Time to read THE LAST CENTURION?

One of the reasons healthcare is so expensive in the US is the cost of prescription drugs. One reason prescription drugs are so expensive in the US is because they are so cheap everywhere else. Essentially, the US subsidizes the rest of the world.

TFLYTSNBN wrote:The bigotry by foreigners displayed on this forum truly astounds me. The US system is expensive.

Expensive is the smallest part of the problem; its ineffective, that's the point. Your medicare totally blundered the early stages of pandemic due to that, and its absolutely unclear, would USA be able to avoid Italian-scale crisis, or not.

TFLYTSNBN wrote:However; anyone walking or being wheeled in to the ER is going to get cared for with or without insurance. This care includes quick access to sophisticated diagnostics such as CAT scan and MRI.

Yeah, how much insulin cost for average US person with diabetes per year? More than 5000 dollars in 2016; probably even more now. American childrens die - in XXI century! - due to not being able to afford it.

TFLYTSNBN wrote:The bigotry by foreigners displayed on this forum truly astounds me.

Is it bigotry to point out that your health care system, in as much as it can be called that, is far more expensive than ours while providing a lesser level of care?

Is it bigotry to point out that the entire culture surrounding health care in the US, including factors such as paid sick days, paid time off, and insurance coverage is encouraging people to work through sicknesses rather than taking time off to recover?

The US system is expensive. Malpractice awsuits and the fear of lawsuits multiply the costs. However; anyone walking or being wheeled in to the ER is going to get cared for with or without insurance. This care includes quick access to sophisticated diagnostics such as CAT scan and MRI.

And? What's your argument here? We, too, have malpractice lawsuits. We, too, require hospitals and ERs to treat patients regardless of their insurance status.
And yet, we still pay a lot less for the same or higher quality of service than you.

cthia wrote:One of the reasons healthcare is so expensive in the US is the cost of prescription drugs. One reason prescription drugs are so expensive in the US is because they are so cheap everywhere else. Essentially, the US subsidizes the rest of the world.

It's not that simple though. As this article points out, while pharma companies are quick to trot out R&D costs as a major factor in their pricing structure, they are also spending a ton of money and advertising and lobbying while generating quite generous profit margins; Yes, we europeans have an advantage in that we have legislation limiting drug prices and letting our national insurers do the negotiating for us, but to claim that that's the only reason our prices are so low and yours so high is a bit of a distortion of the facts. Even if we were to pay more for the same drugs, without similar legislative measures on your side, there is no incentive for drug manufacturers to lower prices in the US.

doug941 wrote:Actually it is nowhere near true. If your medical staff can't provide you with a pillow, do you really think your going to get antibiotics and CAT scan machines? The US system is not perfect, nowhere near, but when was the last time a US doctor had to put his/her used needles in an autoclave so they can be reused?

I base my statements on available statistics, which you haven't refuted. Care to try again without hyperbolic examples and anecdotal evidence?

TFLYTSNBN wrote:The bigotry by foreigners displayed on this forum truly astounds me. The US system is expensive. Malpractice awsuits and the fear of lawsuits multiply the costs. However; anyone walking or being wheeled in to the ER is going to get cared for with or without insurance. This care includes quick access to sophisticated diagnostics such as CAT scan and MRI.

So it's bigotry to point out what a train-wreck the US health-care system is and how abysmally bad it is in comparison with other countries.

I only see one bigot here, the one using the word bigotry in conjunction with the word foreigners.

cthia wrote:One of the reasons healthcare is so expensive in the US is the cost of prescription drugs. One reason prescription drugs are so expensive in the US is because they are so cheap everywhere else. Essentially, the US subsidizes the rest of the world.

No. If you look at the prices for established prescription drugs that have all of their R&D costs paid a long time ago, they keep increasing. Most manufacturers of drugs spend only about 17% of the total spending on R&D.

Between 2008 and 2016, oral prescription drugs increased 9% in price and injectable d:o increased 15% while inflation was 2%. In the beginning of 2019 the average price increase for drugs was 6.3%.

There are specific examples of insulin that increased 50% in price during one year, the term "captive market" comes to mind.

There are several studies suggesting that the prices have nothing to do with R&D costs but everything to do with lack of competition and regulatory capture.

cthia wrote:One of the reasons healthcare is so expensive in the US is the cost of prescription drugs. One reason prescription drugs are so expensive in the US is because they are so cheap everywhere else. Essentially, the US subsidizes the rest of the world.

hmmmmm - maybe it's because the many countries negotiate on a state wide basis, whereas - IIRC - in the US it is on a hospital or group of hospitals basis - so one might say 'free market rules' have done you in.

I guess that also have to pay for things like the Oxycodone scandal don't help.

TFLYTSNBN wrote:The bigotry by foreigners displayed on this forum truly astounds me. The US system is expensive. Malpractice awsuits and the fear of lawsuits multiply the costs. However; anyone walking or being wheeled in to the ER is going to get cared for with or without insurance. This care includes quick access to sophisticated diagnostics such as CAT scan and MRI.

Well - be prepared to be astounded some more.


Actually - I think that we are trying to open your mind to see that other ways are possible and even better.

let me give a personal example... my wife has had kidney problems for years. She had to have a transplant about 15 years ago. My wife requires regular follow-up and quite large amounts of non trivial medication.

Our older daughter was extremely premature [about 10 weeks early and weighing under 1kg] so was in intensive specialist care for a long time.

How much did this cost us? Pretty much nothing. The only cost was £60/every three months for the prescriptions and that dropped to zero on her 60th birthday.

This is in the UK which is not nearly as generous as some of the other EU countries.

How much would that cost in the states? How many would have gone bankrupt?

I feel your pain FLY. But what's a person to do? Foreign arrogance about the US is not affected by the virus.

Wow. Where to start. I know where to start. The one place where I'm detested. My sources. As mentioned on many occasions, one of my sisters is a research scientist in the most exclusive network on the planet. Research Triangle Park (RTP) - which boasts the highest concentration of PHDs in the world. As I mentioned before, my niece and I used to call it Hephaestus. Sis's salary is over seven figures a year.

I keep preaching that much of what you read on the internet is misleading. I tried to point that out to you before. If you are going to base your knowledge of things in the US solely on the internet, you have to know you'll be lacking. If you pair it with the statistics you glean off the internet, and you aren't a statistician actually doing the research, and qualified to do so, you have to know you'll be lacking.


For instance, on the internet it lists a single drug's development cost at around $2.6B. This is just one of many of my sister's pet peeves. The cost of developing a single drug is actually much much higher. But the way bureaucracy works in America, it can't be listed truthfully. Only one of eight drugs bears fruit. If eight "different" drugs are developed to combat a single disease, $21B in research is lost. The Pharmas are not allowed to claim the failed drugs (failed for whatever reason) as part of the development costs of the one success. Although they are. They are different drugs. However, Pharma's can't afford to put all of its eggs in one basket. Therefore, the actual cost to score a single drug often exceeds $21B. Not $2.6B. That is simply one discrepancy of what is reported because of American bureaucracy, and because the right questions are not asked, etc. Also, a lot of the profit of these companies has to be set aside to cover potential lawsuits. Lawsuits that tend to be staggering. A single lawsuit can kill a company. If the profit margin isn't high enough to offset potential lawsuits (think Banks being backed by the Federal Reserve) investors pull out. And the lawsuits can come from many other industries besides the medical profession. Many non-medical companies pay for their data. Etc.

There is no other country on the planet that can do what the US does in medical R&D. No other country can afford the infrastructure and eat the costs of developing drugs to the tune of the US. Absolutely none. You foreigners cry about how things work here (believe me, so do we), but without us, you'll be dead in the water. Literally...


Take Switzerland:

"Roche is headquartered in Basel, so you might think that all of its drugs are created in Switzerland. Actually, many of Roche’s biggest blockbusters were born in the USA at Genentech, its South San Francisco based subsidiary. Roche’s acquisition of Genentech (initiated in 1990 and completed in 2009) has been a transformative driver of the company’s success in recent years. It led Roche to abandon the PhRMA trade group in favor of BIO, and to rebrand of many of its drugs from having the Roche imprint on the label to Genentech.

Let's take France:

Sanofi is located in Paris, so its drugs originate in France, right? Many do, but with its acquisition of Boston-based Genzyme and more recent business deals with Tarrytown, NY-based Regeneron Pharmaceuticals (NASDAQ: REGN) and Cambridge, MA-based Alnylam Pharmaceuticals (NASDAQ: ALNY), much of the company’s R&D work is now happening here in the U.S. Want evidence for the importance of this American connection? Chris Viehbacher, Sanofi’s German-Canadian CEO, has actually moved from Paris to Beantown.

Pfizer’s corporate offices are located in New York City and its largest R&D facilities are in Connecticut, so its drugs are clearly made in America. Or are they? One of Pfizer’s biggest-selling drugs, sildenafil (Viagra), originated in its labs in Sandwich, England. If Pfizer had (or does) successfully acquired AstraZeneca and relocated the company’s headquarters to London for tax purposes, would all of its drugs suddenly become British?

Let's take Canada:

Valeant Pharmaceuticals (NYSE: VRX), a U.S. based pharma company, became Canadian when it was acquired by Biovail back in 2010. The merged company adopted the Valeant name. Now Canadian Valeant is making an effort to acquire California-based Allergan (NYSE: AGN). Will Allergan’s drugs be required to make the long drive north on I-5 and cross the border if Valeant is successful with its bid?

The innovation and country of origin story gets even more complicated. Sometimes a company’s headquarters don’t change as a result of a merger, but its tax status can migrate to another country. U.S.-based Auxilium Pharmaceuticals (NASDAQ: AUXL) is planning to merge with Canada’s QLT. The combined company’s headquarters will remain in the U.S., but because of the 24 percent Canadian stake, the “New Auxilium’s” tax rate will drop from 35 percent (the U.S. rate) to Canada’s 15 percent rate. The deal will only happen if the combined company will “not be treated as a U.S. domestic corporation for U.S. federal income tax purposes.” Would this make the New Auxillium’s drugs Canadian, or will they be American? And will QLT’s products now be considered to be from the U.S.? Similarly, Chicago based AbbVie has recently acquired Ireland’s Shire with a similar “tax inversion” in mind, although the actual tax savings from this hookup have been called into question.

Let’s dive in a little deeper. Consider the data in the table below (from the Milken Institute report, The Global Biomedical Industry: Preserving U.S. Leadership). The table purports to show how the number of drugs produced within certain countries has changed over time. The take home message: drug discovery efforts have moved in large part from Europe and Japan to the U.S. over the past 30 years. But these numbers are difficult to interpret due to the frequent acquisition of both companies and products during this time period."

From what my sister says, many drugs developed in foreign countries are only "completed" in foreign countries with R&D acquired from US companies.

So you see people, your own efforts are being heavily subsidized by the US. Your infrastructure cannot achieve what we do in the medical profession. (Fueled by the astronomical drug costs paid by Americans along with RTP and other research sites is akin to Project Gram and the WDB fueled by the MWJ). You reap the benefits, but American taxpayers are the wind beneath your wings paying the astronomical drug costs so American innovation won't stagnate. So these companies can continue to attract, and keep top notch people like my sister, and fund cutting edge technology, keep investors happy and fund a nest egg to battle just one, let alone several, company busting lawsuits.

Thank you foreigners, you're welcome to our infrastructure. You talk about the crumbs from our table as you feed, nourish, clothe, and treat your families off the savings from American infrastructure, and free market.

America eats the cost of high military expenditures to protect it's allies. America eats the cost of high medical costs to fuel a medical R&D second to none. There are no peers. I have to live with the rants from a woman called my sister, who is knee deep in the hoopla.

cthia wrote:
America eats the cost of high military expenditures to protect it's allies. America eats the cost of high medical costs to fuel a medical R&D second to none. There are no peers. I have to live with the rants from a woman called my sister, who is knee deep in the hoopla.

Yeah, now please answer one simple question: why America could not provide its population with insulin?

The answer is: because your glorious medical researches were aimed specifically toward circumventing Banting's patent, so the companies could justify raising the price on vital medication.

In essense, they developed slightly better insulin solution, to justify order of magnitude higher cost. So essentially, in practical therms they spend money on developement made specifically to pump more money out of patients. The US insuline production is less than 15% of world total, but it generates more than 55% of total revenue in this area.

Yeah, peoples in USA who died because they could not afford insulin must be really proud that the US pharmaceutical put so much efforts into making the most basic, most vital solution too expensive to afford.