Medicare for all

[DOctorJay]

NOS, that's because so much money in the US is being "granted" to admin, Big Pharma and non-clinicians.

second, if anyone hasn't been to Turks and Caicos, I strongly recommend it. it is only a couple hour flight direct from Miami, and very affordable - if you don't stay at the high end resorts. the flight itself is only about $250 round trip.

third: Fire department did not respond to deadly fire because FN 3 months behind on fire bill - APTN News

which prompted this: Children killed in fire prompts Loon Lake Fire Department to improve its operation - APTN News

I'm going to third Turks & Caicos - Beaches resort was awesome, stay in the Key West area if you like it quiet, Italian area if you like a little more action near the large pool. (this is all assuming it's still there after Irma).

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[cowboydoc]

I'm going to third Turks & Caicos - Beaches resort was awesome, stay in the Key West area if you like it quiet, Italian area if you like a little more action near the large pool. (this is all assuming it's still there after Irma).

Sounds like a viable treatment for fibro. Maybe these trips should be included for fibro patients on Medicaid.

 

[Doctodd]

i dont trust big government. i dont trust the private sector.

that being said, i inherently "trust" the feds with my health more than the CEO of Aetna or Pfizer or Medtronic. there is a layer of insulation between a member of congress who doesnt DIRECTLY make money off of overcharging me for a pill or denying an epidural. congress doesnt exist SOLELY to make money off of my health, but the same cant be said for the other entities above

The Feds don't know how make a drug or an SCS or a knee implant. The free market allows competition to bring prices in check for these things. Wish it was that simple.....the Feds are great at taking lobbying money.

 

[NOSfan]

NOS, that's because so much money in the US is being "granted" to admin, Big Pharma and non-clinicians.

Sadly, administrators, Big Pharm and non-clinicians control healthcare........we are just puppets

second, if anyone hasn't been to Turks and Caicos, I strongly recommend it. it is only a couple hour flight direct from Miami, and very affordable - if you don't stay at the high end resorts. the flight itself is only about $250 round trip.

Beautiful place.....but from what I understand, pummeled by Irma 🙁

 

[hyperalgesia]

i dont trust big government. i dont trust the private sector.

that being said, i inherently "trust" the feds with my health more than the CEO of Aetna or Pfizer or Medtronic. there is a layer of insulation between a member of congress who doesnt DIRECTLY make money off of overcharging me for a pill or denying an epidural. congress doesnt exist SOLELY to make money off of my health, but the same cant be said for the other entities above

Who would you trust more to give you the best cell phone service (quality and value)? The best TV, automotive service, education? The CEOs of Aetna and Pfizer will soon become CEOs of Verizon and Ford, delivering competitive products and services to EVERYONE. It's not because cellphones are a "right not a privilege". It's not because the fed sponsored "Phonacare". It's the opposite. It's because the feds have kept their paws out of those industries for the most part and allowed the market to function.

This reminds me of how some patients think of back surgery. When you are finally done trying all the half-ass measures for that occasional morning stiffness, it's time to call in the spine surgeon for a fusion. Because the back is just too important to take a chance on... Call the feds... "Sorry doc, I know you tried but I really need this fixed for good..."

 

[SSdoc33]

Who would you trust more to give you the best cell phone service (quality and value)? The best TV, automotive service, education? The CEOs of Aetna and Pfizer will soon become CEOs of Verizon and Ford, delivering competitive products and services to EVERYONE. It's not because cellphones are a "right not a privilege". It's not because the fed sponsored "Phonacare". It's the opposite. It's because the feds have kept their paws out of those industries for the most part and allowed the market to function.

This reminds me of how some patients think of back surgery. When you are finally done trying all the half-ass measures for that occasional morning stiffness, it's time to call in the spine surgeon for a fusion. Because the back is just too important to take a chance on... Call the feds... "Sorry doc, I know you tried but I really need this fixed for good..."

complete straw-man argument.

we are not selling widgets here. "health-care" is not a single product. you cant think of it that way.

no, the feds cant make a drug. no, the feds cant perform a whipple. no, the feds cant run a nursing home.

you definitely need the private sector for innovation (although the goodwill that pharma engenders for "R&D" is way overblown, but i digress), but why do we need Cigna doing the exact same thing as medicare, while taking 30% off the top? why do americans pay double what other countries pay for drugs? why do we pay hospitals 2-3x what we pay a private contractor for the exact same service?

our overpriced system has developed because everyone wants their pockets lined. an unregulated free market is the etiology of our problem, not the solution.

dont get me wrong, there is definitely a role private enterprise in health care. but if the feds completed stepped out, we would be in much much worse shape.

 

[VA Hopeful Dr]

complete straw-man argument.

we are not selling widgets here. "health-care" is not a single product. you cant think of it that way.

no, the feds cant make a drug. no, the feds cant perform a whipple. no, the feds cant run a nursing home.

you definitely need the private sector for innovation (although the goodwill that pharma engenders for "R&D" is way overblown, but i digress), but why do we need Cigna doing the exact same thing as medicare, while taking 30% off the top? why do americans pay double what other countries pay for drugs? why do we pay hospitals 2-3x what we pay a private contractor for the exact same service?

our overpriced system has developed because everyone wants their pockets lined. an unregulated free market is the etiology of our problem, not the solution.

dont get me wrong, there is definitely a role private enterprise in health care. but if the feds completed stepped out, we would be in much much worse shape.

You've got much of this wrong.

We pay more because we're the ones subsidizing the majority of pharma R&D. And as for how much goodwill that buys them... umm, a lot. Just in the last 3-5 years they've given us a nearly side-effect free cure for Hep C, the first new diabetes drug that reduces CV events since Metformin, amazingly effect drugs for MS, and just recently a t-cell treatment for leukemia. This is all stuff that's new in the short time I've been a doctor.

As for hospital costs - that's a combination of a few factors. The first and most egregious is the massive numbers of well paid administrators. Reduce those and we'll see some impressive cost savings. Problem is, many of those administrators are needed to handle the ever increasing Federal administrative burden. Second is that Americans expect a certain level of, for lack of a better word, service. They want menu-based meals on demand, cable TV, and large well lit rooms. Our hospitals are way nicer than other countries (for the most part). Niceties don't come cheap. Third is the legal environment that says we must be fully staffed 24/7/365 because errors are not tolerated. That's partially due to our litigious society and partly due to EMTALA (there's the Feds again).

A reasonably unregulated free market could make a big difference in the majority of medicine. Will there always be a role for the government? Yes, most of us accept that. No matter what we do some things will always be very expensive and not everyone will be able to afford them. Safety nets aren't going away anytime soon.

But, we need more free market than we have now. In this very forum I have seen some of y'all lament how expensive it is to do procedures in a hospital-owned setting versus a free-standing one. I've seen the same in hospital-owned imaging centers versus free standing. In both cases we're often talking an order of magnitude in cost difference. There's a place here (free standing) that does LESI's for $700 cash. That is all inclusive - physician fee and facility. Anyone want to tell me the price if done in their local hospital?

 

[lobelsteve]

You've got much of this wrong.

We pay more because we're the ones subsidizing the majority of pharma R&D. And as for how much goodwill that buys them... umm, a lot. Just in the last 3-5 years they've given us a nearly side-effect free cure for Hep C, the first new diabetes drug that reduces CV events since Metformin, amazingly effect drugs for MS, and just recently a t-cell treatment for leukemia. This is all stuff that's new in the short time I've been a doctor.

As for hospital costs - that's a combination of a few factors. The first and most egregious is the massive numbers of well paid administrators. Reduce those and we'll see some impressive cost savings. Problem is, many of those administrators are needed to handle the ever increasing Federal administrative burden. Second is that Americans expect a certain level of, for lack of a better word, service. They want menu-based meals on demand, cable TV, and large well lit rooms. Our hospitals are way nicer than other countries (for the most part). Niceties don't come cheap. Third is the legal environment that says we must be fully staffed 24/7/365 because errors are not tolerated. That's partially due to our litigious society and partly due to EMTALA (there's the Feds again).

A reasonably unregulated free market could make a big difference in the majority of medicine. Will there always be a role for the government? Yes, most of us accept that. No matter what we do some things will always be very expensive and not everyone will be able to afford them. Safety nets aren't going away anytime soon.

But, we need more free market than we have now. In this very forum I have seen some of y'all lament how expensive it is to do procedures in a hospital-owned setting versus a free-standing one. I've seen the same in hospital-owned imaging centers versus free standing. In both cases we're often talking an order of magnitude in cost difference. There's a place here (free standing) that does LESI's for $700 cash. That is all inclusive - physician fee and facility. Anyone want to tell me the price if done in their local hospital?

I work in a hospital owned outpatient facility and not a hospital outpatient Department. We have negotiated Medicare rates plus not more than $10 for all inclusive epidural. I believe that means it's 215 - $250. I get paid in rvu as a salary.

 

[VA Hopeful Dr]

I work in a hospital owned outpatient facility and not a hospital outpatient Department. We have negotiated Medicare rates plus not more than $10 for all inclusive epidural. I believe that means it's 215 - $250. I get paid in rvu as a salary.

So your high deductible insurance plan patients pay that too?

 

[Ducttape]

You've got much of this wrong.

We pay more because we're the ones subsidizing the majority of pharma R&D. And as for how much goodwill that buys them... umm, a lot. Just in the last 3-5 years they've given us a nearly side-effect free cure for Hep C, the first new diabetes drug that reduces CV events since Metformin, amazingly effect drugs for MS, and just recently a t-cell treatment for leukemia. This is all stuff that's new in the short time I've been a doctor.

yet, even as we subsidize the majority of pharma R&D, they charge the customer a lot for the treatment.

Harvoni 12 week course costs $94,000, according to GoodRx.

Jardiance costs $415 per month. over a year, that's $4980. each month of Jardiance is roughly 8.6 years worth of metformin...

 

[VA Hopeful Dr]

yet, even as we subsidize the majority of pharma R&D, they charge the customer a lot for the treatment.

Harvoni 12 week course costs $94,000, according to GoodRx.

Jardiance costs $415 per month. over a year, that's $4980. each month of Jardiance is roughly 8.6 years worth of metformin...

That's what I meant by subsidize. Granted NIH does a lot of the basic science work, but the drug companies themselves do the majority of the work after that. If they didn't charge us much more than everyone else, we wouldn't see many new drugs hit the market. Its that simple. Its not dissimilar to why other countries spend way less on defense than we do - because we're essentially carrying the load for everyone else.

Admittedly Harvoni (and drugs like it) cost a staggering amount of money. But, those drugs are a literal game changer. Before that it was this massive cocktail of drugs including interferon which patients absolutely hated because it made them feel awful and yet still had around a 60% cure rate. Now we have a 98-99% cure rate with drugs that are as well tolerated as zantac. Now that may not be worth 95k for a treatment course, but its certainly worth more than $100 to my mind.

As for Jardiance, you can get a $250/month savings card from the company. Brings the price down to around $250 (cash price is normally about $500). Still not ideal, but for a point of A1c and better CV reduction than statins I'm not sure its completely unreasonable.

 

[lobelsteve]

So your high deductible insurance plan patients pay that too?

Nope, just the folks who do not have insurance or are not using insurance.

 

[deleted820760]

NOS, that's because so much money in the US is being "granted" to admin, Big Pharma and non-clinicians.

second, if anyone hasn't been to Turks and Caicos, I strongly recommend it. it is only a couple hour flight direct from Miami, and very affordable - if you don't stay at the high end resorts. the flight itself is only about $250 round trip.

third: Fire department did not respond to deadly fire because FN 3 months behind on fire bill - APTN News

which prompted this: Children killed in fire prompts Loon Lake Fire Department to improve its operation - APTN News

Omg! They let children get burned alive in a fire because someone was behind on their fire bill?!?!?

 

[Ducttape]

oh, so you honestly believe that drug companies are using these copay cards out of the goodness of their own hearts? far be it. its another way to gouge the system.
http://pharmacytoday.org/article/S1042-0991(16)31400-1/fulltext
http://pharmaceuticalcommerce.com/b...manufacturers-is-matched-by-rising-criticism/

in addition, most of the money that pharmaceutical companies spend is not on new drug development, but on marketing for existing drugs.
Big pharmaceutical companies are spending far more on marketing than research

Pharma industry gets high on profits

Pharmaceutical Companies Spent 19 Times More On Self-Promotion Than Basic Research: Report | HuffPost

Prescription drug companies aren’t putting a lot of resources toward new, groundbreaking medication, according to a recent report in BMJ, a medical journal based in London. Instead, it’s more profitable for them to simply to create a bunch of products that are only slightly different from drugs already on the market, the reports authors said.

“[P]harmaceutical research and development turns out mostly minor variations on existing drugs,” the authors write. “Sales from these drugs generate steady profits throughout the ups and downs of blockbusters coming off patents.”

The authors go on to say that for every dollar pharmaceutical companies spend on “basic research,” $19 goes toward promotion and marketing.

 

[VA Hopeful Dr]

Nope, just the folks who do not have insurance or are not using insurance.

That's pretty impressive to be honest. Wish more hospitals did that.

 

[VA Hopeful Dr]

oh, so you honestly believe that drug companies are using these copay cards out of the goodness of their own hearts? far be it. its another way to gouge the system.
http://pharmacytoday.org/article/S1042-0991(16)31400-1/fulltext
http://pharmaceuticalcommerce.com/b...manufacturers-is-matched-by-rising-criticism/

in addition, most of the money that pharmaceutical companies spend is not on new drug development, but on marketing for existing drugs.
Big pharmaceutical companies are spending far more on marketing than research

Pharma industry gets high on profits

Pharmaceutical Companies Spent 19 Times More On Self-Promotion Than Basic Research: Report | HuffPost

You're not telling me anything I don't already know (and I certainly never said those copay cards were out of the goodness of anyone's heart, merely that they exist and can offer significant savings - it was a value-neutral statement).

 

[SSdoc33]

why should Americans subsidize the R&D of these new drugs? if these drug companies only sold them to us, then maybe you would have a point. china, canada, the EU, etc. they use they drugs, but pay half. WTF?!?! that is not cool.

seriously, Pharma are the biggest crooks out there.

some antibiotics, chemo drugs, maybe a few others are essential. everything else can (should) be managed by lifestyle choices.

 

[VA Hopeful Dr]

why should Americans subsidize the R&D of these new drugs? if these drug companies only sold them to us, then maybe you would have a point. china, canada, the EU, etc. they use they drugs, but pay half. WTF?!?! that is not cool.

seriously, Pharma are the biggest crooks out there.

some antibiotics, chemo drugs, maybe a few others are essential. everything else can (should) be managed by lifestyle choices.

Because those other countries refuse to pay more. I'd love if they helped subsidize R&D to but not sure how to make them do so.

Completely agree with your last paragraph. You should have been a family doctor 😉

 

[hyperalgesia]

complete straw-man argument.

we are not selling widgets here. "health-care" is not a single product. you cant think of it that way.

no, the feds cant make a drug. no, the feds cant perform a whipple. no, the feds cant run a nursing home.

you definitely need the private sector for innovation (although the goodwill that pharma engenders for "R&D" is way overblown, but i digress), but why do we need Cigna doing the exact same thing as medicare, while taking 30% off the top? why do americans pay double what other countries pay for drugs? why do we pay hospitals 2-3x what we pay a private contractor for the exact same service?

our overpriced system has developed because everyone wants their pockets lined. an unregulated free market is the etiology of our problem, not the solution.

dont get me wrong, there is definitely a role private enterprise in health care. but if the feds completed stepped out, we would be in much much worse shape.

From my perspective, your body is something that you own that requires care, maintenance, and sometimes service. Just like everything else that is individual, the services and products a person needs or desires are most efficiently offered by a free marketplace.

We probably agree on some points. In order for a marketplace to be free, it must be regulated to a certain extent. When dominant players exist and are gauging people, that is an abject failure in regulation of the marketplace. Maybe our patent process is screwed up...