-Stone-Gap/dp/1250031613/ref=sr_1_1?s=books&ie=UTF8&qid=1400033567&sr=1-1&keywords=little bookstore of big stone gap by wendy welch

Yes, I lived there for quite some time. Around five years when my children were young; prior to my divorce. I spent most of my time in a neighboring town called Appalachia though.

It's a town full of busybodies. The few bright stars who have a significant level of intelligence are able to reign as kings.

You could do quite the study of isolated social dynamics in that place. There is very little external influence on the society and culture there; it's developed in a bit of a vacuum.

 

[confettiflyer]

Ugh, krugman is a disaster


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Generally yes....but if we're talking about how debt isn't destiny and wealth is not defined by the indebtedness of a country, you kind of have to go along with his logic for more stimulus, especially since this whole inflation business is turning out to be a bust.

 

[deleted480308]

Generally yes....but if we're talking about how debt isn't destiny and wealth is not defined by the indebtedness of a country, you kind of have to go along with his logic for more stimulus, especially since this whole inflation business is turning out to be a bust.

sorry, the wanton printing of money is bad policy...as is backing private loans

 

[WVUPharm2007]

Oh the perks of having the world's reserve currency. Our debt isn't as big a problem as tea party crazies made it out to be. In fact, Krugman argued we should have done more if it given the greater risks of a deflationary economy vs inflation.

Given that he spent a nice hunk of his career studying Japan in the 90s and 00s, I would say he has a unique expertise in where the US economy is going.

 

[Marcus X]

An important consideration here is what's coming down the line. Sofosbuvir is pricy now, and I can't help but think that part of that is due to competing drugs in the pipeline. Ledipasivr is coming later this year (also from Gilead, so probably not having too much of an influence). AbbVie has ABT-450, dasabuvir, and ombitasvir coming. There's also daclatasvir, asunaprevir, and a few others coming along. We've got at least three companies primed to release highly effective antiviral agents for HCV in the next two years. Gilead is milking all they can out of sofosbuvir while it's still the only real game in town.

And a course of sofosbuvir is WAY more than a course of pegylated interferon and ribavirin. WAY more.

 

[Aminex]

hepatitis C is not always a "poor choice" situation. Sexual transmission is uncommon. My uncle was a medical technologist who contracted it from a needlestick in the late 70's. His AST/ALT levels were high all throughout the 80's and 90's until he was officially diagnosed in 1997. Since my cousin had a terrifying tale of walking in on them when she was 17, they were sexually active at least until 1996. That's nearly 20 years of sex and my aunt remains negative. He died in 2009 from a failed transplant. 40% of positive patients can't identify any common risk factors, which suggests healthcare-acquired infection is very common. It's a hardy virus and there's evidence that it can dodge autoclaving and other sterilization attempts.

 

[josterberg]

It's a despicable indictment of the American medical system and one reason I, even as a hard-line conservative, believe in socialized medicine (with the freedom of cash private practice like they have here in Costa Rica.)

To make a drug that people will likely die without, or need organ transplant, and charge an eye for it is disgusting. There is no possible way that it is a justifiable cost for the drug. We regulate the amount of money that can be made on a transaction in the Real Estate and Mortgage industry; why not the prescription drug industry?

Shame on our culture. Blood money.

To "jafx", I commend you sir on your humanistic stance. I have HCV- and was lucky enough to land in a Phase III trial of the new Merck drug. However, many people are not as fortunate, have no PC access or skills, or live close enough to a major teaching hospital, where these trials are conducted. To "sb247"- I just can't connect emotionally with your thinking. So, with a projected 1 in 5 rate of likely developing liver cancer if left untreated, you would say to the people who can not qualify for low income assistance from the drug manufacturers, "just go away." Dooming them to suffer the life long consequences of having a virus degrading their liver function, and possibly die, simply due to the all mighty dollar. "First, do no harm" does not seem to be something that resonates with you. I am curious, and refuse to revert to name calling, but please help me understand your thought process, if you would be so kind: What has caused this obvious callousness, one might say an even slightly sociopathic disregard for human life, other than for yours, of course? Is it to be found in parenting, a traumatic experience at the hands of the less fortunate, or is it something deeper, even as rudimentary as the survival instinct we are all born with gone astray? With a high degree of cirrhosis, and my age, I was heading for the transplant lists in 5-10 years, according to my GI MD. Is it not better for society to have me avoid an extremely costly and dangerous procedure, certainly exponentially more expensive than being treated with this new generation of HCV oral meds? I am hoping that Medicare, the huge health care insurance lobby, public pressure and most of all, in a world you seem to identify with, i.e. unfettered capatalism and the competiton that accompanies it, will all conspire to drive the prices down to where patients don't have take out second mortgages on their homes in order to pay for these miraculous new drugs. Please don't use "they must recover their R&D costs" argument, with >3.3 million Americans alone infected w/the HCV, the demand, and thus sales, of their products will make them billions, even at 10% of their obscene "MSRP". One last question- what about your fellow medical professionals, who acquire the HCV due to an accidental needle stick, or nasal/IV abuse of illict drugs? Along with their student loans, are they to be saddled with an additional $84K burden, or do they deserve special consideration?

 

[BenJammin]

What is the average gross margin on a Sovaldi script?

 

[Carboxide]

To "jafx", I commend you sir on your humanistic stance. I have HCV- and was lucky enough to land in a Phase III trial of the new Merck drug. However, many people are not as fortunate, have no PC access or skills, or live close enough to a major teaching hospital, where these trials are conducted. To "sb247"- I just can't connect emotionally with your thinking. So, with a projected 1 in 5 rate of likely developing liver cancer if left untreated, you would say to the people who can not qualify for low income assistance from the drug manufacturers, "just go away." Dooming them to suffer the life long consequences of having a virus degrading their liver function, and possibly die, simply due to the all mighty dollar. "First, do no harm" does not seem to be something that resonates with you. I am curious, and refuse to revert to name calling, but please help me understand your thought process, if you would be so kind: What has caused this obvious callousness, one might say an even slightly sociopathic disregard for human life, other than for yours, of course? Is it to be found in parenting, a traumatic experience at the hands of the less fortunate, or is it something deeper, even as rudimentary as the survival instinct we are all born with gone astray? With a high degree of cirrhosis, and my age, I was heading for the transplant lists in 5-10 years, according to my GI MD. Is it not better for society to have me avoid an extremely costly and dangerous procedure, certainly exponentially more expensive than being treated with this new generation of HCV oral meds? I am hoping that Medicare, the huge health care insurance lobby, public pressure and most of all, in a world you seem to identify with, i.e. unfettered capatalism and the competiton that accompanies it, will all conspire to drive the prices down to where patients don't have take out second mortgages on their homes in order to pay for these miraculous new drugs. Please don't use "they must recover their R&D costs" argument, with >3.3 million Americans alone infected w/the HCV, the demand, and thus sales, of their products will make them billions, even at 10% of their obscene "MSRP". One last question- what about your fellow medical professionals, who acquire the HCV due to an accidental needle stick, or nasal/IV abuse of illict drugs? Along with their student loans, are they to be saddled with an additional $84K burden, or do they deserve special consideration?

They would receive it for free from the hospital if it were a needle stick. We don't treat them any differently if it were other reasons - if insurance covers it, great. If not, then interferon it is. Not saying whether it's right or wrong, just how it is.

 

[Digsbe]

It's a steep price tag, but that's economics. If you think about it they spend billions of dollars in development and have to recoup the costs of that plus all the other drugs they try to develop that never make it to market. They have to recoup that cost only among the Hep C population so it can't be marketed and sold to everyone or have a massive consumer base. The drug has astounding effects and is very effective, if someone is cured it reduces costs of further follow up, possible transplantation and the use of antivirals chronically. From an economic standpoint it may be worth it when taking into account long term cost. It's the market though, the company has to recoup their cost and if it means a true cure there is going to be a steep price on that, they can set the price that they want because it's their drug. They aren't under an obligation to make it free or lose money/break even on their investment.

 

[BidingMyTime]

To "jafx", I commend you sir on your humanistic stance. I have HCV- and was lucky enough to land in a Phase III trial of the new Merck drug. However, many people are not as fortunate, have no PC access or skills, or live close enough to a major teaching hospital, where these trials are conducted. To "sb247"- I just can't connect emotionally with your thinking. So, with a projected 1 in 5 rate of likely developing liver cancer if left untreated, you would say to the people who can not qualify for low income assistance from the drug manufacturers, "just go away." Dooming them to suffer the life long consequences of having a virus degrading their liver function, and possibly die, simply due to the all mighty dollar. "First, do no harm" does not seem to be something that resonates with you. I am curious, and refuse to revert to name calling, but please help me understand your thought process, if you would be so kind: What has caused this obvious callousness, one might say an even slightly sociopathic disregard for human life, other than for yours, of course? Is it to be found in parenting, a traumatic experience at the hands of the less fortunate, or is it something deeper, even as rudimentary as the survival instinct we are all born with gone astray? With a high degree of cirrhosis, and my age, I was heading for the transplant lists in 5-10 years, according to my GI MD. Is it not better for society to have me avoid an extremely costly and dangerous procedure, certainly exponentially more expensive than being treated with this new generation of HCV oral meds? I am hoping that Medicare, the huge health care insurance lobby, public pressure and most of all, in a world you seem to identify with, i.e. unfettered capatalism and the competiton that accompanies it, will all conspire to drive the prices down to where patients don't have take out second mortgages on their homes in order to pay for these miraculous new drugs. Please don't use "they must recover their R&D costs" argument, with >3.3 million Americans alone infected w/the HCV, the demand, and thus sales, of their products will make them billions, even at 10% of their obscene "MSRP". One last question- what about your fellow medical professionals, who acquire the HCV due to an accidental needle stick, or nasal/IV abuse of illict drugs? Along with their student loans, are they to be saddled with an additional $84K burden, or do they deserve special consideration?

You really don't get it. Sovaldi would NOT exist if not for the relatively free market of the US, and the ability of Gilead to charge $1000/pill for it. NOBODY would have it, so there would be no ethical discussion. Anyone COULD have spent years of research and millions of dollars developing this drug and then given it away for free. But no one did. The ONLY one who cared enough to develop was Gilead, and since they did, they get to charge whatever they want for it. Sure, they developed it out of greed....but their greed provided an option that none of the do-gooders/humanitarians were willing to invest in to develop. That is the FACT. Humanitarian groups didn't care enough to invest in developing a drug like Sovaldi, governments with "great" socialized medicine like GB, NONE of them cared enough to invest in developing a drug like Sovaldi, ONLY a greedy company cared enough to invest (taking a risk, since they there was no guarantee their drug would be successful.)

Is greed good? Greed is good, when done non-coercively. Greed can be a good motivator. The greed of Gilead is good for people with hepatitis C, their new drug won't help everyone, but it will help many. Without greed, no one would have been helped. No one.

 

[josterberg]

You really don't get it. Sovaldi would NOT exist if not for the relatively free market of the US, and the ability of Gilead to charge $1000/pill for it. NOBODY would have it, so there would be no ethical discussion. Anyone COULD have spent years of research and millions of dollars developing this drug and then given it away for free. But no one did. The ONLY one who cared enough to develop was Gilead, and since they did, they get to charge whatever they want for it. Sure, they developed it out of greed....but their greed provided an option that none of the do-gooders/humanitarians were willing to invest in to develop. That is the FACT. Humanitarian groups didn't care enough to invest in developing a drug like Sovaldi, governments with "great" socialized medicine like GB, NONE of them cared enough to invest in developing a drug like Sovaldi, ONLY a greedy company cared enough to invest (taking a risk, since they there was no guarantee their drug would be successful.)

Is greed good? Greed is good, when done non-coercively. Greed can be a good motivator. The greed of Gilead is good for people with hepatitis C, their new drug won't help everyone, but it will help many. Without greed, no one would have been helped. No one.

BMT, If you want to live your life with the motto "Greed Is Good", that says a lot, does it not? Why don't you try to look at the world via the lens that >3/4 of the people on the planet are forced to? I have to believe there is a big Karma style pay back for vulture capitalists like Gilead. This oligarchic, and let us call it for what it is, sociopathic mentality that infests the upper 1% of the world's wealthiest individuals is the biggest negative influence in the world today. I suspect you have a bumper sticker saying "The one who dies with the most toys wins". I can't live my life like that, and don't even pretend to understand people who do. When this enormous bubble economy created by greedy "banksters", as my hero FDR called them, finally implodes in the spectacular fashion that it is destined to, what good will all of the gold your ilk has hoarded do you then? Will we go back to the barter system? The time will come, I hate to say, when those you have so easily dismissed as irrelevant will stop at nothing to sustain themselves. Kindness, humanitarianism and the distribution of say, 25% of the fortunes families like the Waltons have accrued, would go a long way in establishing a world community that would be willing to come together to help each other as each has the means to do so. I fear there is something coming, a terrible and traumatic balancing of the scales. No one can look at the policies during the 8 years of the illegal terms of GWB and say we are not headed to a period in economic history that will make the Great Depression look like an NFL tailgate afternoon. The blatant sociopathy of the ultra rich, their strategy of trashing science and man made climate change, all due to their reliance of petro chemical products to keep amassing their fortunes, have doomed us all to a very bleak future. President Obama, in attempting to be all things to all people, could have done little to change the future, even if he had the vision and fortitude to attempt it. With absolutely no proof to offer, I firmly believe "what goes around, comes around". Perhaps on the next trip, you will be the destitute and desperate American, locked in the endless, grinding, soul destroying cycle of poverty, drugs, violence, incarceration, lack of a nurturing nuclear family, and in reality no accessible opportunities to really "pull yourself up by your own bootstraps". That can only happen when you can afford to buy the boots and laces, which you would gladly see denied them, because as you say, "greed is good". I feel sorry for you. Jost

 

[confettiflyer]

When I invest my money in healthcare companies, I expect them to do their best to make drugs that patients will buy, make a ton of money, and remit the profits to my 401k.

I expect nothing less.

 

[zelman]

BMT, If you want to live your life with the motto "Greed Is Good", that says a lot, does it not? Why don't you try to look at the world via the lens that >3/4 of the people on the planet are forced to? I have to believe there is a big Karma style pay back for vulture capitalists like Gilead. This oligarchic, and let us call it for what it is, sociopathic mentality that infests the upper 1% of the world's wealthiest individuals is the biggest negative influence in the world today. I suspect you have a bumper sticker saying "The one who dies with the most toys wins". I can't live my life like that, and don't even pretend to understand people who do. When this enormous bubble economy created by greedy "banksters", as my hero FDR called them, finally implodes in the spectacular fashion that it is destined to, what good will all of the gold your ilk has hoarded do you then? Will we go back to the barter system? The time will come, I hate to say, when those you have so easily dismissed as irrelevant will stop at nothing to sustain themselves. Kindness, humanitarianism and the distribution of say, 25% of the fortunes families like the Waltons have accrued, would go a long way in establishing a world community that would be willing to come together to help each other as each has the means to do so. I fear there is something coming, a terrible and traumatic balancing of the scales. No one can look at the policies during the 8 years of the illegal terms of GWB and say we are not headed to a period in economic history that will make the Great Depression look like an NFL tailgate afternoon. The blatant sociopathy of the ultra rich, their strategy of trashing science and man made climate change, all due to their reliance of petro chemical products to keep amassing their fortunes, have doomed us all to a very bleak future. President Obama, in attempting to be all things to all people, could have done little to change the future, even if he had the vision and fortitude to attempt it. With absolutely no proof to offer, I firmly believe "what goes around, comes around". Perhaps on the next trip, you will be the destitute and desperate American, locked in the endless, grinding, soul destroying cycle of poverty, drugs, violence, incarceration, lack of a nurturing nuclear family, and in reality no accessible opportunities to really "pull yourself up by your own bootstraps". That can only happen when you can afford to buy the boots and laces, which you would gladly see denied them, because as you say, "greed is good". I feel sorry for you. Jost

Let me know when you start your Pharmaceutical Manufacturing Co-op. Put your money where your mouth is, or your words are meaningless.

 

[PharFromNormal]

BMT, If you want to live your life with the motto "Greed Is Good", that says a lot, does it not? Why don't you try to look at the world via the lens that >3/4 of the people on the planet are forced to? I have to believe there is a big Karma style pay back for vulture capitalists like Gilead. This oligarchic, and let us call it for what it is, sociopathic mentality that infests the upper 1% of the world's wealthiest individuals is the biggest negative influence in the world today. I suspect you have a bumper sticker saying "The one who dies with the most toys wins". I can't live my life like that, and don't even pretend to understand people who do. When this enormous bubble economy created by greedy "banksters", as my hero FDR called them, finally implodes in the spectacular fashion that it is destined to, what good will all of the gold your ilk has hoarded do you then? Will we go back to the barter system? The time will come, I hate to say, when those you have so easily dismissed as irrelevant will stop at nothing to sustain themselves. Kindness, humanitarianism and the distribution of say, 25% of the fortunes families like the Waltons have accrued, would go a long way in establishing a world community that would be willing to come together to help each other as each has the means to do so. I fear there is something coming, a terrible and traumatic balancing of the scales. No one can look at the policies during the 8 years of the illegal terms of GWB and say we are not headed to a period in economic history that will make the Great Depression look like an NFL tailgate afternoon. The blatant sociopathy of the ultra rich, their strategy of trashing science and man made climate change, all due to their reliance of petro chemical products to keep amassing their fortunes, have doomed us all to a very bleak future. President Obama, in attempting to be all things to all people, could have done little to change the future, even if he had the vision and fortitude to attempt it. With absolutely no proof to offer, I firmly believe "what goes around, comes around". Perhaps on the next trip, you will be the destitute and desperate American, locked in the endless, grinding, soul destroying cycle of poverty, drugs, violence, incarceration, lack of a nurturing nuclear family, and in reality no accessible opportunities to really "pull yourself up by your own bootstraps". That can only happen when you can afford to buy the boots and laces, which you would gladly see denied them, because as you say, "greed is good". I feel sorry for you. Jost

Hey. Stop being greedy and wanting everything free. Money makes the world go round - always has always will. Don't like it? Damn kid better refuse to get a job and live off the free dollar, that makes the system so much better. Lean in. You want to make a better place? Make a **** ton of money and give it all away.