Health Care Reform thread

[Eagaholic]

Some good points Cerevant, here's some thoughts on them.

1) Malpractice / malpractice insurance reform.  This is the #1 way to reduce costs.

- I don't know that I'd so far as to say it is the #1 way to reduce costs, but it is a strong point. One of the significant burdens on health care costs today is the ever increasing practice of defensive medicine. An example of this is when doctors routinely  order lab tests, meds, or procedures that really are not indicated,  but are done to protect against malpractice suites. This isn't limited to physicians either. Organizations like clinics, hospitals and national health care systems have routine policy and procedure in place which may reduce the number and magnitude of law suites but also increase costs, waiting times, and in some cases even adverse events. Imagine that logic - increasing the chances of a patient having an adverse event just because it may reduce the chances of getting sued.

2) Increase the role of nurse-practitioners in primary care.  90% of primary care does not require the training of a full MD, and by doing this you can increase the supply of providers while keeping costs down.  If you think this doesn't work, look at the dental field where offices now have one or two dentists, and an army of 5-10 hygienists.

I don't necessarily agree with this. Increasing the numbers of nurse practitioners may help, and expanding into in newer areas in certain cases may be fine, but a problem today is a trend toward people with fewer and fewer qualifications and less training who are taking on increasing roles,  previously performed by practitioners with greater skill and expertise.

preventative care is cheaper than emergent care

...in fact I'd say preventative care is cheaper than most any treatment. In a nut shell, this is the single most important concept and the potential cure for ailing health care today. Place a great emphasis and investment in keeping people well  rather than treating them after they get sick and you suddenly solve a lot of problems. The catch is that this is much easier said than done. The average person isn't especially committed to or even educated in how to maintain health (especially with aging, which is a HUGE issue), and there are some formidable powers invested in the status quo. However, there is great promise in the emerging fields of preventative and functional medicine if this can somehow be cultivated.

Oh, and stop bitching about prescriptions in the states.  During my last trip down there I see chains offering 30 days of generics for less than $5.  I can't get anything nearly as cheap as that without insurance up here.

There's a good bit of truth in this but there are valid arguments on both sides. For example pharmaceutical companies do play games with marketing etc. as any kind of company would. But the stratospheric costs of developing and bringing a new drug to market are also very real, as well as liability potential. Back before computers and electronic storage media were commonplace, I remember hearing a factoid about the drug Tagamet as it came to market. Its manufacturer had to submit to the FDA the equivalent volume of paperwork which would completely fill a tractor trailer.

The bottom line to all this, is don't get sick.

[ATV]

Yay i hate America , but give me everything thats coming to me!!

Of course we don't hate America, we just hate ignorant chest-thumping facists. Ahem.

[Diomedes]

why we haven't been using this thread, you're all a bunch of idiots that's why



http://www.nytimes.com/aponline/2009/08/28/us/politics/AP-US-Health-Care-Scare.html

WASHINGTON (AP) -- The Republican national party has mailed a fundraising appeal suggesting Democrats might use an overhaul of the health care system to deny medical treatment to Republicans.

A questionnaire accompanying the appeal says the government might check voting registration records. It says that is ''prompting fears that GOP voters might be discriminated against for medical treatment in a Democrat-imposed health care rationing system.''

bald faced fearmongering well done...these republicans know their base and how to speak to them in code.  I imagine they drafted the response to criticism for this garbage even as they drafted the mailing itself.  scumbags

[rjs246]

Agreed. And I am the biggest culprit.

[Rome]

i schooled two hard core republicans yesterday at the office about the health care issue.  i am the sole pinko in the office, so i usually just bite my tongue when talk turns to politics, but yesterday's daily dose of hypocrisy about the government force-feeding us health care was too much for me to abide.

i mean, we all work for the government in that office, yet all they do is piss and moan about the federal government being bloated and inefficient, and how obama is the devil, so... i kinda lost it on them.  lol.

the best part was when they trotted out the hannity scare tactics of rationed care.  um, we already have rationed care because the health insurance plans we're forced to accept by our employers has financial limits such as huge co-pays and deductibles which force us to involuntarily choose to use the plan as a last resort.  i would love to go in for a full medical workup, but the fact is, even with the so-called full coverage i get, i would still have to pay thousands of dollars to get a full battery of tests and i just can't afford that.  not on the shtein pay those corksuckers provide us.

also - my daughter is on my plan and i have to pay 105 dollars per pay period to have her on my plan (which again sucks total ass).  i started researching alternately superior plans like blue cross to see if there'd be any savings or benefit, but there really isn't.  talk about being in a no-win situation.

[rjs246]

The only rational argument against the current healthcare reform proposals revolve around the fact that they don't do enough to rein in costs. Because right now as the proposals stand, they won't.

Every other argument against it that I've heard is 100% bullshtein.

[Rome]

i pay 2700 bucks for health insurance for my kid via my employer.  i can get basically the same plan if i go to an insurance agent and purchase it from them.

i'd like for one of the "our health care system rules!" zealots tell me again what benefit that represents.

in other news, one of my fellow employees had to get a prescription for migraine/seizure medication.  the insurer we have denied the topamax meds and forced her to get the generic which, in turn, caused a pretty significant exacerbation of the illness she has.  i googled prescription drug sites from canada for her and she ended up getting the name brand medication from the canadian website.

why?  because it ended up being cheaper than what she would have paid via co-pay through our insurance provider.

that is totally farging insane and if there's ever been an example of how our system is broken and needs to be overhauled, then that would be it.

[rjs246]

The examples of why our systems needs to be overhauled are endless. The examples of how awesome it is are incredibly limited.

[MadMarchHare]

Not to mention the money they spend on ad campaigns.

I'm looking forward to MMH's comments in this thread.  He knows more than I do about this stuff.

Sorry for being late to the game.  Pharma is certainly not immune to fault.  They spend a lot of money in DC lobbying (although, to be fair, the AMA and insurance giants spend more).  And I personally believe the single biggest mistake my industry ever made was fighting for direct marketing.  That may single handedly have caused the whole Vioxx fiasco, for instance.

IMO, the insurance industry is one of the biggest players at fault here, and that largely falls back to the concept of letting an industry police itself.  They haven't done that well, and capitalism may not be the best way to regulate health care.

I can really only speak to Pharma in this matter.  Drug costs are high because, well, we can charge whatever people will pay.  I've actually heard that argument in meetings.  That has to change.  However, to get a drug to market for cancer (one of the fastest paths forward) costs about $600MM.  Just yesterday, we were discussing a initiating a phase 1 trial (which measures drug levels in patients, not efficacy), and the bottom line was it costs over $1MM per patient.  If you go after chronic diseases, such as diabetes or arthritis, those phase 2/3 studies take years.  Now the cost of getting those to market is well over $1BB.

Add to that our poor understanding of physiology at the molecular level, and we have about a 10% success rate in development (i.e. 1 in 10 targets moved forward actually reaches market and earns money).

This is compounded by the fact that early in discovery, the patents need to be filed.  So with 15 years of protection, the drug probably doesn't launch until year 8-10.  Now you have to make enough money to cover all expenses for successful and failed drugs in a 5 year span, as well as maintain profit margins for the investors.  It's an expensvie business with high risk/reward.

How do you fix it?  Well, you could make regulatory less onerous, getting drugs to market faster.  Of course, that would probably kill people, since safety would be compromised.  The gov't could bear some of the costs of development, but that isn't feasible.

In the best world, you get the gov't and Pharma to work together.  Increase the patent life of drugs to say 20-25 years, so there is a longer window to make profit.  Pharma compromises by lowering costs to maintain the profits earned before, so drug prices go down.  If they abuse the system, put in price fixing to make them comply.  Will this ever happen?  Probably not, but it's good for everybody, so it should.

Sorry for the essay, but hey, you did ask.

[MadMarchHare]

Ask a pharma rep and he'll tell you we have to pay more because American drug companies spend more in r & d than all the other drug companies in the world combined.
The real answer is because pharma companies spend millions on political candidates who do their whoring for them in Washington.

Why is that? Why do we spend more on R & D then every other drug company in the world combined?

Cheap labor, mostly.  Why do you think all Pharma is outsourcing jobs to Taiwan and China?

[ATV]

Moyers on Maher...

http://crooksandliars.com/media/play/wmv/9655/30820

[phillycrew]

My take:

As an insurance regulator, the health insurance marketplace is not very competitive.  I can see the case Obama makes for a federal plan to bring additional competition, but there is a more efficient way.  Let any employer or individual purchase plans across state borders.  Enact a national minimal capitalization level so that you don't have fly by night companies but you give the little guys and innovators a chance.

Also, health care is compensated based on number of procedures, tests or use of technology.  Instead, we need to look at compensation based on outcomes.  There are too many doctors who are pressured to use MRI or other tests because they need to pay for that equipment which can only be done by charging insurance.  Each provider should have to disclose on a website or their website a list of their costs.  Right now there is no incentive to use keep costs down because the consumer only pays their co-pay.  For the uninsured, like my mom, they have no basis of comparison and go to a MD based on recommendations.  More money needs to flow to primary care physicians and less to specialists.

[ATV]

Competition and purchasing health care is not and can never be like the choice of purchasing milk at a grocery store. Even if someone has an MD they would have rouble deciding between a cheaper plan and one that might be more credible. You can't expect a family to spend weeks attempting to research which insurance is more competent than another. So, I agree there is no marketplace for health insurance, and I agree this is a significant reason costs are so high, but I disagree that there's really anything that could be done about this. The average person doesn't have time or desire to sufficiently deal with this crap.

[MadMarchHare]

So your plan is to let the country bankrupt itself by doing nothing.  Brilliant!

[ATV]

Who is "your"?