So -- Why does healthcare cost so damn much? (warning: novel-length post)

#26
#26
volinreallife said:
I have a problem with this post, not so much with the post, but the data. It seems to me that everytime they go and do these test, they go to poor neighborhoods so they can pretty much swing any kind of data in their favor.(not a fact/my opinion) Did you guys get tested for any of the data that is shown above?
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The polling here is from Kaiser Family Foundation (not associated with Kaiser Permanente), USA Today, etc. Not really controversial sources.

utvolpj said:
which is not my point (and you still don't know what they buy the drug for). What if there was no incentive to develop drugs like that?
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I don't think it's a question of incentive, it's a question of fastest development. When France, Switzerland, other countries that had reasonably large pharmaceutical industries switched to a cost control system, their R&D did slow some. Most of that production switched over to the US, but everybody else still collectively bargains for the drugs produced here.

I think it's safe to say that with patents and such in place, cost/accessibility and price of drugs share an inverse relationship. What you're bringing up is one end of the spectrum. What about the other?
 
#27
#27
JayVols said:
Do you deem a 97.5% profit margin acceptable or gouging?
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don't buy it

From your article:

Can pharmacists still compound the drug?
As with all compounds, the decision to develop a compounded preparation should be based on the recommendation of your prescriber and pharmacist team who will address your specific clinical and therapeutic needs. If in the professional judgment of both your prescriber and the pharmacist it is appropriate to compound a hydroxyprogesterone caproate product rather than using the now manufactured product, then you should be able to obtain the compound. Always discuss your medication needs with your doctor and your pharmacist.


Pharmacists can legally compound FDA approved products when a prescriber determines that the compounded preparation is more clinically appropriate for an individual patient.
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#28
#28
milohimself said:
their R&D did slow some. Most of that production switched over to the US, but everybody else still collectively bargains for the drugs produced here.

I think it's safe to say that with patents and such in place, cost/accessibility and price of drugs share an inverse relationship. What you're bringing up is one end of the spectrum. What about the other?
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what other end? Your first paragraph, while down-playing the impact, shows that implementing this method would slow innovation and advances right? So you're of the opinion we should be forced to accept this while others aren't.
 
#29
#29
utvolpj said:
how are we not? Seems it fits pretty well with the accepted definition
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The definition of socialism is where the state owns the means of production. Britain had a socialized health care system, because the hospitals were all government owned, doctors were all government employees and pharms were all sold by the government. That's a socialized system.

They're moving away from that and into a system where hospitals and doctors are all independent entities which form a market. It still very much has a hand from the government in it, but it no longer fits under the definition of socialism and has thus been making huge strides in terms of accessibility and expedience.

What the ACA proposes says nothing anywhere about the government directly employing any doctors, or owning any of the health care market in any way, really -- It's a bunch of regulation. It's a step away from a laissez-faire market, if you like, but if that's socialist, then what would you call every other developed country on Earth, who has a much larger government involvement with their health systems?

What I see with the ACA is a significant improvement in accessibility, but little in the way of improvement for overall cost, that is usually taken on by the private sector and the tax payer alike.
 
#31
#31
not "owning" the doctors but controlling the distribution of care through regulation seems pretty darn close. You are taking money from some to bring others to the same level. What kind of system is that exactly?

in the US the removal of gov't roadblocks and allowing a market would go a long way toward improving costs.
 
#32
#32
JayVols said:
Did you miss the part where the article stated something to the fact that compounding pharmacies are receiving cease and desist orders?
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no I quoted the relevant part

Pharmacists can legally compound FDA approved products when a prescriber determines that the compounded preparation is more clinically appropriate for an individual patient.
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#33
#33
Two issues touched upon in the OP:

1) Shared Cost. I'm sure this was discussed to death during the Healtcare debates but with or without a new system, we're already paying for the uninsured. As noted, when someone without insurance needs medical help, more times than not they utilize the most expensive form, i.e. emergency care. We bear this burden through tax or premium dollars. So forcing them to have even basic insurance (which would still be purchased through private co.s) would help in the same manner forced auto insurance helps.

2) Pharamacuetical Co.s. I'm not sold on the R&D arguement. The problem I have is that there is way more profit to be made in treating disease than curing disease. This seems to be the focus of Big Pharm. Cancer is a tough example b/c it is not entirely understood (and the increase in death #'s could be attributed to the notion that causes of death are now more easily identified as cancer than in the past). But as treatments have improved, not much has come in the way of cures. Diabetes is a better example. It deals primarily with one organ, the pancreas. My mother has been a diabetic for @30 years and has spent an enormous amout of money on testing, treatment and Dr.s visits since being diagnosed. At one point she was taking 3 insulin injections per day (x needles, cotton swabs & testing devices). Innovations have come along with regard to testing, insulin pumps, etc. but still no sign of a cure. Again, too much money in treating rather than curing. What is the most heralded cure in the last 2 decades? Erectile Dysfuntion. Something wrong here.
 
#34
#34
utvolpj said:
no I quoted the relevant part
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Missed this from one of the articles:


Now that a single company has, with that approval, won market exclusivity for seven years, the compounding pharmacies have to stop making the drug. And the cost for the FDA-approved product will now be as much as $1,500 per dose, the AP says. Over a pregnancy, that could mean $30,000.
 
#35
#35
JayVols said:
Missed this from one of the articles:


Now that a single company has, with that approval, won market exclusivity for seven years, the compounding pharmacies have to stop making the drug. And the cost for the FDA-approved product will now be as much as $1,500 per dose, the AP says. Over a pregnancy, that could mean $30,000.
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again

Pharmacists can legally compound FDA approved products when a prescriber determines that the compounded preparation is more clinically appropriate for an individual patient.
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just because they sent out scary letters doesn't mean they have a leg to stand on. Just going off the articles you linked
 
#36
#36
FDA: Preterm-Birth Drug Makena OK as a Generic

March 30, 2011 -- Pharmacies can continue to make and sell inexpensive, generic versions of the premature birth drug Makena, the FDA said today.
KV Pharmaceuticals recently won FDA approval of its brand-name Makena (hydroxyprogesterone caproate), a synthetic form of the hormone progesterone. The drug is approved to lower the risk of some preterm births in women who have already had at least one previous preterm birth.
The approval seemed to be good news -- until KV announced that Makena would cost $1,500 a shot -- up from the $10 to $15 that compounding pharmacies charge.
After getting the approval, KV sent a letter to compounding pharmacies telling them that the FDA would enforce the company's exclusive right to make the drug.
"This is not correct," the FDA said today.
"In order to support access to this important drug, at this time and under this unique situation, FDA does not intend to take enforcement action against pharmacies that compound hydroxyprogesterone caproate based on a valid prescription for an individually identified patient unless the compounded products are unsafe, of substandard quality, or are not being compounded in accordance with appropriate standards for compounding sterile products," the FDA announced.
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#38
#38
Is the 97.5% just based on the cost to manufacture the drug now, or does it included the up front cost and time (years) to research and get the drug approved? The old saying is that when a pharmaceutical makes a pill it costs $0.05/ per pill...but the first one cost $10 million.
 
#39
#39
JayVols said:
Let's hope their "intentions" don't change when the company starts loosing money hand over fist. If they do decide to enforce exclusivity, do you think a 97.5% profit margin is acceptable pj?
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for a drug with a very inexpensive alternative? Sure. I also have no problems with the station down the street selling their gas for $8/gal when everyone else is at $3.85
 
#40
#40
Enjoyed the write-up, Milo.

Only factor missing from your analysis was listing for transaction cost and profit for third party payers. I would be curious as to how that has grown over the years, both in terms of percentage and in gross.
 
#41
#41
Risky sexual behavior was listed as an action associated with the highest causes of death, yet nothing on the list pertains to anything sexual, unless papiloma is a leader in fatal cancer.
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#42
#42
rjd970 said:
Is the 97.5% just based on the cost to manufacture the drug now, or does it included the up front cost and time (years) to research and get the drug approved? The old saying is that when a pharmaceutical makes a pill it costs $0.05/ per pill...but the first one cost $10 million.
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They didn't R&D the drug. It has been around for years. They just filed with the FDA for exclusive rights. It's an attempted money grab, pure and simple.
 
#43
#43
utvolpj said:
for a drug with a very inexpensive alternative? Sure. I also have no problems with the station down the street selling their gas for $8/gal when everyone else is at $3.85
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I agree when one has options, charge whatever you want. The risk here is, if the exclusivity that was granted by the FDA is pursued, there will be no options.

Same goes for the gas analogy. As long as I have choices, charge whatever. But if the only gas station price gouges, I have huge issues.

I would not be surprised to see the drug company file court papers to force the exclusivity that it was granted. Then, women would be forced to pay $1,500/dose for a drug that costs less than $10/dose to make with no R&D costs to recoup. That's criminal, IMO. Guess we will know in time.
 
#44
#44
The old saying in pharmaceuticals is that the first pill costs a billion. The ones after that cost 3 cents.
 
#45
#45
JayVols said:
I agree when one has options, charge whatever you want. The risk here is, if the exclusivity that was granted by the FDA is pursued, there will be no options.

Same goes for the gas analogy. As long as I have choices, charge whatever. But if the only gas station price gouges, I have huge issues.

I would not be surprised to see the drug company file court papers to force the exclusivity that it was granted. Then, women would be forced to pay $1,500/dose for a drug that costs less than $10/dose to make with no R&D costs to recoup. That's criminal, IMO. Guess we will know in time.
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the drug would cost $30k and another article listed the extra cost of a premature child at $50k. How would someone complaining about the cost be able to afford the child anyway.

and the drug is for those at risk of another premature birth (which means they had one previously and are at greater risk). Surely they can make a conscious choice on whether the cost is worth it right?
 
#46
#46
Haven't read the whole thing but let's start with the opening stats and the underlying assumption.

The big killers in 1900 were acute diseases - my guess is that these did there killing across the age span.

So, if we treated these acute diseases the same way in 1900 that we do now then cancer and heart disease would be the top killers in 1900. People died younger or the old died quickly when hit with an acute disease without proper treatment. If they survived the acute disease, the chronic diseases would move up the list.

You also have to look at diagnostic improvements. My guess is that cancer took it's toll then too but was not as frequently diagnosed.

I'll get to the rest and don't deny our diet has worsened but the use of 1900 stats vs today is highly misleading given the preemptive role of acute disease.
 
#47
#47
utvolpj said:
the drug would cost $30k and another article listed the extra cost of a premature child at $50k. How would someone complaining about the cost be able to afford the child anyway.

and the drug is for those at risk of another premature birth (which means they had one previously and are at greater risk). Surely they can make a conscious choice on whether the cost is worth it right?
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In theory, yes. But the cost of the drug before exclusivity rights were granted is no where near $30K. Sorry, I will always find such proffiteering immoral and in my opinion should be illegal.
 
#48
#48
volinbham said:
Haven't read the whole thing but let's start with the opening stats and the underlying assumption.

The big killers in 1900 were acute diseases - my guess is that these did there killing across the age span.

So, if we treated these acute diseases the same way in 1900 that we do now then cancer and heart disease would be the top killers in 1900. People died younger or the old died quickly when hit with an acute disease without proper treatment. If they survived the acute disease, the chronic diseases would move up the list.

You also have to look at diagnostic improvements. My guess is that cancer took it's toll then too but was not as frequently diagnosed.

I'll get to the rest and don't deny our diet has worsened but the use of 1900 stats vs today is highly misleading given the preemptive role of acute disease.
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The comparison of the stats was very misleading. The 1900 stats were essentially useless.

My issue with the whole thing was the final two sentences, which were shown as minor drawbacks and all but glossed over. In my mind, they are the issue. Doc quality will go south and innovation will undoubtedly head back to a crawl. Euros can go there because we won't.
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#50
#50
I think a basic problem lies in the education process for doctors, and the amount of money they are paid after residency. I'm not advocating that doctors not be compensated according to what they do, but isn't it true that doctors in the US make and additional 30-60K a year starting out than doctors in similar fields do in other countries?? Isn't this due to an almost over education of the doctors, too long a residency, and doctors basically getting compensated up for what is considered lost wages during that residency?? Maybe I am off base, but it seems as if a lot of it starts there first.
 
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