Does Drug Development Require Profit?

[Rhea]

I don’t think we need to close down all drug companies, just advocating to make the budget include a government funded lab as a player in the game.

 

[Loren Pechtel]

The left loves to claim this, but there are multiple factors involved:

1) No sales costs.

A plus. Also no money taken out called profit

The point is that it's not a fair comparison.

2) Bill payment is outsourced to the IRS and thus not on the books.

A plus.

You work for Enron???

3) They force facilities to accept lower reimbursements.

A plus.

It results in more and more doctors completely refusing to deal with Medicare. It's gotten bad enough we have a hospital chain here that got sufficiently fed up with it that they decided they are better off not going along--even though that means that if they end up with a Medicare patient they simply write it off.

4) And despite this they clearly aren't doing it the cheapest--observe the medicare advantage plans. That's private industry providing medicare for less than the government can.

Medicare replacement plans are not Medicare.

Allowing the replacement plans makes Medicare worse. I agree.

The point is that the Medicare Advantage plans are offering a service which many find superior and they're doing it cheaper. Thinking they shouldn't exist doesn't change this.

 

[Loren Pechtel]

4) And despite this they clearly aren't doing it the cheapest--observe the medicare advantage plans. That's private industry providing medicare for less than the government can.

I don’t think that is accurate.

Advantage plans are a plan to get extra benefits, and the Medicare program pays Medicare Advantage insurers a monthly fee per enrollee to cover the cost of carrying their beneficiaries.

Medicare advantage is an add-on upgrade made necessary by the Republican sandbagging of the Medicare system.

Many such plans have a $0 premium. Thus they're doing basically the same thing as the government--but they're offering extras. That means they're doing it cheaper than the government.

 

[Loren Pechtel]

I don’t think we need to close down all drug companies, just advocating to make the budget include a government funded lab as a player in the game.

I'd have no problem with that. In fact, I think it would be a good idea to have a government lab that works on the stuff that is of value but not so profitable. (For example, new antibiotics.)

 

[ZiprHead]

The point is that it's not a fair comparison.

2) Bill payment is outsourced to the IRS and thus not on the books.

A plus.

You work for Enron???

Is the IRS not the collections agent for the US government? How much do you think it costs to have a programmer create code to automatically send the Medicare portion of the tax collection to the Medicare budget account? You always bring up your programming experience so, c'mon, tell us how much that would cost, especially in comparison to private insurance plans?

 

[ZiprHead]

4) And despite this they clearly aren't doing it the cheapest--observe the medicare advantage plans. That's private industry providing medicare for less than the government can.

I don’t think that is accurate.

Advantage plans are a plan to get extra benefits, and the Medicare program pays Medicare Advantage insurers a monthly fee per enrollee to cover the cost of carrying their beneficiaries.

Medicare advantage is an add-on upgrade made necessary by the Republican sandbagging of the Medicare system.

Many such plans have a $0 premium. Thus they're doing basically the same thing as the government--but they're offering extras. That means they're doing it cheaper than the government.

Still, while many offer $0 premiums, the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick, and what they pay can differ depending upon your overall health.2 Here's a look at some of the disadvantages of Medicare Advantage Plans.

KEY TAKEAWAYS
A Medicare Advantage (MA) Plan, known as Medicare Part C, provides Part A and B benefits, and sometimes Part D (prescription) and other benefits.1
All Medicare Advantage providers must accept Medicare-eligible enrollees.3
Sick participants may find that medical care costs skyrocket under a Medicare Advantage plan due to copayments and out-of-pocket expenses.2
Medicare Advantage customers can switch back to Original Medicare during an annual enrollment period.3
Prospective Medicare Advantage customers should research plans, copays, out-of-pocket costs, and eligible providers.

Disadvantages of Medicare Advantage Plans
In general, Medicare Advantage Plans do not offer the same level of choice as a Medicare plus Medigap combination. Most plans require you to go to their network of doctors and health providers.1 Since Medicare Advantage Plans can’t pick their customers (they must accept any Medicare-eligible participant), they discourage people who are sick by the way they structure their copays and deductibles.

Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick:

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

 

[Loren Pechtel]

The point is that it's not a fair comparison.



You work for Enron???

Is the IRS not the collections agent for the US government? How much do you think it costs to have a programmer create code to automatically send the Medicare portion of the tax collection to the Medicare budget account? You always bring up your programming experience so, c'mon, tell us how much that would cost, especially in comparison to private insurance plans?

You utterly missed the point.

Of course what you describe is trivial. What's not trivial is getting the money in in the first place. My point about Enron was keeping costs off the books, which is what you're trying to do here.

 

[Loren Pechtel]

Many such plans have a $0 premium. Thus they're doing basically the same thing as the government--but they're offering extras. That means they're doing it cheaper than the government.

Still, while many offer $0 premiums, the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick, and what they pay can differ depending upon your overall health.2 Here's a look at some of the disadvantages of Medicare Advantage Plans.

KEY TAKEAWAYS
A Medicare Advantage (MA) Plan, known as Medicare Part C, provides Part A and B benefits, and sometimes Part D (prescription) and other benefits.1
All Medicare Advantage providers must accept Medicare-eligible enrollees.3
Sick participants may find that medical care costs skyrocket under a Medicare Advantage plan due to copayments and out-of-pocket expenses.2
Medicare Advantage customers can switch back to Original Medicare during an annual enrollment period.3
Prospective Medicare Advantage customers should research plans, copays, out-of-pocket costs, and eligible providers.

Disadvantages of Medicare Advantage Plans
In general, Medicare Advantage Plans do not offer the same level of choice as a Medicare plus Medigap combination. Most plans require you to go to their network of doctors and health providers.1 Since Medicare Advantage Plans can’t pick their customers (they must accept any Medicare-eligible participant), they discourage people who are sick by the way they structure their copays and deductibles.

Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick:

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

You do get limited docs. And you think Medicare itself is very good about paying for cases like you describe??

 

[Swammerdami]

The latest Atlantic has a dismal, frightening article about the drug southernhybrid mentioned.

Earlier this week, the Food and Drug Administration overruled—to much criticism—its own scientific advisory committee and approved the Alzheimer’s treatment Aduhelm. The agency made this decision despite thin evidence of the drug’s clinical efficacy and despite its serious side effects, including brain swelling and bleeding. As a result, a serious risk now exists that millions of people will be prescribed a drug that does more harm than good.

Less appreciated is how the drug’s approval could trigger hundreds of billions of dollars of new government spending, all without a vote in Congress or indeed any public debate over the drug’s value. Aduhelm’s manufacturer, Biogen, announced on Monday that it would price the drug at an average of $56,000 a year per patient, a figure that doesn’t include the additional imaging and scans needed to diagnose patients or to monitor them for serious side effects.

The federal government will bear the brunt of the new spending. The overwhelming majority of people with Alzheimer’s disease are eligible for Medicare, the federally run insurance program for elderly and disabled Americans. If even one-third of the estimated 6 million people with Alzheimer’s in the United States receives the new treatment, health-care spending could swell by $112 billion annually.

To put that figure in perspective, in 2020, Medicare spent about $90 billion on prescription drugs for 46 million Americans through the Part D program, which covers prescription medication that you pick up at your local pharmacy. We could wind up spending more than that for Aduhelm alone.

Most of the costs will be borne by taxpayers. But Medicare beneficiaries will take an additional hit. Because Aduhelm is an infusion drug that will be administered in doctors’ offices and clinics, not taken at home, it will be covered by Medicare Part B—not Part D. Under Part B, beneficiaries pay 20 percent of the costs of their care, which, for a single year of Aduhelm treatment, will be at least $11,200. Although most seniors have supplemental plans to cover these out-of-pocket expenses, prices for those plans are sure to spike, whether they’re on Aduhelm or not. That would be quite hard on seniors, many of whom live on fixed incomes.

 

[ZiprHead]

The point is that it's not a fair comparison.



You work for Enron???

Is the IRS not the collections agent for the US government? How much do you think it costs to have a programmer create code to automatically send the Medicare portion of the tax collection to the Medicare budget account? You always bring up your programming experience so, c'mon, tell us how much that would cost, especially in comparison to private insurance plans?

You utterly missed the point.

Of course what you describe is trivial. What's not trivial is getting the money in in the first place. My point about Enron was keeping costs off the books, which is what you're trying to do here.

Utter bollocks. The Medicare budget is published yearly. The IRS budget is published yearly. You admit the cost is trivial yet you continue to make a mountain out of this molehill.

 

[Loren Pechtel]

You utterly missed the point.

Of course what you describe is trivial. What's not trivial is getting the money in in the first place. My point about Enron was keeping costs off the books, which is what you're trying to do here.

Utter bollocks. The Medicare budget is published yearly. The IRS budget is published yearly. You admit the cost is trivial yet you continue to make a mountain out of this molehill.

You're not addressing the point at all.

 

[ZiprHead]

You utterly missed the point.

Of course what you describe is trivial. What's not trivial is getting the money in in the first place. My point about Enron was keeping costs off the books, which is what you're trying to do here.

Utter bollocks. The Medicare budget is published yearly. The IRS budget is published yearly. You admit the cost is trivial yet you continue to make a mountain out of this molehill.

You're not addressing the point at all.

Really? What is the point.

 

[Bomb#20]

The existence of drug companies doesn't stop the government from doing it.

If government can do an adequate job they should simply demonstrate they can by doing it.

Which I think we should - needs to get pastt the barrier of funding that is lobbied hard against by …. Big pharma.

The government could easily do it.

And do it cheaper.

The government is prevented from doing it by the Congress.

And the Congress is bribed to not do it by the entire corporate machinery that wants a highly profitable private business to get insider information from and to invest in.

I don’t think we need to close down all drug companies, just advocating to make the budget include a government funded lab as a player in the game.

You know, the sheer parochialism in these responses to LP's point is a testament to the enormous effectiveness of for-profit drug development and to the unintended consequences of pursuing a non-profit drug development strategy. What you guys are saying is mush-headed. Lobbying hard by Big pharma does not and cannot stop government from doing an adequate job; the government is not prevented from doing it by the Congress since the Congress has negligible power to stop the government from doing exactly as it pleases; and the budget of government already includes many government funded labs as players in the game.

The reason you guys believe what you said, in spite of its utter disconnect from reality, is that you guys are taking for granted that "government" means the United States government. Why would you do that? Well, duh, why wouldn't you take that for granted? Nearly all other countries are bit-players or non-players.

But the prevailing situation, where a hugely disproportionate fraction of drug research takes place in the U.S. and is paid for by American taxpayers and American sick people, thereby massively subsidizing the future health-care of the large majority of the world population who will thereby get new drugs they aren't paying to discover, is not a law of nature. It's just a mechanical consequence of the different drug development strategies different governments have chosen. Most governments are perfectly content to have their populations free-ride on the American drug-development juggernaut.

Switzerland and a few other countries are doing a decent job of funding their government research labs well enough to carry their share of the burden; they've already proven that government can do an adequate job without the profit motive. But you're glossing over the huge difference in practice separating government can from government will. Americans aren't willing to subsidize the rest of the world up the wazoo because we're a uniquely unselfish people. We do it because the incentive structure built into our for-profit drug development strategy makes it inevitable. So why in the name of Cthulhu would you imagine that if we refocus our strategy on non-profit development, we'll do it like Switzerland instead of like, say, France? Why wouldn't you expect Americans, suddenly given the option of paying reasonable drug prices for government-developed drugs, to selfishly follow the dictates of game theory, cut back on new drug research, make like nearly everybody else in the world, and sponge off the Swiss?

 

[Loren Pechtel]

You're not addressing the point at all.

Really? What is the point.

You're not addressing the financial benefit of having your collections department off the books.

 

[ZiprHead]

You're not addressing the point at all.

Really? What is the point.

You're not addressing the financial benefit of having your collections department off the books.

The collections department is on a differant set of books that is available to the public.

 

[Jarhyn]

You're not addressing the financial benefit of having your collections department off the books.

The collections department is on a differant set of books that is available to the public.

IKR? But Oversight Allergies and a fear of Hemophilia among the wealthy bas prescribed a different course.

 

[Loren Pechtel]

You're not addressing the financial benefit of having your collections department off the books.

The collections department is on a differant set of books that is available to the public.

The point is you aren't counting collections cost against the cost of providing the healthcare. You should be counting it, though.

 

[untermensche]

You're not addressing the financial benefit of having your collections department off the books.

The collections department is on a differant set of books that is available to the public.

The point is you aren't counting collections cost against the cost of providing the healthcare. You should be counting it, though.

Collection costs pay for themselves.

Or you wouldn't do it.

 

[Jarhyn]

The point is you aren't counting collections cost against the cost of providing the healthcare. You should be counting it, though.

Collection costs pay for themselves.

Or you wouldn't do it.

Collection costs may eat past the margin though. Regardless, there are no collections costs when it comes from a single payer...

 

[ZiprHead]

You're not addressing the financial benefit of having your collections department off the books.

The collections department is on a differant set of books that is available to the public.

The point is you aren't counting collections cost against the cost of providing the healthcare. You should be counting it, though.

You've already admitted it was trivial. Why are you making a mountain out of a molehill?