Who Cares About Healthcare?!!!!??!!!

[Napoleon4000]

Really? A one hour or two hour show to discuss the obvious: we need to get away from privatization and adopt the same National Health Cares system that exist in: Scandinavia, Japan, Switzerland and Canada. This topic will get old. There is no need for profit when we think about the survival of individuals, but alas, both Hospitals and HMOs are mostly (with few exceptions) privately owned and for profit.

If one really cares about health care, REALLY, my opinion is that:
1. more social medicine is necessary
2. less government favor of HMOs and pharmaceutical companies
(especially when it comes to new drugs (vioxx) and lobbying
3. Complete illegalization of conflict of interest links between academia and industry (no faculty should be allowed to mingle with companies)
4. Revision of patent law to give more rights to universities and public institutions like NIH
5. TRUE exposure to social medicine (show what the health care system is REALLY like in Japan and others above)
6. more government innitiatives for the looming geriatric crisis: more people living longer
7. REALLY deal with social security
8. BETTER government incentives to go into really needy areas (otherwise all this is bull crap)
9. Government bailouts of Hospitals in a similar fashion to airlines
10. Better planned, more rigorous and better funded clinical trials of both new and non-traditional medicines.

Much of this is REALLY common sense with no easy solution or happy medium. This country was founded by industrialists whose marginal and myopic point of view has trasncended into this obvious looming health care crisis. To REALLY begin to deal with the problem, the entire infrastructure must be changed. We also need to change the way we think and of newer approaches. So....who's gonna start it. You...me...them????? Health care. What an oxymoron. I mean we would have to do away with junk food too. No more hippocrisy. No more "do as I say, not as I do." This system is for the rich to perpetuate the rich.

It's a joke. And although we have had some great achievements we should not settle and try and become the human society we are supposed to become. Better...faster...stronger...healthier...What do you think?

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[Law2Doc]

Really? A one hour or two hour show to discuss the obvious: we need to get away from privatization and adopt the same National Health Cares system that exist in: Scandinavia, Japan, Switzerland and Canada. This topic will get old. There is no need for profit when we think about the survival of individuals, but alas, both Hospitals and HMOs are mostly (with few exceptions) privately owned and for profit.

If one really cares about health care, REALLY, my opinion is that:
1. more social medicine is necessary
2. less government favor of HMOs and pharmaceutical companies
(especially when it comes to new drugs (vioxx) and lobbying
3. Complete illegalization of conflict of interest links between academia and industry (no faculty should be allowed to mingle with companies)
4. Revision of patent law to give more rights to universities and public institutions like NIH
5. TRUE exposure to social medicine (show what the health care system is REALLY like in Japan and others above)
6. more government innitiatives for the looming geriatric crisis: more people living longer
7. REALLY deal with social security
8. BETTER government incentives to go into really needy areas (otherwise all this is bull crap)
9. Government bailouts of Hospitals in a similar fashion to airlines
10. Better planned, more rigorous and better funded clinical trials of both new and non-traditional medicines.

Much of this is REALLY common sense with no easy solution or happy medium. This country was founded by industrialists whose marginal and myopic point of view has trasncended into this obvious looming health care crisis. To REALLY begin to deal with the problem, the entire infrastructure must be changed. We also need to change the way we think and of newer approaches. So....who's gonna start it. You...me...them????? Health care. What an oxymoron. I mean we would have to do away with junk food too. No more hippocrisy. No more "do as I say, not as I do." This system is for the rich to perpetuate the rich.

It's a joke. And although we have had some great achievements we should not settle and try and become the human society we are supposed to become. Better...faster...stronger...healthier...What do you think?

Bear in mind that what works in a place like Canada, Japan or a Scandanavian nation simply won't work here. These are countries which, compared to the US, have very small populations, negligible drug problems, lower AIDS rates, fewer poor and homeless, less obesity and heart disease (less fast food), and higher per capita taxes. For the same reason that HMOs didn't work too well when extrapolated from a fairly small and healthy Californian population to the nation at large, the Canadian socialized medicine system will not work when extrapolated to the US. We would need a system tailored to our unique issues, not assertions that "we need what they do there", because that simply won't work. Also, the wealthier Canadians often go outside of their system and use the US as their backup when their own system fails them -- if we move to that system, we won't have that luxury. And FYI the pharmaceutical industry probably actually saves money in terms of health care costs, as better drugs limit the needs for surgery, more cost intensive hospital stays and the effects of progressive diseases, so I'm not sure I'd put them in the enemy camp along with the HMOs. It's easy to point to problems, but hard to come up with workable financially feasible solutions to this kind of problem. But while socialized medicine is likely to come in some form or another, it is unlikely to be the panacea you are hoping for.

 

[Napoleon4000]

Thanks. I'm not expecting a panacea. However, I am speaking my mind. And yes, while these countries this or that is just another excuse not to do something. Funny though, our system is impotent- hence looming crisis. And yes, while pharmaceutical companies save money, they MAKE more than is necessary. Purchasing medications without health insurance is like buying a car - almost unaffordable. My experience is very personal on this matter. Drugs save lives but so does education and preventive medicine. Hypothetically, if we - as nation - mandated that companies eliminate junk food, mandated 1 hour of exercise as part of work, and in general did not limit medical education to those seeking it, it would surely pay off. However, none of this meets the bottom dollar lines required by major companies. And to further fuel the issue, continual conflicts of interest between academia and industry and government don't give me any hope of alleviation in sight. Mercedes, big house, wife (husband) two kids....this is the norm. What I'm saying is that the table has to be wiped clean. Start again. Hard and unrealistic though. The system needs to change:
1) no more high fructose corn syrup
no more:
donuts
sodas
mac donalds
pizza
pretty much anything bad for you

economic downfall...

Just wait until oil runs out. Pretty much all drugs with have astronomical costs; including plastics, tires, toys;

The health care problem is just about health care it's about social values; government expectations; personal needs (no wants). It's a much bigger problem. With no simple solution because I don't want to infringe upon someone's right to do what they want in free society. Complex. I'm not 2 years old. Nor was I born within the last three and half decades. Healthcare is an oxymoron. It's fake work conjured up by someone who wants people to think in this context. MD, DO what ever is as much about lifestyle, as it is not about actual concern for the well being of another human being. I like to be devils advocate for a reason. I do appreciate your comments though.

 

[Law2Doc]

And yes, while pharmaceutical companies save money, they MAKE more than is necessary.

With this kind of statement I think you are moving from socialism to communism.
Drug companies do quite well, but because of high research costs, significant FDA requirements, and significant lawsuit implications, they won't (and can't) do anything on a small profit margin basis. Some companies went out of the childhood vaccine business altogether because litigation costs were too high. The US government still has a tough time getting drug companies to investigate medicines for small percentage population diseases because the profit just isn't there, and has had to pass "orphan drug" tax incentives to stimulate research in such areas. And what you aren't realizing is that some of the high costs of drugs are due to the fact that it takes literally billions of dollars in some cases to do pharmaceutical research, then go through 5+ years of FDA mandated testing, and then bring a drug to market, only to have a short remainder of the patent term left to recoup the investment before other companies can legally rip them off and sell generics. Thus drug companies thus only want to produce drugs that have appeal to a large percentage of the population and that they can charge a lot for. Greater (tax) incentives can drive this a different direction, but not at cost savings you desire. Most of the pharmaceutical company heavy hitters have diversified into consumer products (toothpaste and baby powder), as a lot of their pharmaceutical research doesn't pan out, and so if things get too costly or unprofitable for them in a given medicine, they will quite painlessly bail out of that business. Thus when you start to determine how much money is too much, you start driving companies out of the business. And then you are really going to see healthcare costs skyrocket.

 

[Napoleon4000]

Thus, my original conclusion is reiterated even by you. Healthcare IS an oxymoron. It's not about the health of people, but the money companies can make. Ooooh communism is such a bad word. I don't give a crap about semantics and the forces that society places on certain words. And thank for the education, yet patronizing comments about the pharmaceutical industry. Bottom line, is that money is a companies bottom line. Myopic. Thanks agian. I enjoyed this.

 

[CatsandCradles]

With this kind of statement I think you are moving from socialism to communism.

I'm not a Catholic, but I think there was a priest in El Salvador who did a lot of social work with poor folks. He said that, "When I feed the poor, people call me a saint. But when I start asking why there are poor people, they call me a communist."

I have forgotten his name, but I know he was later executed by government soldiers for being a speaker for farmers being terrorized by the government.


In Cuba, they have the highest number of doctors for the population compared to anywhere else on earth - and it has definantly made an impact. They have a pretty top notch AIDs program and prevention program.

I suggest reading Mountain Beyond Mountains by Tracy Kidder. Excellent book that examines the life of Paul Farmer, an infectious disease speacialist from Harvard. The book is about Haiti, but the number of doctors Cuba sends over to Haiti has created a lot of improvements in population health.

The Cuban doctors aren't the best, they don't have access to high tech gizmos, but they're doing good for what they got.

That said, I think that...

...well you see I don't know what to think. A social medical system might work in America - but I'm worried that we might end up like Germany.

In Germany, if you want a heart surgery, you got it. It doesn't matter how poor you are and that's the best thing about it. The Germans have good equipment and techniques compared to communist Cuba - but the bad news is rather frightening: You will be waiting for several months for the surgery!

If your a young person, then you save a lot of money. If your an older person, then you are in more trouble if you need immediate invasive care.

With a socialized medical system where doctors are paid a fixed salary, they will not work as hard. It's human nature.

For example, let's say Washington DC caps the surgeon's salary at $100,000
then the surgeon will do the minimum amount of work and leave early each day. It's human nature. Why work harder and see more patients each day when your only getting paid the same thing? There is no incentive to work harder.

In a very ideal world, the doctor will work just as hard and dilligently even if it is a capped salary. But very few of us are like this. Those of us who are like this will probably have gone over seas and working with some missionary group or organization like Doctors Without Borders ($600 a month for 6 months! )

I'd love to see a system where poorer folks and working class folks get just as good care provided at the very best private hospitals - but pulling that off is no walk in the park.

I imagine you would need tons of finacial reform in the government. With a war in Iraq and difficulty in the domestic front with natural disasters, a social medical system just seems completely unreal for the moment. The government is in red ink heavily.

This is a very interesting topic always. Better healthcare for poorer folks might not come soon, but I do have faith that it will somehow.

 

[Napoleon4000]

Catsandcradles,
you have redeemed the human race and this entire forum. I think it's funny that people in this country don't see life for how it really is. Especially just living here and never really seing the world. I hope you do great things. I will say no more except...thank you.

 

[Gut Shot]

And FYI the pharmaceutical industry probably actually saves money in terms of health care costs, as better drugs limit the needs for surgery, more cost intensive hospital stays and the effects of progressive diseases, so I'm not sure I'd put them in the enemy camp along with the HMOs.

Considering that the pharmaceutical companies spend more on marketing than on R&D, and that they maintain the highest profit margin of any major industrial sector (unless oil has overtaken them), I have no problem putting them in the enemy camp. It's too bad they're the hand that feeds. The Medical Letter is all you need to make decisions when prescribing, so I long for them to take all their commercials and pens and lunches and free vacations and marketing reps and deposit them in the Hudson. It's wishful thinking, I know.

The cost saving notion is potentially comforting, but I don't buy it without some analysis. I don't have the time, data or expertise, but I will note that from 1993 to 2003 the amount we spent on health care in this country rose from 13.3% to 15.3% of our GDP ($888 vs $1,679 billion). During this same period the percentage spent on prescription drugs has risen from 5.8% to 10.7% of total healthcare expenditures. Source: KFF I find it hard to believe that the flood of expensive new medications on the market in the last 10 years has had any significant effect on this rising tide, other than perhaps contributing to it.

 

[chef_NU]

Considering that the pharmaceutical companies spend more on marketing than on R&D, and that they maintain the highest profit margin of any major industrial sector (unless oil has overtaken them), I have no problem putting them in the enemy camp. It's too bad they're the hand that feeds. The Medical Letter is all you need to make decisions when prescribing, so I long for them to take all their commercials and pens and lunches and free vacations and marketing reps and deposit them in the Hudson. It's wishful thinking, I know.

The cost saving notion is potentially comforting, but I don't buy it without some analysis. I don't have the time, data or expertise, but I will note that from 1993 to 2003 the amount we spent on health care in this country rose from 13.3% to 15.3% of our GDP ($888 vs $1,679 billion). During this same period the percentage spent on prescription drugs has risen from 5.8% to 10.7% of total healthcare expenditures. Source: KFF I find it hard to believe that the flood of expensive new medications on the market in the last 10 years has had any significant effect on this rising tide, other than perhaps contributing to it.

Let's not pretend that people in the pharmaceutical business are evil. They are people, just like everyone else. It's not like you fill out a questionairre for the application and you check the box "I will do anything and everything at the expense of my values". The people who run the pharmaceutical companies are the same people who run our stationary stores and our fast food chains. The only difference is that the system is set up in their favor, and they are capitalizing on it. People, on average, are the same. And when you talk about a large sector of the economy employing people from diverse backgrounds, it's difficult to make such a categorical generalization. So please, let's stop berating the pharm industry for taking advantage of an f'ed up health care and economic system. Anyone else would do the same.

 

[Gut Shot]

So please, let's stop berating the pharm industry for taking advantage of an f'ed up health care and economic system. Anyone else would do the same.

Sorry, my standards of human behavior and dreams of a slightly less f'ed up world prevent me from doing so. The pharm industry has always been wrought with greed, corruption, collusion and price fixing. Here is an interesting Australian site that summarizes some of their sins, replete with how much various companies have coughed up in fines and court settlements.

Sticking up for the pharm industry is like sticking up for a father who beats his kids but still puts bread on the table, and I refuse to find that situation acceptable. Maybe your opinion will shift slightly when you're dealing with clinic patients who can't afford their meds, only to have a drug rep (who's pulling down 80K a year) stroll in and invite you to an expensive dinner.

 

[Law2Doc]

Sticking up for the pharm industry is like sticking up for a father who beats his kids but still puts bread on the table, and I refuse to find that situation acceptable. Maybe your opinion will shift slightly when you're dealing with clinic patients who can't afford their meds, only to have a drug rep (who's pulling down 80K a year) stroll in and invite you to an expensive dinner.

It might be your opinion that would shift if you saw past the few bad drug reps you seem to have been exposed to, to the actual men and women who really work in the industry. I think your perspective is influenced by your unfortunate clinic patients, just as some of us who have worked closely with pharmaceutical companies have seen that most of the people who work in and run those companies are good hard working people who actually have an interest in coming up with new and helpful cures. That they cannot do so cheaply (due to high R&D costs and lengthy FDA trial requirements) or without significant marketing costs is unfortunate, but a fact of business. And certainly $80k per year is less than many health professionals make, so I'm not sure what your point is in referencing the marketing reps salary.

 

[Gut Shot]

It might be your opinion that would shift if you saw past the few bad drug reps you seem to have been exposed to, to the actual men and women who really work in the industry. I think your perspective is influenced by your unfortunate clinic patients, just as some of us who have worked closely with pharmaceutical companies have seen that most of the people who work in and run those companies are good hard working people who actually have an interest in coming up with new and helpful cures. That they cannot do so cheaply (due to high R&D costs and lengthy FDA trial requirements) or without significant marketing costs is unfortunate, but a fact of business. And certainly $80k per year is less than many health professionals make, so I'm not sure what your point is in referencing the marketing reps salary.

I'm not sure you could have misunderstood my post any more. I have no beef with drug reps or pharma employees in general, but the industry does do some pretty seedy things. Marketing is a fact of life, but I remember a time before all the drug commercials when patients weren't showing up in droves demanding drugs they don't really need. They also routinely spend three times as much on marketing as they do on their much ballyhood R&D. Three times!

I reference 80K because $80,000 multiplied by the number of drug reps in existence is an awful lot of money to spend pushing pills face-to-face. I'm not rambling on here as an indictment of the drug industry, it's just painful for me to see this crappy situation that has evolved. Things are what they are, I simply lament that they aren't a lot better.

 

[50dent]

There's a reason why businesses get alot more accomplished than non-profit businesses in terms of better products and having better service. It's called human nature and selfishness(to a degree) that when structured right brings about the best in human potential. The healthcare field is no different. Im obviously not an economist or historian but for medicine to advance for the better like it has been, keeping it business minded and striving for more profit sounds like a great idea to me because the poor and underserved slowly get the benefits of this growth. I agree with the above post that universal healthcare(i think that's what it's called) would limit this growth and hurt society more than help. True compassion isn't only caring but doing what works.

 

[DropkickMurphy]

Really? A one hour or two hour show to discuss the obvious: we need to get away from privatization and adopt the same National Health Cares system that exist in: Scandinavia, Japan, Switzerland and Canada. This topic will get old. There is no need for profit when we think about the survival of individuals, but alas, both Hospitals and HMOs are mostly (with few exceptions) privately owned and for profit.

If one really cares about health care, REALLY, my opinion is that:
1. more social medicine is necessary
2. less government favor of HMOs and pharmaceutical companies
(especially when it comes to new drugs (vioxx) and lobbying
3. Complete illegalization of conflict of interest links between academia and industry (no faculty should be allowed to mingle with companies)
4. Revision of patent law to give more rights to universities and public institutions like NIH
5. TRUE exposure to social medicine (show what the health care system is REALLY like in Japan and others above)
6. more government innitiatives for the looming geriatric crisis: more people living longer
7. REALLY deal with social security
8. BETTER government incentives to go into really needy areas (otherwise all this is bull crap)
9. Government bailouts of Hospitals in a similar fashion to airlines
10. Better planned, more rigorous and better funded clinical trials of both new and non-traditional medicines.

Much of this is REALLY common sense with no easy solution or happy medium. This country was founded by industrialists whose marginal and myopic point of view has trasncended into this obvious looming health care crisis. To REALLY begin to deal with the problem, the entire infrastructure must be changed. We also need to change the way we think and of newer approaches. So....who's gonna start it. You...me...them????? Health care. What an oxymoron. I mean we would have to do away with junk food too. No more hippocrisy. No more "do as I say, not as I do." This system is for the rich to perpetuate the rich.

It's a joke. And although we have had some great achievements we should not settle and try and become the human society we are supposed to become. Better...faster...stronger...healthier...What do you think?

As they saying goes, opinions are liking a--holes. Everyone has one, and you don't ever believe yours stinks.

If we went to socialized medicine I do believe the system would fail just like Canada's has (yeah, it's great for the not so sick patients and the preventative side of things but when the fecal material hits the fan, things tend to not work that well (at least according to a group of Canadian docs I talked to at a conference).

This is also not to mention that you would rapidly see our future paychecks as physicians dwindle down to where it would not even be worth the trouble of 8 years of school, years of residency and all the headaches that are part of practice as a physician.

As Charlie711 so nicely pointed out, true compassion isn't only caring but doing what works. You might serve more people in terms of numbers with socialized medicine, but you would be doing far less good for individuals in far more cases than you do currently.

 

[Gij]

Here is what I think with respect to Pharmaceutical companies:

1. People in Pharma are human and probably decent scientists, businessmen and women, but remember they have to answer to people in Wall Street. It is not their job to keep prices reasonable.

2. Their industry has the highest margin of profit than any other. This is not fair to patients, but please somebody give me an example where fairness has been the business model.

3. I don't think the cost of litigations can justifies such a high margin of profit. Basically, they earn far more than any other industry AFTER the R&D, advertisement and yes litigation costs . Could the person who made this claim provide us with some explanation so that non-business majors like me could understand the reasoning?

4. Pouring money into drug companies does not necessarily bring us better drugs. I have said this somewhere else: Do you think Nexium is better than generic Prilosec? (if you don't know the story read the bottom) ==> pharma's goal is not better medicine, it is more profit (I am not blaming them). However, as a byproduct sometime we get better products (not the best way to go if improving quality of drugs was the motive).

5. Drugs cost have NOT traditionally been a major fraction of the healthcare cost, but expect that to increasingly become a bigger part. As somebody pointed out earlier, cost of drugs have been increasing considerably faster than the overall cost of healthcare. There has been minimal cost control on drugs. That's got to stop

Finally, I want to say that the problem with the cost of drugs should not be blamed on the drug companies, but we do need leadership to put a cap on this uncontrolled increase in drug costs. I believe for example a system like Canada could do that to some extent (for those who don't like them, they are not perfect, but have done better than us by any measures).



Nexium/prilosec story: Nexium was born by makers of Prilosec when their patent on Prilosec ran out. Nexium is not enough different from Prilosec for the price different that exist between generic prilosec and Nexium. This model of incremental changes to keep profits is a common practice in pharma.

 

[50dent]

4. Pouring money into drug companies does not necessarily bring us better drugs. I have said this somewhere else: Do you think Nexium is better than generic Prilosec? (if you don't know the story read the bottom) ==> pharma's goal is not better medicine, it is more profit (I am not blaming them). However, as a byproduct sometime we get better products (not the best way to go if improving quality of drugs was the motive).

Pouring money into drug companies does NOT bring us better drugs. Having multiple drug companies competing against one another for profit will bring about better products at cheaper rates. It is important to remember why we americans love capitalism so much..because it works. I think the best thing the government can do is to give grants to help start more drug companies, not put price caps on them.

 

[Gij]

Pouring money into drug companies does NOT bring us better drugs. Having multiple drug companies competing against one another for profit will bring about better products at cheaper rates. It is important to remember why we americans love capitalism so much..because it works. I think the best thing the government can do is to give grants to help start more drug companies, not put price caps on them.

I think somewhere in my post I mentioned that progress does happen, but we need to look at things more quantitatively: how much improvement for each extra $ spent is the issue here. What allows a company to win the competition is not always improvement in the quality of drugs (again look at how generic Prilosec and Nexium coexist). Wining the competition very often requires my company's drug to be enough different (not necessarily better) from yours, so I can have my market. Just look at the range of drugs that are similar but are vastly different in prices. Have we made progress in drug making: yes. Have we done it efficiently? I think no. We do not need capitalism in Healthcare. What has it done for us? Canada's healthcare system, although not perfect, provides better care for its people at a lower cost (compare the WHO ranking or look at the number of beds per capita or infant mortality rate or....). If you call spending more and getting less "work"ing, capitalism does work for healthcare. Somebody said earlier that he doesn't care about names capitalism, socialism, communism etc. We should not stick to something that gives us worse results at higher prices.
Somebody else said that US healthcare is different from Canada (higher prevalence of obesity, poorer health in lower social classes etc.) and therefore we can't have their system. I want to say that we are not genetically different, maybe some of the health problem is because we don't have universal healthcare.
Lastly, I don't think controlling the cost of drugs will cause the pharma to quit and get into another business. If I am not mistaking ~20% profit margin is much much larger than any other industry. They will go for much less. I am copying pasting some stats I found online:

In the fourth quarter of 2000, Pfizer reported a17.4 percent profit margin, Lilly reported 25.8 percent, and Bristol-Meyers-Squibb reported 22.3 percent. (The all-industry average for that same quarter was 4.6 percent.) As an industry, the pharmaceutical group made $23.759 billion in 2000. The consistent return over time of the established pharmaceutical companies is in the 19 to 24 percent range. In the same quarter, and by way of contrast,the automotive industry averaged 0.9 percent, aerospace and defense 4.3 percent, with tobacco and banks, respectively, at 11.2 and 10.2 percent.
Business Week, February 26, 2001

 

[50dent]

"However, as a byproduct sometime we get better products (not the best way to go if improving quality of drugs was the motive)."


You are right I didn't read your post thoroughly enough. I think you make valid points in your last post but I do not think socializing medicine or pharmaceutical development can bring about better results or growth than what we are obtaining now. You are very informed on this, I need to google some more on the conditions of canada's health care system. I've always heard that they have alot more taxes because of this and im not sure how much of an increase it would take for America to have a similar system. There is always going to be a trade off. More taxes on the middle and upper classes would deffinately have economic effects that could make it worse for american's as a whole.I'm not sure though.

 

[Sosumi]

Nexium/prilosec story: Nexium was born by makers of Prilosec when their patent on Prilosec ran out. Nexium is not enough different from Prilosec for the price different that exist between generic prilosec and Nexium. This model of incremental changes to keep profits is a common practice in pharma.

And just who is prescribing Nexium? I was really upset to hear recently that my aunt had to pay $150 for her Nexium prescription because she had lost her prescription coverage and is on a fixed income. She bought it anyway not realizing there were cheaper, equally efficacious alternatives such as Prilosec.

 

[Saluki]

And just who is prescribing Nexium? I was really upset to hear recently that my aunt had to pay $150 for her Nexium prescription because she had lost her prescription coverage and is on a fixed income. She bought it anyway not realizing there were cheaper, equally efficacious alternatives such as Prilosec.

Advertising at its best. At the supermarket, people buy the name-brand lucky charms because they've been convinced they taste better than generic. At the pharmacy, people buy the name brand, because they don't even realize there's another choice.

 

[Siggy]

As they saying goes, opinions are liking a--holes. Everyone has one, and you don't ever believe yours stinks.

I guess we should never debate or discuss anything, because afterall, who would push an opinion or idea that they believed stunk? Its ignorant sayings like this that leads to the current apathy we see in the United States towards politics. You don't have to agree with the OP (I don't either), but you should still show respect and show how he is wrong instead of repeating something like this (which you do later in your post).

Remember, a whitty saying proves nothing.

 

[Gij]

"However, as a byproduct sometime we get better products (not the best way to go if improving quality of drugs was the motive)."


You are right I didn't read your post thoroughly enough. I think you make valid points in your last post but I do not think socializing medicine or pharmaceutical development can bring about better results or growth than what we are obtaining now. You are very informed on this, I need to google some more on the conditions of canada's health care system. I've always heard that they have alot more taxes because of this and im not sure how much of an increase it would take for America to have a similar system. There is always going to be a trade off. More taxes on the middle and upper classes would deffinately have economic effects that could make it worse for american's as a whole.I'm not sure though.

Yes, Canadians are paying more taxes. On the other hand we are paying more overall $ amount per capita for healthcare. Somebody is paying this money. However, probably it doesn't come in the form of direct taxation. I think taxes will help share the burden more effectively (that is what insurances are supposed to do: risk sharing). Other things to consider is that the percentage overhead administrative cost of running a government-based healthcare is much lower than what we pay for private insurance. Remember private insurance are for-profit, so that's an additional cost that people have to pay. I think there needs to be budget that is set for healthcare annually. This will control prices. Drug companies can compete, but they know something like Nexium won't fly, because it won't be justified to spend the KNOWN limited $ on something that is expensive without significant benefit over a cheaper version. I think this will force pharma/biomedical companies to not only make good products, but to make them cheap or else they won't be successful in the competition.
Just a friendly suggestion that might help you with your google search: going to the world health organization (look for WHO report 2000) and Organisation for Economic Co-operation and Development (OECD) web sites might not be bad for comparing our countrie's healthcare system with socialized (or whatever it is called) medicine.

 

[makushin]

.

 

[Gij]

You may consider the 'free-rider' dynamic between the US and the rest of the world when it comes to R&D. For this reason alone, socialized healthcare will never work here like it does everywhere else.

I am a little economic-illiterate. Are you saying that we are making the drugs and others just buy them from us? Please clarify this and also what constitutes the social medicine that you are referring to.

Thank you,

 

[makushin]

I am a little economic-illiterate. Are you saying that we are making the drugs and others just buy them from us? Please clarify this and also what constitutes the social medicine that you are referring to.

Thank you,

As I am aware, Americans pay much more for drugs than anyone else. In many countries they just reverse engineer the drugs, so American drug companies are forced to sell cheap, because said countries do not recognize patent laws. Essentially they are participating in an artificial market, of which the RD is payed for by us. We will not get the drugs at these wholesale prices, lest we sacrifice RD, hence sacrificing quaility.

Many countries freeride off us in many different capacities... hell... the military is the most obvious example.

 

[chef_NU]

Here is what I think with respect to Pharmaceutical companies:

1. People in Pharma are human and probably decent scientists, businessmen and women, but remember they have to answer to people in Wall Street. It is not their job to keep prices reasonable.

2. Their industry has the highest margin of profit than any other. This is not fair to patients, but please somebody give me an example where fairness has been the business model.

3. I don't think the cost of litigations can justifies such a high margin of profit. Basically, they earn far more than any other industry AFTER the R&D, advertisement and yes litigation costs . Could the person who made this claim provide us with some explanation so that non-business majors like me could understand the reasoning?

4. Pouring money into drug companies does not necessarily bring us better drugs. I have said this somewhere else: Do you think Nexium is better than generic Prilosec? (if you don't know the story read the bottom) ==> pharma's goal is not better medicine, it is more profit (I am not blaming them). However, as a byproduct sometime we get better products (not the best way to go if improving quality of drugs was the motive).

5. Drugs cost have NOT traditionally been a major fraction of the healthcare cost, but expect that to increasingly become a bigger part. As somebody pointed out earlier, cost of drugs have been increasing considerably faster than the overall cost of healthcare. There has been minimal cost control on drugs. That's got to stop

Finally, I want to say that the problem with the cost of drugs should not be blamed on the drug companies, but we do need leadership to put a cap on this uncontrolled increase in drug costs. I believe for example a system like Canada could do that to some extent (for those who don't like them, they are not perfect, but have done better than us by any measures).



Nexium/prilosec story: Nexium was born by makers of Prilosec when their patent on Prilosec ran out. Nexium is not enough different from Prilosec for the price different that exist between generic prilosec and Nexium. This model of incremental changes to keep profits is a common practice in pharma.

Your problem: consumers are paying increasingly more money for products that aren't correspondingly more effective. All the while, there are cheap drug alternatives that can do the job.

Your answer: have the government essentially perform price fixing

????????

No. The problem here is that Americans simply fail to become educated consumers. At this point, some of the blame can be transferred to doctors, since they are educated health professionals, yet still prescribe whatever is the "fad" for new drugs. But really, if we just leave the idiots out in the deep end, eventually they will realize that they need to consider alternatives to purchasing the fad drugs. Either that, or they will spend all of their fixed income on brand-name drugs and starve to death. The government's job isn't to protect irrational people.

 

[Gij]

As I am aware, Americans pay much more for drugs than anyone else. In many countries they just reverse engineer the drugs, so American drug companies are forced to sell cheap, because said countries do not recognize patent laws. Essentially they are participating in an artificial market, of which the RD is payed for by us. We will not get the drugs at these wholesale prices, lest we sacrifice RD, hence sacrificing quaility.

Many countries freeride off us in many different capacities... hell... the military is the most obvious example.

Two things:
1. Assume other countries do that (which I don't know if I agree with please convince me otherwise). Do you think that if we reduce the profit margin of the pharma from 20% to let's say 10 or 15% (still 2-3 folds higher than average of all industries) they will quit? If so please explain the reasoning. I'd like to know more.
2. Here is what I know: when you come up with something that you can patent, you go to your patent lawyer. You find your potential market. If that is US only then you run a US only patent. If it includes European countries then you spend more and do that as well. Patents usually not only assign to the inventor the exclusive production rights for the product invented, but also anything that could resemble it or come directly out of it in the future. Patent lawyers' job is to extend the potential application of the drug to the point that prevents the potential "reverse engineering" issues. I'd be interested to know a few example of these reverse engineered drugs and the scope of it (i.e. how prevalent this practice might be). I'd like to see who is stupid enough to reverse engineer the likes of Nexium?
I know that you can find the exact drugs that we get here in the US (not reversed engineered version or generic) in Canada for much cheaper. Pharma don't have a problem selling the drugs for cheaper when there is the negotiation power. I'd like to also ask that what percentage of the profit do you think goes into R&D? If I, as a consumer, pay much more for the advertisements than innovation, I don't think giving less to the drug companies would have such a big direct effect on me. Maybe, I'll see less commercials on TV. Paying less also might bring into competition the price factor, meaning that I know not only I have to make something, but I have to make it cheap. Right now making something cheap does not seem to me to make financial sense.

One last thing about your comment that some countries don't recognize patent laws. Any country that I am consider as a potential market (bascially all the developed countries like canda, UK, Japan, Germany etc.) do honor patent laws when filed properly. A poor developing country that does not honor the patent law is not what I am concerned with as the owner of a drug company. They often simply don't have neither the purchasing nor the production power. I come from one!!

 

[chef_NU]

I really don't understand you here gij. Pharmaceutical companies are not in the business of making cheap drugs, or helping the American people. They are in the business of making money, just like any other business. The government has absolutely no right to "force" ANYONE to change they way they price their product, nor do they have any right to say what profit margins, or R&D, or any of that other crap should be. I just don't understand how you could ever defend such a practice. It's not a question of whether or not pharmaceutical companies would stay in business as a result of government regulation, its a question of why in the hell should government be able to regulate them in the first place. When we start passing laws to loot the profits of particular industries just because they are successful, the whole nation is headed down the sinkhole.

"Capitalism punishes failure, government punishes success."

 

[DrBowtie]

I just wanted to say chef NU, you are awesome. That is all.

 

[Gij]

I really don't understand you here gij..."

Double post sorry!

 

[Gij]

I really don't understand you here gij. Pharmaceutical companies are not in the business of making cheap drugs, or helping the American people. They are in the business of making money, just like any other business. The government has absolutely no right to "force" ANYONE to change they way they price their product, nor do they have any right to say what profit margins, or R&D, or any of that other crap should be. I just don't understand how you could ever defend such a practice. It's not a question of whether or not pharmaceutical companies would stay in business as a result of government regulation, its a question of why in the hell should government be able to regulate them in the first place. When we start passing laws to loot the profits of particular industries just because they are successful, the whole nation is headed down the sinkhole.

"Capitalism punishes failure, government punishes success."

Did I ever say that we should tell them how much their margin of profit should be? I hope I didn't leave that impression. It is as simple as this. I have $10 in my pocket. I can spend $2 and only $2 on my drug. Now when I buy the $2 drug, the maker of the drug can have 0.1% or 200% margin of profit. I really don't care. There is no need for stating the obvious that pharma are in business of making money. I acknowledged this earlier when the discussion was about whether they are human or not. All I am saying is that we can have a budget that we can afford, and pharma will stay happy and thrive no less than now. Government does not have the right to tell industries what to make, but if 15% of GDP goes to healthcare ~40% of which is directly paid by the government, if the rate of growth of medication costs is even higher than the overall rate of growth of the healthcare cost, if people and government are already spending too much (more than any other country) and we are still in poor health (37th by WHO ranking as I have said may times) then I think telling the drug company that I have $2 and only $2 that I can spend on your drug should not offend capitalism.

 

[Gij]

Your problem: consumers are paying increasingly more money for products that aren't correspondingly more effective. All the while, there are cheap drug alternatives that can do the job.

Your answer: have the government essentially perform price fixing

No price fixing, but setting a budget might do it.
????????

No. The problem here is that Americans simply fail to become educated
consumers.

And when it comes to alternative treatments how this mass eduction should be done practically? please no discussion about people eating less saturated fat etc. That's not what we are talking about here. I must say that I am not against education.

At this point, some of the blame can be transferred to doctors, since they are educated health professionals, yet still prescribe whatever is the "fad" for new drugs.

Agreed, as you said "some of the blame", but blaming people doesn't fix anything.

But really, if we just leave the idiots out in the deep end, eventually they will realize that they need to consider alternatives to purchasing the fad drugs. Either that, or they will spend all of their fixed income on brand-name drugs and starve to death. The government's job isn't to protect irrational people.

Please elaborate on your reasoning. Regardless of the reasoning though, I don't have a good feeling about the words such as "eventually" and "starve to death".

 

[Gut Shot]

No. The problem here is that Americans simply fail to become educated consumers.

Small potatoes, my friend.

As the Kaiser Family Foundation lays out in 2002 numbers:

Population percentile ranking by health care spending / Percent of total expenditure

Top 1% - 22.3%
Top 5% - 48.7%
Top 10% - 63.7%
Top 50% - 96.6%
Bottom 50% - 3.4%

With half the country incurring only 3.4% of expenditure, and 90% incurring only 36.3%, we have reached a point where, as the Brookings Institute put it, "Most health costs are incurred by a small proportion of the population whose expenses greatly exceed plausible limits on out-of-pocket spending."

So educate away, but it won't put a scratch on the 800 lb. gorilla. If you really want to change things, find a way to deal with 40% of all Medicare spending going to people in their last month of life.

 

[Gij]

... find a way to deal with 40% of all Medicare spending going to people in their last month of life.

Somewhat relevant to your last sentence is the issue of long term care, which seems to me to be one the hardest issues to deal with. Setting a boundary on how much we are going to spend is not an easy task. I initiated a discussion earlier on that, but I am yet to see some fresh ideas (not the old discussion of individual Vs government which pops up everywhere). This is a big problem that is only getting bigger as the average age is rising and the baby boomers are getting old.

 

[Gut Shot]

This is a big problem that is only getting bigger as the average age is rising and the baby boomers are getting old.

My only idea is to somehow make suicide appeal to boomer sensibilites. Actually, it doesn't have to be outright suicide. Perhaps just palliative care in lieu of weeks or months of expensive, futile therapies. Sort of like "you've burdened the world enough with your self-obsessed existences, why not just go quietly and with some shred of dignity"?

Eh, what are the odds, ya know?

I'm planning to cash in, myself. Besides being in pathology, I'm kicking around the notion of creating Woodstock-themed coffins. Figure they could look like stylized VW vans, replete with customized paint jobs. I'd price 'em out of this world, of course.

 

[chef_NU]

Small potatoes, my friend.

As the Kaiser Family Foundation lays out in 2002 numbers:

Population percentile ranking by health care spending / Percent of total expenditure

Top 1% - 22.3%
Top 5% - 48.7%
Top 10% - 63.7%
Top 50% - 96.6%
Bottom 50% - 3.4%

With half the country incurring only 3.4% of expenditure, and 90% incurring only 36.3%, we have reached a point where, as the Brookings Institute put it, "Most health costs are incurred by a small proportion of the population whose expenses greatly exceed plausible limits on out-of-pocket spending."

So educate away, but it won't put a scratch on the 800 lb. gorilla. If you really want to change things, find a way to deal with 40% of all Medicare spending going to people in their last month of life.

If my memory serves me correctly, we were talking about spending on pharmaceuticals, not on health care in general. But I agree with your statement about not spending money on people in their last month of life. It is my opinion that if they can't pay, let them die.

 

[Gut Shot]

If my memory serves me correctly, we were talking about spending on pharmaceuticals, not on health care in general.

I know, I was just pointing out why pharmaceuticals are small potatoes. Could you dig up some numbers on how much money is spent/wasted on "fad" drug prescribing or prescibing expensive drugs when there are cheaper, equally efficacious counterparts?

But I agree with your statement about not spending money on people in their last month of life. It is my opinion that if they can't pay, let them die.

Trouble is in knowing when that last month is going to be.

 

[bananaface]

I know, I was just pointing out why pharmaceuticals are small potatoes. Could you dig up some numbers on how much money is spent/wasted on "fad" drug prescribing or prescibing expensive drugs when there are cheaper, equally efficacious counterparts?

google: Vioxx sales

 

[Gut Shot]

google: Vioxx sales

Very well. Let's see... "Documents show dubious Vioxx sales tactics," "Merck halts Vioxx sales," "Vioxx sales may resume in Canada," "Congress to probe Vioxx sales tactics"...

Ah, here we go. Vioxx sales totalled $2.5 billion in 2003.

For that year, this represents 1.40% of all retail prescription drug spending, and 0.147% of all health care expenditures.

 

[bananaface]

Vioxx is was shown to be no more effective than prescription strength ibuprofen. It was a helluvalot more expensive though.

 

[Gut Shot]

Vioxx is was shown to be no more effective than prescription strength ibuprofen. It was a helluvalot more expensive though.

True, but in the grand scheme still small potatoes.

 

[bananaface]

True, but in the grand scheme still small potatoes.

In the grand scheme, yes. But, small potatoes add up. It's just one of many less than ideal choices made by prescribers and consumers.

 

[Gut Shot]

In the grand scheme, yes. But, small potatoes add up.

Brilliant. Got any more numbers? I mean, Vioxx is wonderfully illustrative of the pharmaceutical industry's tactics, but "small potaotes add up" is just hand waving.

For 2003 retail drug sales accounted for 10.5% of total healthcare expenditures. Now, cut those potatoes in half, yes HALF, and you've managed to save a whopping 5.3% of the total healthcare tab. Way more is spent on overhead in the private insurance biz.

It's just one of many less than ideal choices made by prescribers and consumers.

Okay, but is it the problem? You know, THE problem that Chef_NU made it out to be? Cause that's what it sounded like to me, like it's THE problem.

 

[bananaface]

Brilliant. Got any more numbers? I mean, Vioxx is wonderfully illustrative of the pharmaceutical industry's tactics, but "small potaotes add up" is just hand waving.

For 2003 retail drug sales accounted for 10.5% of total healthcare expenditures. Now, cut those potatoes in half, yes HALF, and you've managed to save a whopping 5.3% of the total healthcare tab. Way more is spent on overhead in the private insurance biz.

Okay, but is it the problem? You know, THE problem that Chef_NU made it out to be? Cause that's what it sounded like to me, like it's THE problem.

Inefficient drug spending is not THE problem, but it is certainly a problem. My comment was meant more to say that a series of small problems contribute to the overall situation and should not be individually dismissed. Drugs aren't the only potatoes!

 

[chef_NU]

Government does not have the right to tell industries what to make, but if 15% of GDP goes to healthcare ~40% of which is directly paid by the government, if the rate of growth of medication costs is even higher than the overall rate of growth of the healthcare cost, if people and government are already spending too much (more than any other country) and we are still in poor health (37th by WHO ranking as I have said may times) then I think telling the drug company that I have $2 and only $2 that I can spend on your drug should not offend capitalism.

Gij I don't think you seem to understand capitalism. If I ran a drug company and you came to me and said "I have $2 and only $2 to spend on your drug", my response would be "And....?. Why should I care at all about your individual situation? I will continue to price my drug at the level that will generate the greatest amount of profit. If that means its $50, its $50. If that means its $.02, its $.02. All I care about is making money. Of course, if I price my product grossly more than it is worth, I'm not going to be making the most money I could, would I?" You need to understand that in a capitalist system, the market value of a product determines its price. Not the government. Not the SDN poster. Not the poor unfortunate soul with only $2. The market value.

The same needs to apply to healthcare. People spend money on healthcare. They buy the best they can afford with the money that they have. If they can't afford the health care that they want or need, tough ****. It's no different than any other economic phenomenon. However, when you no longer force consumers to shoulder the cost of their care, OF COURSE health expenditures will spiral out of control. There is nothing stopping everyone from demanding the best quality care, regardless of price. You can try government regulations to control costs. But me, personally, would rather let the valuation of care by millions of consumers determine the cost of my treatment rather than a select group of politicians who are constantly being influenced by industrial and partisan interests.