Deleted
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Post by Deleted on Apr 7, 2011 13:50:21 GMT -5
"One thing they could do is allow folks 55 and older to opt into Medicare. The pool would then have younger (presumably healthier) participants in it, so the risk level (and therefore costs) would go down. " How about we all can opt in? ...
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Deleted
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Post by Deleted on Apr 7, 2011 13:51:41 GMT -5
Who cares how much their taxes are Dark... the taxes are going to something else... cause they pay about HALF what we do in health care... or less... (I think we're like 2.5X right now...)
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Deleted
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Post by Deleted on Apr 7, 2011 14:04:35 GMT -5
"One thing they could do is allow folks 55 and older to opt into Medicare. The pool would then have younger (presumably healthier) participants in it, so the risk level (and therefore costs) would go down. " Basic Medicare (the part that pays for hospital only) doesn't cost anything once you're eligible. It's been paid for (theoretically) via payroll deductions over your working life. So, allowing the 55s and over onto that part would be a cash drain unless you charged them adequate premiums. You also have to be careful of any "opt in" plan, especially one that's not allowed to decide whom to write based on their health history. There will be a group that can barely afford the premiums and. of that group, the ones with chronic and expensive health problems will sign up. The healthy ones will take their chances. Thus begins the "adverse selection" death spiral, in which premiums continue to increase and the healthier segments of the insured population go elsewhere or go without. Then the experience gets worse, premiums increase... And I get tired of the single-=payer plans in other countries being held up as a paragon. In Germany the docs regularly go on strike because they're unhappy with pay. In France they're out in the street protesting because the government is closing hospitals, or important units of hospitals, forcing patients to go further away for care. In the UK and Canada, people who can afford it go to Thailand or India for non-emergency surgery such as knee replacements rather than wait years on the National Healthcare waiting list. UK citizens fly to Poland and Hungary for dental care. (Look up "medical tourism".) I know we have a massive problem in the US, but I'm not convinced any other country is doing it well on the scale we need it.
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Deleted
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Post by Deleted on Apr 7, 2011 14:08:25 GMT -5
No... by opt in i mean to pay in order to get in... I think that is what is generally meant... not being 'allowed in', but buying into it...
I am sure single payer in other countries isn't perfect... I'm sure no system is perfect.... I think we are bright and capable folk though, and if we had been able to have a conversation that looked at the best single payer programs and debated the pros and cons... i'm sure we could have come up with something even better than the current best...
But no... we devolve to yelling tag lines... Death Panels... boo...
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Sum Dum Gai
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Post by Sum Dum Gai on Apr 7, 2011 15:06:09 GMT -5
The problem with letting people buy their way into Medicare is that the people most unhappy with private insurance tend to be those with the most health costs. Super healthy people with no chronic conditions can already get pretty decent insurance, it's the 58 year old life long smoker who's already had one minor heart attack, only has roughly twenty percent of lung function left, and has blood pressure up through the roof, that would be clamoring to get into Medicare. I don't think you have to be a doctor to realize that treating that guy is going to be damn expensive. That's why insurance companies don't want to cover him.
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Post by Deleted on Apr 7, 2011 15:37:35 GMT -5
The problem with letting people buy their way into Medicare is that the people most unhappy with private insurance tend to be those with the most health costs. Super healthy people with no chronic conditions can already get pretty decent insurance,<snip> Yes- I always shudder when governments set up some sort of insurance entity figuring that since they don't have the Evil Profit Motive like all those greedy insurance companies, they can charge people what they think they ought to pay and still make money. Hasn't worked with hurricane coverage. Hasn't worked with flood insurance. Hasn't worked for Assigned Risk auto plans.(These programs all exist but in most cases the government entity has been forced to raise rates, get $$ from the taxpayers or private insurers to subsidize the rates, and/or is trying to shut down and depopulate the plan.) I'm not sure why it's going to work for health insurance.
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wvugurl26
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Post by wvugurl26 on Apr 7, 2011 18:03:53 GMT -5
They'd have to rewrite the law if you want Medicare to negotiate prices. The big pharma companies didn't want to negotiate with the govt for that big of a chunk of the population. They spend a lot of money on lobbyists. And there you have our current situation in which each Part D plan or more likely their pharmacy benefit manager negotiates prices with their network pharmacies.
Knowing the outcry that would come from proposing the govt negotiate prices, you could start by outlawing lock in pricing and require them to use pass through methodology. Pharmacy gets say $200 for Plavix regardless of what their cost is. Pharmacy knows what it gets for each drug so they have an incentive to find a better deal. If say they find a supplier to sell it to them for $195, they get to keep that $5 and for Part D reporting purposes the cost is reported at $200 so you have inflated drug costs.
Dark the fraud is beyond rampant. I've never seen such pervasive and rampant fraud in my life and we are 10-15 steps behind the bad guys. By the time we catch up with the money has been moved to offshore accounts. To really stop it they are going to have to verify the bill and then pay it. No more of this pay the bill and then verify it. We can't afford to keep doing that, we lose too much to fraud every year.
Stopping pay and chase is the single most effective thing they can do to cut down on the medicare costs that are spiraling out of control. Verify the bills and then pay them and too damn bad if the hospitals, doctors, and pharmacies can't wait to get their money. You shouldn't depend on the government to fund your operating cash flow in the first place.
This practice of providing operating cash flow to providers is ridiculous and it needs to stop. You have your paperwork in order and bill accurately and you should slide right on through and get your money in a timely manner. If you are billing pap smears for men, billing for more than 24 hours in a day, or are a provider in California billing for a beneficiary in Nebraska you should be subject to more scrutiny before you get paid if you do have a legitimate claim and there was a billing error.
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achelois
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Post by achelois on Apr 7, 2011 18:13:30 GMT -5
"doctors are paid a salary, not a fee for service. They make the same amount of money regardless of how many surgeries, how many tests, etc"
I can tell you that if you pay a doctor the same amount for doing, say, five cataract surgeries as you do for doing fourteen in a day--guess how many the doctor will do. They will do the bare minimum required. Human nature.
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Sum Dum Gai
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Post by Sum Dum Gai on Apr 7, 2011 18:20:12 GMT -5
I can tell you that if you pay a doctor the same amount for doing, say, five cataract surgeries as you do for doing fourteen in a day--guess how many the doctor will do. They will do the bare minimum required. Human nature. Which would be a good thing in this context. Right now doctors do too many unnecessary procedures to cover their asses, and it's a conflict of interest anyway. They get to decide how much work is "necessary" and then bill it, knowing that they'll be paid for all of it, there won't be much if any oversight to make sure they aren't inflating the bill, and the customer doesn't care anyway because they aren't responsible for paying for it. It's a system that is set up perfectly to be robbed blind.
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achelois
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Post by achelois on Apr 7, 2011 18:25:33 GMT -5
Be careful what you wish for.
I did the anesthesia for the fourteen cataracts today. All the patients were very happy they would be able to see out of that eye again...this particular surgeon does fourteen twice a week. The waiting times will expand dramatically if it is not in the surgeons best interest to do that many.
I am paid a salary. I do not particularly WANT to rush that much and do fourteen cases before lunch. It is not in my best interest to do that. I think it would be very nice to put them on salary and slow down.
Besides, they do not get paid the whole amount they bill.
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wvugurl26
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Post by wvugurl26 on Apr 7, 2011 18:26:12 GMT -5
When an Armenian crime ring is billing Medicare in over 25 states using clinic addresses that are nothing more than mail drop slots, we have skedaddled way past being robbed blind. When you can make more money and easier to boot off ripping off the govt than selling drugs, guns, and sex you have a big problem.
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lurkyloo
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Post by lurkyloo on Apr 7, 2011 19:52:30 GMT -5
FYI, one reason other countries can do nationalized healthcare in a more cost-effective fashion than the US is that the EU and other countries set a maximum (typically much lower than the US) for what pharma companies can charge for their drugs. Pharma plays along because they still make a profit by selling there, but the lion's share of the profit comes from the US. If the US tried to enforce that sort of deal, developing new drugs wouldn't be worth the risk anymore--it's incredibly expensive and risky to develop new therapies. So basically, the US healthcare system is subsidizing medical development for the rest of the world. Sucks to be us.
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Mardi Gras Audrey
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Post by Mardi Gras Audrey on Apr 7, 2011 19:54:36 GMT -5
One of the problems that we will have if we let Medicare negotiate drug prices is similar to what we already have with their reimbursement rates for procedures. The Medis (Medicare and Medicaid) use their negotiating power to tell providers what they are going to pay. That is great for the payer (govt) but horrible if you are seeing their patients at a loss because the reimbursement rate is below what it costs to run your facility. We are already seeing this play out in CA, where providers are refusing to see Medicaid patients because the reimbursements are so low. The private insurers are essentially holding the system together by making up for what the Medis don't pay. if you think that putting everyone on the Medis is the answer, what do you think will happen when all the providers stop seeing those patients? Yes, the people will have insurance but they won't get care because very few doctors/hospitals will take them. We have already had a lot of hospitals close down that were serving mainly Medi patients. They couldn't get reimbursed enough to keep the place open. I have heard many people say that doctors should be forced to take these patients but doesn't that essentially amount to slavery? You can't force a provider to take a patient, especially when it costs more to see the patient than the doctor will be reimbursed. If you try to do that, what will happen is that the doctor supply will drastically decrease until you either have no doctors. Do you really think that someone who has $200k in student loans, 12 years of college education, and worked 80 hours a week with a limited life for most of their 20s and 30s will want to settle for a paycheck of $30k a year? I doubt it... they are the best and brightest... they will go into business, law, or some other field where the payout is better for the amount of work you had to put in..
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Mardi Gras Audrey
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Post by Mardi Gras Audrey on Apr 7, 2011 19:56:24 GMT -5
FYI, one reason other countries can do nationalized healthcare in a more cost-effective fashion than the US is that the EU and other countries set a maximum (typically much lower than the US) for what pharma companies can charge for their drugs. Pharma plays along because they still make a profit by selling there, but the lion's share of the profit comes from the US. If the US tried to enforce that sort of deal, developing new drugs wouldn't be worth the risk anymore--it's incredibly expensive and risky to develop new therapies. So basically, the US healthcare system is subsidizing medical development for the rest of the world. Sucks to be us. This....
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Post by Deleted on Apr 7, 2011 21:21:51 GMT -5
"If the US tried to enforce that sort of deal, developing new drugs wouldn't be worth the risk anymore--it's incredibly expensive and risky to develop new therapies."
not really.... Pharma spends more on marketing than R&D these days and the vast majority of 'new' drugs they put out are in fact repackaging and pattent extensions on old ones...
Pharma has no motive to cure disease.... Why would they want to get rid of their market? They have a motive to treat... and to create as many chronic illnesses as possible... long term clients... expanded markets... think about those things for a minute in the contex of pharma...
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formerexpat
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Post by formerexpat on Apr 7, 2011 22:21:30 GMT -5
The term marketing can be misleading. Sponsorship of conferences for doctors to learn about drugs can be considered marketing. This isn't an advertisement as much as it's professional education and is highly regulated.
Also, the free samples given to doctors that are regularly given to lower income people are also considered marketing.
I'm not saying that the advertising of drugs is not a problem but simply saying pharma spends more on advertising can be a bit misleading without understanding what is included in "advertising".
I think it's a good thing that these drugs are available for much cheaper prices / free to lower income people, assuming they're being prescribed responsibly [key word, assuming].
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Deleted
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Post by Deleted on Apr 7, 2011 22:39:16 GMT -5
Yeah... that's who i want educating my doctors... pharma reps... really, really pretty ones... You know that pharma has been paying out some pretty big settlements for breaking rules in how they 'educate' doctors... ?
Their 'education' routinely costs us the taxpayers billions of dollars... even when the FDA says a newer drug is not better than an older one, and cannot be marketed as such... through 'education' pharma still gets their patented drugs pushed to first line treatment... kaching! ...
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lurkyloo
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Post by lurkyloo on Apr 7, 2011 22:47:28 GMT -5
Oped: You're not really very closely involved with the pharma industry, are you? You're spouting some very common misconceptions.
It's true that pharma spends a lot of money on marketing. And there's a lot of room for sleazy (but not legally unethical) tactics; that comes with the emphasis on sales and marketing. But, the typical civilian has no idea whatsoever exactly how difficult (and EXPENSIVE) it is on the scientific end to find and develop a new drug. Typically by the time you've identified a pathway, found a lead target, optimized it chemically (or biologically, for all these antibodies, etc.), run it through huge numbers of tox screens, animal models, and gotten it ready for clinical trials, you've already spent years and millions on the project. Clinical trial costs run tens to hundreds of millions, as I recall, and the failure rate is something like 90%. Modern safety guidelines are extremely strict; many classics (aspirin and Tylenol, for example) wouldn't be approved under current restrictions.
The lack of new drugs is not intentional, believe me. It's an ongoing mystery why so few promising new drug candidates are coming out and making it through clinical trial, but it sure as hell ain't for lack of trying, or lack of bright and dedicated people working on the problems.
These me-too drugs you're talking about? They don't get FDA approval unless they represent a significant improvement over the original.
Yes, pharma is interested in curing diseases. Contrary to popular belief, they do NOT stumble over the cure for cancer every other week and promptly lock it away in a safe so they can continue milking suffering patients and their insurance.
I'm not directly in pharma, but close enough (and with enough friends and former colleagues there) to get seriously annoyed with uneducated opinions like yours. Yes, pharma is a for-profit business. The industry has also saved or extended many millions of lives. If you have such a jaded view, the answer is simple: don't take any medications. I bet that'll show 'em.
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Post by Deleted on Apr 7, 2011 23:04:23 GMT -5
Elan Corp. will pay $203 million and a U.S. unit of the Irish drugmaker will plead guilty to a misdemeanor charge to resolve an investigation of its marketing of the epilepsy medicine Zonegran. “Elan’s off-label marketing efforts targeted non-epilepsy prescribers and the company paid illegal kickbacks to physicians in an effort to persuade them to prescribe Zonegran for these off-label uses,” according to the statement. www.businessweek.com/news/2010-12-16/elan-to-pay-203-million-unit-to-plead-guilty-in-zonegran-probe.htmlPHILADELPHIA – A criminal information1 was filed today against Novartis Pharmaceuticals Corporation (“NPC”) for the off-label marketing of the anti-epileptic drug Trileptal, announced Assistant Attorney General for the Justice Department’s Civil Division Tony West and United States Attorney Zane David Memeger. NPC has agreed to plead guilty and pay a criminal fine and forfeiture of $185 million. NPC will also pay $237.5 million to resolve civil liabilities for its off-label marketing of Trileptal and payment of kickbacks to health care providers to induce them to prescribe Trileptal, as well as Diovan, Exforge, Tekturna, Zelnorm, and Sandostatin. www.justice.gov/usao/pae/News/Pr/2010/Sept/novartis_release.pdfA unit of Forest Laboratories, the maker of the antidepressant Celexa, agreed on Wednesday to pay more than $313 million to settle criminal and civil complaints, including a claim that it had illegally promoted the drug for use in children. The Forest settlement comes two weeks after Allergan, the maker of Botox, agreed to pay $600 million to settle claims that it had illegally marketed the drug from 2000 to 2005 for off-label uses including headaches and cerebral palsy in children. The settlements this month, however, pale compared with two last year when Pfizer agreed to pay $2.3 billion and Lilly agreed to pay $1.4 billion to settle illegal marketing claims. www.nytimes.com/2010/09/16/health/16drug.html?_r=2&ref=healthPharmaceutical Innovation AMSA seeks to foster the innovation of safe and effective new drugs. Over the last twenty five years, only 2% of drugs were found to provide an important therapeutic innovation, while over 90% did not appear to offer any real benefit over already-available drugs (Prescrire International 2005).
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Post by Deleted on Apr 7, 2011 23:04:43 GMT -5
JAMA. 1995 Apr 26;273(16):1296-8.
The accuracy of drug information from pharmaceutical sales representatives. Ziegler MG, Lew P, Singer BC.
Department of Medicine, University of California at San Diego School of Medicine, USA.
Comment in:
JAMA. 1995 Oct 25;274(16):1267-8. JAMA. 1995 Oct 25;274(16):1267; author reply 1268.
Abstract OBJECTIVE: To provide quantitative data about the accuracy of the information about drugs presented to physicians by pharmaceutical sales representatives.
DESIGN: One hundred six statements about drugs made during 13 presentations by pharmaceutical representatives were analyzed for accuracy. Statements were rated inaccurate if they contradicted the 1993 Physicians' Desk Reference or material quoted or handed out by the sales representative.
SETTING: University teaching hospital.
RESULTS: Twelve (11%) of 106 statements about drugs were inaccurate. All 12 inaccurate statements were favorable toward the promoted drug, whereas 39 (49%) of 79 accurate statements were favorable (P = .005). None of 15 statements about competitors' drugs were favorable, but all were accurate, significantly P < .001) differing from statements about promoted drugs. In a survey of 27 physicians who attended these presentations, seven (26%) recalled any false statement made by a pharmaceutical representative, and 10 (37%) said information from the representatives influenced the way they prescribed drugs.
CONCLUSIONS: Eleven percent of the statements made by pharmaceutical representatives about drugs contradicted information readily available to them. Physicians generally failed to recognize the inaccurate statements.
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Post by Deleted on Apr 7, 2011 23:19:20 GMT -5
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lurkyloo
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Post by lurkyloo on Apr 8, 2011 0:50:15 GMT -5
I have my own opinions of the pharma industry and the way it's run--I don't think they're saints, and as in the financial industries, marketing and salespeople tend to push the envelope all the way over the cliff. (These activities, btw, tend to get both punished and highly publicized--few industries are as closely regulated as pharmaceuticals.) In general, stockholders expect insane regular growth in stock prices, and management has done no favors to productivity or pharma PR image in trying to meet expectations--R&D expenditures have been trending down, and sales reps under pressure to increase sales have resorted to shady tactics. I'm certainly no fan of the direct-to-consumer commercials. That said, the world is so much better off with an active pharma industry that I find it laughable when people try to argue that they're completely evil. Would you refuse antibiotics if you had pneumonia? Chemo if you had cancer? They just came out with the first new (MS, I think? Wait, could've been lupus) medication in 50 years, and the first-ever drug for thyroid cancer. And they're working on new targets all the time. You may not see it because many--most--projects ultimately fail in the effort to bring a drug to market. Several of the bigger companies just announced that they were exiting various fields, presumably because their years and years of effort have brought no promising results. That's the nature of research, especially pharmaceutical research: you don't know if it's going to work or not, and you can pour an awful lot of money, time and effort into a dead end. Hence the high-risk-high-reward tag. This blog has quite a number of interesting posts, many concerned with the state of (and public perception of) the pharma industry: www.pipeline.corante.comA particular somewhat relevant post: pipeline.corante.com/archives/2011/03/29/the_nih_goes_for_the_gusto.phpThis one is more pharma-specific: pharmalot.com Finally, if you're going to piss and moan, why not target all these herbal-supplement "natural" therapy type suppliers? They don't have to prove efficacy; I'm not even sure they have to prove safety.
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stimpy
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Post by stimpy on Apr 8, 2011 2:03:36 GMT -5
One solution is to increase the number of fraud auditors and increase the penalties for fraud. Somewhere between $60 billion and $90 billion is lost each year. Only $4 billion is recovered. This would require an increase in spending for auditors, courts time, district attorneys, prisons, and prison staff. I would much rather spend some money now in order to save even more money later. www.cbsnews.com/stories/2011/01/24/national/main7279531.shtml www.gao.gov/products/GAO-11-409T <-- $70 billion in 2010.
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Deleted
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Post by Deleted on Apr 8, 2011 7:09:50 GMT -5
"Finally, if you're going to piss and moan, why not target all these herbal-supplement "natural" therapy type suppliers? They don't have to prove efficacy"
Last i heard, medicare/caid did not PAY for herbal-supplements... meaning the taxpayers do not pay for herbal supplements... taxpayers DO pay million/billions of dollars to pharma 'marketing' fraud...
I generally don't get my information from blogs. I tihnk they are fun to read, but i prefer to go a bit deeper for my actual information.
Stimpy... in addition to increasing recovered funds, streamlining the process, and adding more fraud detection as you suggest, we need CRIMINAL jail time for offenders... pharma admin who knowingly defraud the government (and put human life at risk) should be held personally responsible for their actions...
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shanendoah
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Post by shanendoah on Apr 8, 2011 10:41:33 GMT -5
alison-bass.blogspot.com/2011/02/dismantling-myth-of-high-drug.htmlThis is a link to a blog that's written by a former medical reporter for the Boston Globe. There is a direct link to the study the author is talking about in the blog, though sadly, my work computer blocks it, so I currently can't read the study for myself. Basically, the American taxpayer pays 39% of all new drug development costs. This 39% comes in multiple forms. First is the research done by universities that is paid for by the NIH. Universities, being non-profit entities do not then sell their research to pharma companies, (though think of the cut in tuition costs if they did), they give it to them. Then, there are the tax cuts. Did you know that pharma companies get to count, as the cost of creating drugs, the difference between what they spent/made and what they could have made if they had simply invested that money in the stock market? And in order to figure that out, they assume that they would get an 11% rate of return in the market. I'm not saying that drugs aren't expensive to develop, but I am saying that they aren't as expensive as the pharma companies like to claim. Again, the Medi's don't need to be able to negotiate prices based on their market share. Just give them the best negotiated price on a drug. If pharma figures they can make money on a drug based on Blue Cross's 15% share of the market, they can certainly make money by charging the Medis' 30% share of the market the same price. (Percentages were pulled out of my ass, as examples only; don't try quoting me on that.) Staff model health careLet me start by saying I worked for ophthamologists for 3 years. I am well aware of how thrilled people are to get their cataract surgery. I'm also aware of how happy people are to have lasik. Insurance pays for one but not the other. I'm afraid I don't buy the argument that doctors would work less hard to give their patients the best possible care if suddenly they made a steady salary instead of charging fee for service. Yes, they might see fewer patients in a day, because they could afford to spend more time with their patients and deliver higher quality health care. Healthcare outcomes can be directly related to the amount of face time patients have with their doctors. You would not believe how many patients we had complain that they were in their appt for 90 minutes and saw their doctor for less than 15 of them. That type of rushing around leads to more medical errors, which leads to greater risk of malpractice suits, which leads to higher costs of being a doctor. I was also not saying that all clinics suddenly need to be owned by corporate entities and then pay physicians (though I've never heard of a physician leaving our organization because they were unhappy about the pay, and we have more physicians attempting to join our staff model than we have room for.) However, I think hospitals should go to the staff model. The MDs that work for them should be paid just like the RNs that work for them - a salary, not a fee based on how many patients they see, what procedures they order, and what drugs the prescribe. Staff models also make it much easier on newly credentialed doctors. They don't have to find money to buy into a practice, they don't have to hope they can build a patient base, they don't have to wait for insurance payments to slowly come in. Instead, they have a salary (you know, like most of the rest of us) that allows them to determine their budget, pay their bills - including student loans, and spend their time treating their patients. And trust me, even in staff models, specialists and surgeons make more than enough money. Remember, better health care outcomes = less cost to the system.
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NomoreDramaQ1015
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Post by NomoreDramaQ1015 on Apr 8, 2011 10:44:59 GMT -5
I don't really think, IMO, that it drug development that makes drugs expensive (though it isn't exactly cheap either), it's all the middlemen from the research to selling the drug. I attended a lecture about drug development and it was amazing how many hands get in the cookie jar before a drug actually makes it to market.
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Post by The Walk of the Penguin Mich on Apr 8, 2011 11:47:01 GMT -5
First is the research done by universities that is paid for by the NIH. Universities, being non-profit entities do not then sell their research to pharma companies, (though think of the cut in tuition costs if they did), they give it to them.
Not as much as you'd think. Universities now have many patent attorneys on staff looking out for the interest of the university too.
Another thing to consider, NIH has had periods where when they cut research funding. In the 25+ years I've been employed by labs working in research, nearly half the time our expenses and salaries have been paid by drug companies in some very lean times. We've had years where millions of $$ has come into a university (where they also pay indirect costs directly to the university to keep it functioning) from drug companies (to pay for product testing in early trials). That drug money also kept the student projects in existance too.
So there is back scratching going on on BOTH sides of this.
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Post by The Walk of the Penguin Mich on Apr 8, 2011 11:50:41 GMT -5
don't really think, IMO, that it drug development that makes drugs expensive (though it isn't exactly cheap either), it's all the middlemen from the research to selling the drug.
Actually, those middlemen keep the costs down. When we were doing early product testing for one drug company, we were paid far less than what it would cost for the drug company to acquire a set up like our's in order to test their drugs.
We were already in place, were losing funding and the company needed some testing done. So they paid lab salaries/supplies for a 2 year time period, until we were able to get more NIH funding. We still continued to do testing for them and for 14 years, it was always a part of our lab's income.
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