The question isn't whether or how much this new system would raise the coverage among the uninsured by. Obviously since they are uninsured, any coverage is better than no coverage. That goes without saying and I believe that much is obvious to a monkey who reads this. The question is what sacrifices we are making to get them that coverage. If that coverage comes at the cost of this devolving into a Medicare-like system where the government skims the coffers or raises premiums/taxes-that-are-really-just-premiums to put towards other things, then that is a price that we as a country may not be willing to pay to get x amount of people covered.
I think you're referring to the use of current medicare trust funds (among the people who are collecting wages and not using that medicare) and use toward current costs that may or may not be limited to the Medicare program (which
in theory should not be the case but I can conceive as happening in one way or another.) This is not necessarily entailed by the public nature of the system, and carries the political weight of being everyone's insurance fund (and not just in the future.) In systems without any legislation to keep healthcare tax levying separate from other taxes, like Spain's, there is a catalogue of services that must be provided by autonomous communities (which are the healthcare-providing units) at minimum but which may be exceeded. If taxes in general are exceeded, this is not distinct from the power of raising taxes currently given to our legislators.
I stand by "R&D goes first" but I should have said that M&A departments are getting bigger and encroaching on territory that was once occupied by R&D. The R&D departments haven't gone completely and I would indeed be hard pressed to find a big pharma company that has entirely replaced R&D with M&A. The point is that R&D falls whereas M&A goes up.
This doesn't seem sustainable in the long run (even less so than R&D in general,) I assume that there is a finite number of acquirable companies to absorb R&D risks. How is this discussed in terms of long term strategy, to your knowledge?
As a group, these companies are incredibly diverse and I would not put much stock in that outcome. A difference in spending of just under 2% on the average does not reflect the more nuanced changes that companies must make. In the course of a decade, many things happen - in fact, it's an off-cited rule of thumb in the industry that a blockbuster drug comes along about once every ten years. Things like Lipitor or Zoloft. These things end up affecting revenue and decision-making in the long run. Show me data that tracks these companies in the very same way the authors tracked them in that study, just in over longer time scales after the revenue decrease. If that shows consistent increases in the R&D spending, then I will rest my case. Again, the very data they show demonstrates the very opposite. In most years and for most companies, the R&D spending tracks revenue for the companies they show in Figure 1a.
That the R&D growth rate tended to decrease with decreases in revenue was not at dispute, again they say that while revenue growth rates are essentially flat over the sampled period the R&D grew on average and the SG&A shrunk on average. And while these changes are small (as are the sampled changes in revenue, the largest of which is Roche at 3.77%) they show priority does not shift out of R&D growth relative to revenue growth, but adjusts accordingly. As such, we may see a decline in R&D if revenues go down, but in the long term it does not seem that "R&D goes first" - its growth dips below that of revenue in the revenue decreases of Merck and Co, Pfizer (except around the last few sampled year(s,) and of Sanofi in some years. On the other hand, when AstraZeneca, Bristol-Myers Squibb, Lilly, and Novartis keep R&D at levels above their revenue while Johnson & Johnson keeps it below revenues consistently until around the end, when it dips above. At best, from looking at the data, we can say responses in terms of what parts get cut out the most when spending goes down (though everything does go down) are not uniform in the short or long term.
The author is looking at short-term trends when he should know that the pharma industry responds to longer-term effects. I can't speak to his motivation but his own data is clear. For most companies, R&D tracking generally tracks revenue except in the a few companies specifically in the last few years. Longer-term trends are also diluted and can be reversed by many market effects. For example, having one blockbuster drug come in can make up for reductions in spending due to loss of revenue from another drug/failed trial/drug being pulled from the market/etc. He's looking at overall revenue and overall R&D, which ignores cause and effect entirely.
I'm not following you, would having a blockbuster drug not be reflected in the revenues? And should the delay in tracking or in strategic reaction, if not reflected in one-year-change graphs, still show up in 10-year trackings of those companies?
Interesting question. Alright, let's do a case study on chemotherapy. Usually, chemotherapies can cost in the tens of thousands for a couple month-course. How much would you negotiate that price down by? Let's say it's $30,000. A reduction of 30% would be a final cost of $21,000. Is that an acceptable reduction for you?
Again, you ask too much of me. I'm assuming that neither the manufacturer wants to be insolvent nor the administrating body wants to be gouged and incentives move from there as each. The nuances of specific drugs with specific production costs and specific therapeutic advantages are probably beyond generalization, but even if they were not I would not be able to come up with those numbers. I would venture to guess that if production costs and some extent of profit margins remain at $21,000 that would be reasonable. It seems that if Germans pay $21,000 for this theoretical drug and it is worth manufacturing and selling for the theoretical manufacturer, it can be worth manufacturing and selling at adjusted price levels for the same manufacturer for Americans. If continuation of the billions of dollars in R&D invested by the private sector every year requires fatter profits, then Germans, Brits, etc. as much as Americans should need to adapt prices. Assuming we're overburdening our taxpayers and unhealthy citizens to pay for the world's R&D, it's worth asking whether that R&D investment burden per se is helping more than it's hurting
in America (not to say, again, that R&D isn't immensely valuable for humanity.)
Private insurance, the alternative we have referred to before.
I created a significant turd last night. Astronomically significant, actually.
I'm glad you have healthy bowel movements.
I don't disagree that people have been using the term quite loosely. Doesn't justify continuing to use it. There's an age-old adage that I shouldn't have to repeat here, as you've probably heard it sometime during your childhood.
Sure, but given that people do use it we can understand what they may mean even if it's not what we think it should mean. No need to divert from the relevant argument over semantic discrepancy.
As for the adage, I'm foreign-born so I did not get to hear it in my childhood, but I can vaguely imagine how it goes.
That "adjusted" community rating is just risk rating by category. Again, it's a matter of terminology and this one is again in common usage but even the ACA is risk rated. It just allows less risk rating than before.
Indeed.
