US Presidential Candidates

Daryl wrote:From a distance it doesn't seem to be anything to do with population or geographic size, why should these have ny bearing? It does seem to be a result of several factors.
The US mindset regarding anything that might seem socialist (see other thread here about California being communist - insanity), scared of government control, and mainly vested interests that will fight for the right to rip off people.

Probably too big a mess to untangle now. Mark Twain said "To create utopia first shoot all the lawyers", I'd agree and add the financial middlemen who profit from misery.
Our system isn't perfect with greedy specialists and drug companies always trying to get more than an approprite share, but it and dozens of similar others do meet the basic KPI of no one being denied lifesaving treatment because of lack of money.

Before giving someone a large responsibility it is often wise to see how they do in a smaller test case. In this instance, I'm not interested in the government running the healthcare for the entire society of 350 million people when they can't even manage it for the VA (estimated to be less than 10 million people - they can't even get good numbers). Note not every eligible veteran uses the VA, some are not near a location where it is available, other have better healthcare through their current employer etc. But in any case, I want to see them fix the VA before I give them a larger more complex situation to address.

Biochem's point about succeeding in a little project first is a good test.

Providing catastrophic insurance that everyone contributes into through government or private insurance through government oversight is easy enough. Why the heck do we want to turn over the employ of our medical practitioners to an organization run on political and bureaucratic motives? You agree that middlemen with their own agenda is not a good thing. Why give healthcare over to middlemen hungry for political power?

Daryl wrote:From a distance it doesn't seem to be anything to do with population or geographic size, why should these have ny bearing? It does seem to be a result of several factors.
The US mindset regarding anything that might seem socialist (see other thread here about California being communist - insanity), scared of government control, and mainly vested interests that will fight for the right to rip off people.

Probably too big a mess to untangle now. Mark Twain said "To create utopia first shoot all the lawyers", I'd agree and add the financial middlemen who profit from misery.
Our system isn't perfect with greedy specialists and drug companies always trying to get more than an approprite share, but it and dozens of similar others do meet the basic KPI of no one being denied lifesaving treatment because of lack of money.

PeterZ wrote:Biochem's point about succeeding in a little project first is a good test.

Providing catastrophic insurance that everyone contributes into through government or private insurance through government oversight is easy enough. Why the heck do we want to turn over the employ of our medical practitioners to an organization run on political and bureaucratic motives? You agree that middlemen with their own agenda is not a good thing. Why give healthcare over to middlemen hungry for political power?

As opposed to middlemen hungry for corporate profit? Either way we have middlemen who aren't focused on the interest of the patient.

Which brings me back a post or three. Government oversight of private enterprise.

Keep the private enterprise's profit motive to reduce costs and waste. Employ government oversight to reduce abuse, fraud and general malfeasance. The trouble is that oversight and regulations need to be balanced. Where to set the equilibrium is a tough question to answer.

I would suggest that regulations that increase both private sector and public sector layers of bureaucrats between a doctor and his patient is a bad thing to be avoided at all costs. The operating theory is to use the left's champion, government, to keep the right's champion, private enterprise, in check. All the while utilizing private enterprise to overcome government's short comings. Having these competing motivations keeps both honest, or at least keep the worst natures of both in check.

Starsaber wrote:

PeterZ wrote:Biochem's point about succeeding in a little project first is a good test.

Providing catastrophic insurance that everyone contributes into through government or private insurance through government oversight is easy enough. Why the heck do we want to turn over the employ of our medical practitioners to an organization run on political and bureaucratic motives? You agree that middlemen with their own agenda is not a good thing. Why give healthcare over to middlemen hungry for political power?

As opposed to middlemen hungry for corporate profit? Either way we have middlemen who aren't focused on the interest of the patient.

Good points. From visiting the UK often and talking to friends there it does seem that the NHS is a good thing overall, but possibly a little too bureaucratic.

With ours there are bureaucrats in the background to set the rules, but we select our own GP who is an independent operator. Some bulk bill (charge Medicare), some bulk bill pensioners while charging all others a copayment, and some charge all and you seek some $ back from Medicare.

With hospitals there is the free system and the pay system. The free one is great for emergencies and life threatening cases, but not elective stuff.

Medicines are controlled at about $6 a month for pensioners, and the negotiated rate ($6-$30) for others. I know Biochem will disagree but I get annoyed when the patent on a life saving drug runs out and it drops from say $30 to $6. Obviously the company was making a ridiculous profit before that.

Just a thought, and if any laws prevent government run corporations in the US, probably not a good one, but could the U.S. set up a Crown Corporation (I know you guys would never call it that, but unsure of proper term) to provide a minimal level of health insurance? If it's charter was set up so that they charged only what it cost to basically break even and be revenue neutral while charging as little as possible and covering all basic and catastrophic medical care? And for ALL people, no one gets denied. That way, the only cost to the taxpayer would be the initial setup. If the Capitalism is always better crowd is right, then it shouldn't worry the current insurers as they should be able to do it cheaper, but it would make sure that every citizen had at least one insurer available to them regardless of health history. And if removing the profit motive lets them offer services for less even with the bloat and corruption that govt entities are prone to, then the other companies might drop their rates to a more affordable level. Just a thought I had, feel free to give it a double broadside

Daryl,
http://www.fdareview.org/03_drug_development.php
http://www.forbes.com/sites/matthewherper/2012/02/10/the-truly-staggering-cost-of-inventing-new-drugs/

A major part of the cost of drugs are the R&D requirements. It takes 11-14 years to bring a new drug to market. The chart indicates only 8% of compounds are actually approved by the FDA. Yet testing all of them costs money. Who pays for that research if the pharmaceutical company is prohibited from charging for those expenses? The second link gives you some idea of average R&D investment and the number of drugs approved.

If there is no incentive to spend a decade and a half trying to find a new drug with a 92% of failure somewhere along the way, very few researchers would do it. Then if they succeed the company may have exclusivity for less than 10 years. The patent is often granted before clinical or even preclinical trials to prevent others from competing. So a 20 year patent may only provide less that 10 years of exclusive use of an approved drug.

PeterZ wrote:Daryl,
http://www.fdareview.org/03_drug_development.php
http://www.forbes.com/sites/matthewherper/2012/02/10/the-truly-staggering-cost-of-inventing-new-drugs/

A major part of the cost of drugs are the R&D requirements. It takes 11-14 years to bring a new drug to market. The chart indicates only 8% of compounds are actually approved by the FDA. Yet testing all of them costs money. Who pays for that research if the pharmaceutical company is prohibited from charging for those expenses? The second link gives you some idea of average R&D investment and the number of drugs approved.

If there is no incentive to spend a decade and a half trying to find a new drug with a 92% of failure somewhere along the way, very few researchers would do it. Then if they succeed the company may have exclusivity for less than 10 years. The patent is often granted before clinical or even preclinical trials to prevent others from competing. So a 20 year patent may only provide less that 10 years of exclusive use of an approved drug.

Agreed.

R&D is expensive and if we want new drugs we have to pay for it. The FDA keeps demanding more clinical trials, larger clinical trials, longer clinical trials, more comprehensive clinical trials. You wind up with better science at the end but there is a cost. A huge one in $$$$$ but also a hidden one of patients waiting for a medicine. There will never be 100% certainty that the medicine is effective and does not contain unacceptable side effects (serious low incidence side effects are very difficult to spot). At what certainty level should we release the drug 80%, 90%, 95%, 99%? Each increasing demand results in higher costs a significantly longer wait time while the clinical trials to support it are conducted. And even then there is no certainty that some 1/10,000 or 1/100,000 side effect won't derail the drug if it is serious enough.


Note the thing that ticks me off is the Martin Shkreli's of the world. He is a hedge fund manager and his business plan was: don't bother with R&D with it's high costs and failure rates. Buy an already approved generic instead. One for such a tiny indication that there is only a single manufacturer. Make sure it's a life threatening indication so people must buy the drug. Raise the price from $13.50/pill to $750/pill, literally overnight. Pure profit. They counted on how slowly the FDA would approve any competitor's facility to keep them going for years. (For a pharmaceutical manufacturer, the FDA approves each step of the process, and must inspect the new plant etc. It takes forever.).

He's not the only one. There are others they just aren't so dumb as to be so obvious. A more typical smarter evil profiteer raises the price slowly in increments, so it's less obvious what is happening.

On the bright side - even without government interference, he lost out. He missed that compounding pharmacy manufacturers don't need the individual process approved, so they could start competing within months. (Compounding pharmacies make drugs for individual patients with special needs, for example those allergic to inactive ingredients typically found in tablets etc. They don't have to have each individual step approved because they are making medicines tailored to an individual and a single facility may have literally 1000s of processes each for a different patient).

Therein lies the market based solution for egregious profiteering. The market chases profits and competition drives down the amount of profit per transaction. Some a$$hat sets outrageous profits without any underlying justification? A competitor will happily undercut him. Those profits still unjustifiable? Another competitor will happily undercut those two or a new entrant will offer the third, cheaper alternative. This goes on until the market extracts a reasonable profit for the constraints that apply to this particular product.

If government simply ensures that this process happens, prices will find sustainable base range.

This might be a better link to the cost of drug approval. As an example, Novartis spent 83 billion dollars to approve 21 drugs. At an 8% success rate, they had to research 263 compounds costing an average of $318 million per compound. Yet they can only recoup that cost with 21 approved drugs for a period of less than 10 years.
http://www.forbes.com/sites/matthewherper/2012/02/10/the-truly-staggering-cost-of-inventing-new-drugs/#e2ec01d44771

biochem wrote:

PeterZ wrote:Daryl,
http://www.fdareview.org/03_drug_development.php
http://www.forbes.com/sites/matthewherper/2012/02/10/the-truly-staggering-cost-of-inventing-new-drugs/

A major part of the cost of drugs are the R&D requirements. It takes 11-14 years to bring a new drug to market. The chart indicates only 8% of compounds are actually approved by the FDA. Yet testing all of them costs money. Who pays for that research if the pharmaceutical company is prohibited from charging for those expenses? The second link gives you some idea of average R&D investment and the number of drugs approved.

If there is no incentive to spend a decade and a half trying to find a new drug with a 92% of failure somewhere along the way, very few researchers would do it. Then if they succeed the company may have exclusivity for less than 10 years. The patent is often granted before clinical or even preclinical trials to prevent others from competing. So a 20 year patent may only provide less that 10 years of exclusive use of an approved drug.

Agreed.

R&D is expensive and if we want new drugs we have to pay for it. The FDA keeps demanding more clinical trials, larger clinical trials, longer clinical trials, more comprehensive clinical trials. You wind up with better science at the end but there is a cost. A huge one in $$$$$ but also a hidden one of patients waiting for a medicine. There will never be 100% certainty that the medicine is effective and does not contain unacceptable side effects (serious low incidence side effects are very difficult to spot). At what certainty level should we release the drug 80%, 90%, 95%, 99%? Each increasing demand results in higher costs a significantly longer wait time while the clinical trials to support it are conducted. And even then there is no certainty that some 1/10,000 or 1/100,000 side effect won't derail the drug if it is serious enough.


Note the thing that ticks me off is the Martin Shkreli's of the world. He is a hedge fund manager and his business plan was: don't bother with R&D with it's high costs and failure rates. Buy an already approved generic instead. One for such a tiny indication that there is only a single manufacturer. Make sure it's a life threatening indication so people must buy the drug. Raise the price from $13.50/pill to $750/pill, literally overnight. Pure profit. They counted on how slowly the FDA would approve any competitor's facility to keep them going for years. (For a pharmaceutical manufacturer, the FDA approves each step of the process, and must inspect the new plant etc. It takes forever.).

He's not the only one. There are others they just aren't so dumb as to be so obvious. A more typical smarter evil profiteer raises the price slowly in increments, so it's less obvious what is happening.

On the bright side - even without government interference, he lost out. He missed that compounding pharmacy manufacturers don't need the individual process approved, so they could start competing within months. (Compounding pharmacies make drugs for individual patients with special needs, for example those allergic to inactive ingredients typically found in tablets etc. They don't have to have each individual step approved because they are making medicines tailored to an individual and a single facility may have literally 1000s of processes each for a different patient).

PeterZ wrote:Daryl,
http://www.fdareview.org/03_drug_development.php
http://www.forbes.com/sites/matthewherper/2012/02/10/the-truly-staggering-cost-of-inventing-new-drugs/

A major part of the cost of drugs are the R&D requirements. It takes 11-14 years to bring a new drug to market. The chart indicates only 8% of compounds are actually approved by the FDA. Yet testing all of them costs money. Who pays for that research if the pharmaceutical company is prohibited from charging for those expenses? The second link gives you some idea of average R&D investment and the number of drugs approved.

If there is no incentive to spend a decade and a half trying to find a new drug with a 92% of failure somewhere along the way, very few researchers would do it. Then if they succeed the company may have exclusivity for less than 10 years. The patent is often granted before clinical or even preclinical trials to prevent others from competing. So a 20 year patent may only provide less that 10 years of exclusive use of an approved drug.

R&D is a valid concern, but they could save money by not advertising so much. Prescription medicine decisions should be up to the doctor, but I can't watch a show without seeing an ad ending with "ask your doctor about..." some prescription drug that's supposed to help with a condition. If your doctor thought that was the right medicine for your situation, they'd already be prescribing it.