TheHill: "Want to save a quick $20 billion in healthcare?"

[Carbocation1]

The author is CRNA who advocates for the elimination of "fraudulent" billing by anesthesiologists who supervise multiple anesthetics.

http://thehill.com/blogs/pundits-bl...want-to-save-a-quick-20-billion-in-healthcare

The nurses are flooding the comments section.

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Members don't see this ad.

 

[Carbocation1]

"Your protected title is PHYSICIAN, my protected title is Certified Registered Nurse Anesthetist and NURSE. Both of us can use the term DOCTOR as it is simply an academic title. You have a clinical doctorate, you are a physician."

-militant crna

 

[Strider_91]

"Your protected title is PHYSICIAN, my protected title is Certified Registered Nurse Anesthetist and NURSE. Both of us can use the term DOCTOR as it is simply an academic title. You have a clinical doctorate, you are a physician."

-militant crna

I read that whole thread an all of the comments. Truly scary to read as someone who is just starting medical school. Is there really no studies which show that MDA outcomes > crna outdomes?

Is it just that is hasn't been studied or is evidence actually showing they are equal. I find it very hard to believe that you would be approved by an irb to study high risk patients with a seemingly obvious less level of care and potentially let people die so idk how that can even be studied?!

 

[Man o War]

Man these people are scary. They write like a 12 year old having a temper tantrum.
Delusions of grandeur.

 

[Man o War]

I read that whole thread an all of the comments. Truly scary to read as someone who is just starting medical school. Is there really no studies which show that MDA outcomes > crna outdomes?

Is it just that is hasn't been studied or is evidence actually showing they are equal. I find it very hard to believe that you would be approved by an irb to study high risk patients with a seemingly obvious less level of care and potentially let people die so idk how that can even be studied?!

Nobody will ever do that study because it's unethical, and they exploit that fact. I can promise you if you did a large scale randomized study designed properly, there would be unnecessary deaths and complications.
I can't tell you how many of them never did a cardiac case, blocks, or the lines needed to properly care for the patients in big cases. Their pediatric case counts were pretty much non existent.
Tons of BS in that article and comment section. Nothing new, they've been hollering about this stuff for years.

 

[sigrhoillusion]

Nobody will ever do that study because it's unethical, and they exploit that fact. I can promise you if you did a large scale randomized study designed properly, there would be unnecessary deaths and complications.
I can't tell you how many of them never did a cardiac case, blocks, or the lines needed to properly care for the patients in big cases. Their pediatric case counts were pretty much non existent.
Tons of BS in that article and comment section. Nothing new, they've been hollering about this stuff for years.

Sometimes I get put in a pediatric room with a CRNA and I feel like I need to stand outside the door and pray. I'm only a few months in and have been amazed by the number of "difficult" intubations, lip lacerations and blown IVs I've seen, which have turned into routine procedures at my hands. And again I'm still very green...

 

[sigrhoillusion]

Sometimes I get put in a pediatric room with a CRNA and I feel like I need to stand outside the door and pray. I'm only a few months in and have been amazed by the number of "difficult" intubations, lip lacerations and blown IVs I've seen, which have turned into routine procedures at my hands. And again I'm still very green...

And one of his arguments is that a huge chunk of money is spent waiting for the anesthesiologist to come for induction. While this is an issue with lazy anesthesiologists, I feel like I spend a TON of time waiting to start induction many times. The patient will go back into the room, I'll give them a minute or two to get the patient over, but then I'll come in the room and the patient is still on the stretcher, then the montiors take another few minutes to be put on, and then 10 minutes later it's sleep time...

I love sitting in a room by myself. Patient gets back on time, mask on, BP cuff on and started, pulse ox, EKG, do timeout just as first BP cuff is read, and then off to sleep. PAtient wakes up quickly (most of the time...) without the use of the BIS. Cases get done on time, quick turnovers, back to the next one. I feel like we are always at least on time those days.

 

[BLADEMDA]

It's all smoke and mirrors. Medicare doesn't reimburse Anesthesiologists more money for medical direction vs medical supervision (bill QZ). The reimbursement is the same whether a CRNA or Anesthesiologist does the case.

Second, the author doesn't mention the millions of dollars wasted on pass through legislation so Mike M and his men can do solo anesthesia in rural USA.
Congress should stop paying these wasteful dollars for rural USA and instead close many of these hospitals. If they won't close them then level the playing field so rural hospitals get federal money to hire Anesthesiologists over CRNAs.

Third, anesthesia is a high risk specialty; even a member of Congress can grasp all the things that could go wrong under anesthesia. That's why Canada and the UK limit the role of advanced practice nurses in this area. No other first world country allows advanced practice nurses to give anesthesia without an anesthesiologist available to assist them. The USA should not succumb to the propaganda of a nursing organization whose agenda is money and power.

 

[Man o War]

Not to mention the poor quality graduates CRNA schools are mass producing. The fact is there simply aren't enough cases to go around to adequately train residents, fellows, and the hoards of CRNAs these schools are churning out.

 

[jwk]

The author is CRNA who advocates for the elimination of "fraudulent" billing by anesthesiologists who supervise multiple anesthetics.

http://thehill.com/blogs/pundits-bl...want-to-save-a-quick-20-billion-in-healthcare

The nurses are flooding the comments section.

Interesting that anyone can sign up to be a "contributor".

 

[deleted682700]

I read that whole thread an all of the comments. Truly scary to read as someone who is just starting medical school. Is there really no studies which show that MDA outcomes > crna outdomes?

Is it just that is hasn't been studied or is evidence actually showing they are equal. I find it very hard to believe that you would be approved by an irb to study high risk patients with a seemingly obvious less level of care and potentially let people die so idk how that can even be studied?!

You as a md Doctor is expected to bail the inexperienced CRNA that are out there to serve the AMC

 

[deleted682700]

It's all smoke and mirrors. Medicare doesn't reimburse Anesthesiologists more money for medical direction vs medical supervision (bill QZ). The reimbursement is the same whether a CRNA or Anesthesiologist does the case.

Second, the author doesn't mention the millions of dollars wasted on pass through legislation so Mike M and his men can do solo anesthesia in rural USA.
Congress should stop paying these wasteful dollars for rural USA and instead close many of these hospitals. If they won't close them then level the playing field so rural hospitals get federal money to hire Anesthesiologists over CRNAs.

Third, anesthesia is a high risk specialty; even a member of Congress can grasp all the things that could go wrong under anesthesia. That's why Canada and the UK limit the role of advanced practice nurses in this area. No other first world country allows advanced practice nurses to give anesthesia without an anesthesiologist available to assist them. The USA should not succumb to the propaganda of a nursing organization whose agenda is money and power.

Why should Rural hospitals close? May be suburban hospitals like those in Oakland, that are good at losing millions be targeted for public audit

May be a stress test to see which hospitals can survive

 

[Planktonmd]

Why should Rural hospitals close? May be suburban hospitals like those in Oakland, that are good at losing millions be targeted for public audit

May be a stress test to see which hospitals can survive

Actually the closure of small hospitals that are unable to keep up with the staffing requirements is a patient safety issue.
The French have done that and eliminated many rural facilities and that actually improved the quality of care.

 

[pgg]

Actually the closure of small hospitals that are unable to keep up with the staffing requirements is a patient safety issue.
The French have done that and eliminated many rural facilities and that actually improved the quality of care.

Do you know what that did to their access to care? Just curious. So-so care might be better than no care, or good care 6 months later.

 

[Planktonmd]

Do you know what that did to their access to care? Just curious. So-so care might be better than no care, or good care 6 months later.

This policy of hospital closure and hospital bed elimination has been going on in France for a long time, at the same time French health care continued to be ranked number 1 while the US is at 37:

World Health Organization Ranking; The World’s Health Systems
1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 USA
38 Slovenia
39 Cuba
40 Brunei
41 New Zealand
42 Bahrain
43 Croatia
44 Qatar
45 Kuwait
46 Barbados
47 Thailand
48 Czech Republic
49 Malaysia
50 Poland
51 Dominican Republic
52 Tunisia
53 Jamaica
54 Venezuela
55 Albania
56 Seychelles
57 Paraguay
58 South Korea
59 Senegal
60 Philippines
61 Mexico
62 Slovakia
63 Egypt
64 Kazakhstan 65 Uruguay
66 Hungary
67 Trinidad and Tobago
68 Saint Lucia
69 Belize
70 Turkey
71 Nicaragua
72 Belarus
73 Lithuania
74 Saint Vincent and the Grenadines
75 Argentina
76 Sri Lanka
77 Estonia
78 Guatemala
79 Ukraine
80 Solomon Islands
81 Algeria
82 Palau
83 Jordan
84 Mauritius
85 Grenada
86 Antigua and Barbuda
87 Libya
88 Bangladesh
89 Macedonia
90 Bosnia-Herzegovina
91 Lebanon
92 Indonesia
93 Iran
94 Bahamas
95 Panama
96 Fiji
97 Benin
98 Nauru
99 Romania
100 Saint Kitts and Nevis
101 Moldova
102 Bulgaria
103 Iraq
104 Armenia
105 Latvia
106 Yugoslavia
107 Cook Islands
108 Syria
109 Azerbaijan
110 Suriname
111 Ecuador
112 India
113 Cape Verde
114 Georgia
115 El Salvador
116 Tonga
117 Uzbekistan
118 Comoros
119 Samoa
120 Yemen
121 Niue
122 Pakistan
123 Micronesia
124 Bhutan
125 Brazil
126 Bolivia
127 Vanuatu 128 Guyana
129 Peru
130 Russia
131 Honduras
132 Burkina Faso
133 Sao Tome and Principe
134 Sudan
135 Ghana
136 Tuvalu
137 Ivory Coast
138 Haiti
139 Gabon
140 Kenya
141 Marshall Islands
142 Kiribati
143 Burundi
144 China
145 Mongolia
146 Gambia
147 Maldives
148 Papua New Guinea
149 Uganda
150 Nepal
151 Kyrgystan
152 Togo
153 Turkmenistan
154 Tajikistan
155 Zimbabwe
156 Tanzania
157 Djibouti
158 Eritrea
159 Madagascar
160 Vietnam
161 Guinea
162 Mauritania
163 Mali
164 Cameroon
165 Laos
166 Congo
167 North Korea
168 Namibia
169 Botswana
170 Niger
171 Equatorial Guinea
172 Rwanda
173 Afghanistan
174 Cambodia
175 South Africa
176 Guinea-Bissau
177 Swaziland
178 Chad
179 Somalia
180 Ethiopia
181 Angola
182 Zambia
183 Lesotho
184 Mozambique
185 Malawi
186 Liberia
187 Nigeria
188 Democratic Republic of the Congo
189 Central African Republic
190 Myanmar
Source: World Health Organization


Here is the map of bed elimination by region between 2015 and 2017 in France:

 

[pgg]

You didn't answer my question.

I don't doubt that health care in France is high quality or that French people are happy with it (they're paying a high price in taxes, so I would hope they'd get good care).

I was just curious what their access to care is like. Wait times for elective surgery, wait time to see a dermatologist, etc.

 

[aneftp]

You didn't answer my question.

I don't doubt that health care in France is high quality or that French people are happy with it (they're paying a high price in taxes, so I would hope they'd get good care).

I was just curious what their access to care is like. Wait times for elective surgery, wait time to see a dermatologist, etc.

Yup, it's all spin with what's "quality healthcare". Why is the US ranked in the low 30s?

Because many countries will spin data. And the World Health Organization goes along with "weighing" what they think is important and what's not important.

1. The birth data in the USA is very misleading because we often times have women who are older giving birth. Other countries use different metrics.

http://www.nationalreview.com/article/276952/infant-mortality-deceptive-statistic-scott-w-atlas

2. The WHO doesn't put much weight into "wait times" "pain and suffering" while waiting for an elective orthopedic new hip.

So is the USA is best health care system in the world? I'm not sure about the real answer. But we are certainly not the 40th best country. We have the most expensive system in the world and get dinged for that.

 

[deleted682700]

France is less than the size of texas. Of all the countries listed by WHO, a biased anti Us agenda organization (probably jealous) only australia ranks a few steps ahead of USA. Do they have any rating of the whole of euro land?

 

[deleted171991]

You didn't answer my question.

I don't doubt that health care in France is high quality or that French people are happy with it (they're paying a high price in taxes, so I would hope they'd get good care).

I was just curious what their access to care is like. Wait times for elective surgery, wait time to see a dermatologist, etc.

Neither should matter as long as they have better outcomes (i.e. lower mortality, longer survival etc.) which they do. Population-level healthcare should be focused on outcomes and costs, with patient satisfaction very low on the list of priorities. That's why Europeans tend to have tiered systems, where those who want to be pampered pay much more and are offered a completely different customer experience.

I am sure that, even in Canada, one can get better and faster access at private clinics. Our problem is that Americans just can't stand if they don't get the same level of care as their rich countrymen, which is considered absolutely normal in Europe. For example, many elective joint replacement surgeries are a waste (at a society and outcome level), and I bet the waiting times for them are pretty long in Europe (as they should be, if not urgent or truly last-resort). I have met a good number of Americans with 5+ serious elective surgeries during their lives (I am not talking cataracts or C-sections), most of them probably unneeded (e.g. back surgeries, or major surgeries at age 90+); that just doesn't happen in Europe, not on public money.

 

[deleted171991]

Yup, it's all spin with what's "quality healthcare". Why is the US ranked in the low 30s?

Because many countries will spin data. And the World Health Organization goes along with "weighing" what they think is important and what's not important.

1. The birth data in the USA is very misleading because we often times have women who are older giving birth. Other countries use different metrics.

http://www.nationalreview.com/article/276952/infant-mortality-deceptive-statistic-scott-w-atlas

2. The WHO doesn't put much weight into "wait times" "pain and suffering" while waiting for an elective orthopedic new hip.

So is the USA is best health care system in the world? I'm not sure about the real answer. But we are certainly not the 40th best country. We have the most expensive system in the world and get dinged for that.

Yeah, it's always the foreign conspiracy.

 

[pgg]

Neither should matter as long as they have better outcomes (i.e. lower mortality, longer survival etc.) which they do.

Is that because their healthcare is better, or because the French aren't as fat as we are?

 

[pgg]

Yeah, it's always the foreign conspiracy.

It's not a conspiracy, but the data isn't as directly comparable as many would have us believe. Not infrequently, there's willful disregard of significant population and cultural differences when it's convenient to the argument being made.

For one trivial example, consider off-cited yet ridiculous claim that Cuba has lower infant mortality rates than the US. Never mind that in the US a 25 week preemie who dies is an infant death, but in Cuba it's a stillbirth because there's no way any 25 week preemie ever survives in that country. But Cuban healthcare is better, per this manipulated metric.


To be clear, I've got no problem with rationing/delaying elective surgery to treat self-inflicted disease. Long waits for TKAs in countries with socialized medicine is a feature, not a bug.

 

[BLADEMDA]

Is that because their healthcare is better, or because the French aren't as fat as we are?

But, they smoke more which is major factor for many diseases.

http://www.csmonitor.com/World/Europe/2014/0209/Why-can-t-the-French-stop-smoking

 

[pgg]

But, they smoke more which is major factor for many diseases.

http://www.csmonitor.com/World/Europe/2014/0209/Why-can-t-the-French-stop-smoking

Maybe their wine consumption is protective. Or maybe it's their 30-hour work week. Or maybe their smug sense of superiority over all things non-French.

 

[Planktonmd]

Maybe their wine consumption is protective. Or maybe it's their 30-hour work week. Or maybe their smug sense of superiority over all things non-French.

Or... maybe they have a better healthcare system that actually focuses on disease prevention not on producing more profit by doing more procedures.

 

[pgg]

Or... maybe they have a better healthcare system that actually focuses on disease prevention not on producing more profit by doing more procedures.

Maybe.

Or maybe it's because socialized medicine breeds laziness and they are better at obeying

LAW #13: THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

 

[deleted171991]

Or maybe it's because socialized medicine breeds laziness and they are better at obeying

Do you mean paternalistic medicine?

LAW #13: THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

Not really (except for residents who don't know what they are doing). Sometimes nothing is appropriate, most of the time it's not. Otherwise Africa would have the best healthcare in the world.

 

[pgg]

If you can't tell, I'm being 73% facetious by bringing up their 30 hour work week, drinking habits, and a 1970s book about torturing interns.

The other 27% of me is serious though about pointing out the methodological perils of glib and simplistic comparisons of US vs French "population health metrics". They're not like us in many ways. Only one of which is their health care system.

 

[deleted171991]

If you can't tell, I'm being 73% facetious by bringing up their 30 hour work week, drinking habits, and a 1970s book about torturing interns.

The other 27% of me is serious though about pointing out the methodological perils of glib and simplistic comparisons of US vs French "population health metrics". They're not like us in many ways. Only one of which is their health care system.

You are absolutely right about stress levels. They don't work 30 hours, but the system discourages working much above 40, and they have more vacation. Overall, they are probably happier people with more fulfilling lives, and that matters indeed. They work to live, not live to work.

 

[Iso4ane]

Neither should matter as long as they have better outcomes (i.e. lower mortality, longer survival etc.) which they do. Population-level healthcare should be focused on outcomes and costs, with patient satisfaction very low on the list of priorities. That's why Europeans tend to have tiered systems, where those who want to be pampered pay much more and are offered a completely different customer experience.

One thing I think about, but don't know the answer too, is how large a role homogeneity of a population plays in deliverance of healthcare. I like to think (could be false for all I know) that in parts of the many parts US, we are much more diverse than many of the EU countries.

 

[doctalaughs]

Its pretty clear that we just need to ration expensive and minimally beneficial care and stop inventing expensive drugs that bankrupt our economy while selling the same drugs overseas at 1/10th the cost. It's also clear that the American people are unwilling to do these things. So... they get what they get.


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[deleted682700]

Can you really tell your American employer that your back hurts and u need 6 weeks off. No way /how. The pace of life, expectations from employees, productivity is very high, even when compared to Europe. Yes this medicine in America is very expensive and till now we had the luxury of a third party, insurance company/govt pick up the tab.

Surely you run out of other people's money and then, covert rationing begins.

 

[aneftp]

Rationing is an evil word Americans don't want to hear about their Healthcare.

Liberals try to say rationing Healthcare happens everyday with the poor's limited "access" to care. The poor are rationed with their healthcare.

Conservatives say rationing Healthcare is like death panels.

Who's correct?

 

[dhb]

Neither should matter as long as they have better outcomes (i.e. lower mortality, longer survival etc.) which they do. Population-level healthcare should be focused on outcomes and costs, with patient satisfaction very low on the list of priorities. That's why Europeans tend to have tiered systems, where those who want to be pampered pay much more and are offered a completely different customer experience.

I am sure that, even in Canada, one can get better and faster access at private clinics. Our problem is that Americans just can't stand if they don't get the same level of care as their rich countrymen, which is considered absolutely normal in Europe. For example, many elective joint replacement surgeries are a waste (at a society and outcome level), and I bet the waiting times for them are pretty long in Europe (as they should be, if not urgent or truly last-resort). I have met a good number of Americans with 5+ serious elective surgeries during their lives (I am not talking cataracts or C-sections), most of them probably unneeded (e.g. back surgeries, or major surgeries at age 90+); that just doesn't happen in Europe, not on public money.

A lot of wrong in that post.
French at #1? Sorry that's a joke they might have closed beds but they still have some places where you wouldn't bring your dog

 

[VA Hopeful Dr]

Actually the closure of small hospitals that are unable to keep up with the staffing requirements is a patient safety issue.
The French have done that and eliminated many rural facilities and that actually improved the quality of care.

And that makes sense in a small-ish, reasonably densely populated country. In a place as big as America, closing rural hospitals could easily mean 4-5 hours to the nearest decent sized hospital.

For example, my state (South Carolina) is small enough that even only leaving the hospitals that have residency programs would mean at worst a 45 minute drive from anywhere in the state to the nearest hospital.

Take a state like Montana, and those rural hospitals play a much more important role.

 

[pgg]

Next you'll be telling me public transportation is better in Europe than it is in Montana.

 

[deleted126335]

Rationing is an evil word Americans don't want to hear about their Healthcare.

Liberals try to say rationing Healthcare happens everyday with the poor's limited "access" to care. The poor are rationed with their healthcare.

Conservatives say rationing Healthcare is like death panels.

Who's correct?

We have rationing now. Rationing by inconvenience and expense. Long wait. Onerous application process. High copays and deductibles incentivize patients to choose to defer getting care.

 

[aneftp]

We have rationing now. Rationing by inconvenience and expense. Long wait. Onerous application process. High copays and deductibles incentivize patients to choose to defer getting care.

Some patients are rationed this way.

Others who have good insurance without co pays or very little co pay do not think twice about cost (since it doesn't affect them)

The issue is do u want to be like social medicine system where 95 % of the care is "rationed" for the masses and the 5% who are richer can afford to do the private system

Right now. Maybe only 20-30% of the USA population faces "rationing" The rest have Medicaid (free) or good private insurance.

 

[deleted171991]

One big problem with the system is lack of transparency. If they are going to nickel and dime me for every breath I take inside their facility, they should have to post the cost of every single breath online, so I can choose the hospital with cheaper air. The way it is now, one cannot plan for the cost of medical care, because it's a big black box, and there are no real market forces at work.

 

[Planktonmd]

And that makes sense in a small-ish, reasonably densely populated country. In a place as big as America, closing rural hospitals could easily mean 4-5 hours to the nearest decent sized hospital.

For example, my state (South Carolina) is small enough that even only leaving the hospitals that have residency programs would mean at worst a 45 minute drive from anywhere in the state to the nearest hospital.

Take a state like Montana, and those rural hospitals play a much more important role.

I think they should close Montana as well!

 

[deleted162650]

I think they should close Montana as well!

I can think of a lot of states that should be closed long before MT.

 

[deleted682700]

I think they should close Montana as well!

Please don't close big sky

 

[deleted171991]

The true story of America’s sky-high prescription drug prices

 

[Planktonmd]

A lot of wrong in that post.
French at #1? Sorry that's a joke they might have closed beds but they still have some places where you wouldn't bring your dog

How do you define "a place where you wouldn't bring your dog"?
And at least they are fixing the problem by shutting down these places while here we are trying to keep them alive by creating new sub par physician "extenders"!

 

[dhb]

They also have large territories without GPs.
Although that the median quality of care is ok, there are large variations.

 

[doctalaughs]

The true story of America’s sky-high prescription drug prices

Yeah its ridiculous. They need to make a law here that we will bargin on drug prices not pay a cent more than any other country or entity in the world. Why should US citizens pay for drugs for the rest of the world (in addition to our taxpayer money funding a large proportion of the world's research that led to these drugs)? I's say thats 50% of our healthcare problem right there.


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[pgg]

Not to completely defend drug prices in the US, but it's drug sales and profits in the US that keep pharmaceutical companies in business and developing new drugs. Trials are expensive and most fail.

Do we want new classes of antibiotics?

In any case, what's your answer? Should the US government fix prices of drugs the way the Venezuelan government fixes the price of milk and chicken?

 

[deleted171991]

Not to completely defend drug prices in the US, but it's drug sales and profits in the US that keep pharmaceutical companies in business and developing new drugs. Trials are expensive and most fail.

Do we want new classes of antibiotics?

In any case, what's your answer? Should the US government fix prices of drugs the way the Venezuelan government fixes the price of milk and chicken?

That's such BS, no offense. These companies are in monopoly positions for their respective drugs, and need to be regulated like monopolies or utilities. Free market doesn't work with them. They are too big and too corrupt, and they manipulate laws and politicians like they are a state within a state. Even small operators like generics manufacturers are emboldened now to set absolutely ridiculous prices, just because the big companies have made sure that the barrier of entry for manufacturing and selling drugs in this country is absurdly high.

With Comcast, one can choose to have TV/Internet or go read a book. But with a life-saving drug, one can choose whether to pay up to extortion or die (sooner). The profits of drug (or any essential healthcare) companies should be capped by law, based on their research expenses. They should be incentivized to develop new products, not to milk the market.

 

[pgg]

The profits of drug (or any essential healthcare) companies should be capped by law, based on their research expenses. They should be incentivized to develop new products, not to milk the market.

I don't disagree with any of that, but the devil is in the details.

I personally think there's a deeper and broader problem with our patent system (not just as pertains to drugs), and that's where the main fix belongs.

 

[doctalaughs]

Not to completely defend drug prices in the US, but it's drug sales and profits in the US that keep pharmaceutical companies in business and developing new drugs. Trials are expensive and most fail.

Do we want new classes of antibiotics?

In any case, what's your answer? Should the US government fix prices of drugs the way the Venezuelan government fixes the price of milk and chicken?

Even if you are against "price fixing" there is no reason drug companies should be charging 50 times the cost in the USA as in India and 3 times the cost of Europe for the exact same product, just because we aren't bargaining at all.

That's just a form of indirect wealth transfer from US citizens to citizens of other nations that are willing to play hardball with these huge companies. And it's only possible because the pharma industry operates extremely differently than a free market model.


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