Radiology is short too?

[vector2]

The problem is that the drug companies will argue, "Would you rather have 1970s drugs at 1970s prices? or 2020s drugs at 2020s prices?"
The argument is not without totally without merit. Research, development, clinical trials, risks of liability, etc. cost a fortune. If you want to lessen the reward for success, you need to look at the cost of failure. That said, drug company margins are pretty fat compared to most industries.

No doubt drug development is expensive. But how much of that development is the taxpayer directly or indirectly subsidizing?

In this cross-sectional study of 356 drugs approved by the US Food and Drug Administration from 2010 to 2019, the NIH spent $1.44 billion per approval on basic or applied research for products with novel targets or $599 million per approval considering applications of basic research to multiple products.

Comparison of Research Spending on New Drug Approvals by the National Institutes of Health vs the Pharmaceutical Industry, 2010-2019

How does National Institutes of Health (NIH) investment in pharmaceutical innovation compare with investment by the pharmaceutical industry?In this cross-sectional study of 356 drugs approved by the US Food and Drug Administration from 2010 to 2019, the ...

www.ncbi.nlm.nih.gov

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[doctalaughs]

This is essentially what the UK does with their "£ per QALY" system. The use of quality-adjusted life year is fraught with a bit of peril, but I'm not sure if there are many other ways to structure a universal basic health care plan more fairly.

Yes, there are many bad things about the UK system but this is not one of them. We need a QALY system so that copycat and minimally -more effective drugs don’t make their pharma overlords a fourtune. Same for devices and procedures.

We also need more medical guidelines about standards of care based on health and age.

While I don’t believe in a single payer system, we need to define what is “basic” care and make that covered 100% and then have people private-pay for higher levels of care (ie private vs govt insurance).

 

[Angus Avagadro]

This is essentially what the UK does with their "£ per QALY" system. The use of quality-adjusted life year is fraught with a bit of peril, but I'm not sure if there are many other ways to structure a universal basic health care plan more fairly.

Yep, the National Institute for Health and Care Excellence, acronym "NICE", ( love the name), uses that QALY model to determine if they will pay for a more expensive drug to say add 18 mos of life to the 40 yr old Mom with breast cancer, or deny payment to use a cheaper less effective drug. It is a very cold and beauracratic approach. Many of the folks I have met while traveling in the UK aren't happy with it, but appear resigned to it. About 6 yrs ago, the Intl Red Cross called the NHS in the UK a Humanitarian Crisis. I agree, I don't have a more equitable suggestion, all are fraught with inequity. It all comes down to the money. With the corporatization of healthcare, we see reduced access and quality with profits going to the insurers. We used to have County and Catholic hospitals providing indigent care, now many if not all are extinct. I was beginning to come around to the idea of the govt running it, then I see the mismanagement of Medicaire and Social Security and wonder.

 

[doctalaughs]

Yep, the National Institute for Health and Care Excellence, acronym "NICE", ( love the name), uses that QALY model to determine if they will pay for a more expensive drug to say add 18 mos of life to the 40 yr old Mom with breast cancer, or deny payment to use a cheaper less effective drug. It is a very cold and beauracratic approach. Many of the folks I have met while traveling in the UK aren't happy with it, but appear resigned to it. About 6 yrs ago, the Intl Red Cross called the NHS in the UK a Humanitarian Crisis. I agree, I don't have a more equitable suggestion, all are fraught with inequity. It all comes down to the money. With the corporatization of healthcare, we see reduced access and quality with profits going to the insurers. We used to have County and Catholic hospitals providing indigent care, now many if not all are extinct. I was beginning to come around to the idea of the govt running it, then I see the mismanagement of Medicaire and Social Security and wonder.

Yeah definitely problems with the UK system but at this point either we have some cold but consistent efficacy-based regulation or just hand a good chunk of our GDP to greedy corporate middlemen and still have them deny care for arbitrary reasons.

Like I said, the government basic care needs these regulations and private pay above that might have looser regulation and lower wait times (key is they need to be transparent though).

A plus of the QALY system is that drugs end up being cheaper in other countries because the companies know they aren’t going to get their “1% better” drug at exorbitant prices just because it got FDA approved and is on-patent.

 

[Angus Avagadro]

Yeah definitely problems with the UK system but at this point either we have some cold but consistent efficacy-based regulation or just hand a good chunk of our GDP to greedy corporate middlemen and still have them deny care for arbitrary reasons.

Like I said, the government basic care needs these regulations and private pay above that might have looser regulation and lower wait times (key is they need to be transparent though).

A plus of the QALY system is that drugs end up being cheaper in other countries because the companies know they aren’t going to get their “1% better” drug at exorbitant prices just because it got FDA approved and is on-patent.

I don't disagree. The problem in America is Americans don't believe in a 2 tiered system, but in essence that is what we have. Few will acknowledge it. Without meaningful tort reform and hard price negotiations with drug companies, I don't forsee much change. If we would make the familes or the power of attorneys responsible for say 2% of the bill to keep 90 yo Gammaw on the vent, we could save a ton of healthcare dollars. Finding the balance of ethical quality care and cost is the challenge. Maybe it's time for physician unions and ending the non profit status of healthcare networks. The pendulum needs to swing back. Too much of our helathcare premiums go to the C suite and insurance companies.

 

[anbuitachi]

i think our healthcare system, orders wayy too much imaging, many unncessary. part of it is due to medicolegal culture in USA

if you are 99% sure from labs, exam/history, patient doesnt have large PE, many would still order that CTA, bc that means you are going to probably miss 1 out of 100 or whatever, and may be sued for millions if outcome sucks.