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Does Drug Development Require Profit?

Rhea

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Two items over at electoral-vote.com blog today regarding Biden's negotiations with Europe:

Vaccine patents: Many people in Europe want the U.S. to waive patent rights on the COVID-19 vaccines to allow any company anywhere to produce them. Pfizer and Moderna are wildly against doing this and have said if these patents can be suspended, then there will be more suspensions of patents in the future and no drug company will do research any more. The U.S. has so far backed the drug companies. How will this play out?



Cost of drugs: The U.S. often complains that Europe doesn't pay enough for drugs, leaving U.S. companies reliant on U.S. customers to keep the companies healthy. But progressives want Medicare to negotiate with the drug companies to lower U.S. prices. If the U.S. and the E.U. both get low prices, will the drug companies remain in business?

So if big pharma in America won't make drugs, who will?

Well, what about US Government labs?

Some thoughts:

Big Pharma:
  • employs lots of smart people, who would still be smart without jobs at that place.
  • pays large salaries to executives
  • pays big dividends to shareholders
  • will only work on high profit solutions, even if the low-profit items are a huge boost to the economy


Government
  • can employ the same smart people. (strangely bimodal arguments about whether government jobs are not worth taking versus government workers having it easy with fabulous retirement)
  • doesn't have to pay huge salaries to executives
  • doesn't have to pay anything at all to shareholders.
  • can use the difference to attract and retain the smart people
  • receives direct dividends (unspent medicaid) for any discovery that helps the nation's people, even when they can't pay


It seems like the government lab system has proven itself time and again, and that it is counter to its charter to protect the interests of a few rich people over the betterment of the whole.
 

J842P

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The United States already has a mixed public, private biomedical research system. The real, scientific heavy-lifting is mostly publicly funded through the NIH and NSF, and occurs at Universities.

I guess the idea is that we put huge regulatory obstacles in front of gettin a therapeutic agent into human beings, and thus, we use the private sector for the last mile and since it is incredibly expensive, the expect to make a lot of money to recoup costs and make a profit.
 

Rhea

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The United States already has a mixed public, private biomedical research system. The real, scientific heavy-lifting is mostly publicly funded through the NIH and NSF, and occurs at Universities.

I guess the idea is that we put huge regulatory obstacles in front of gettin a therapeutic agent into human beings, and thus, we use the private sector for the last mile and since it is incredibly expensive, the expect to make a lot of money to recoup costs and make a profit.

All understandable - except the need for the profit. If the government did the last mile, and recouped their expenses, but without the profit, we would be better off.
 

untermensche

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Taking the profit motive out of the process will make the process more honest.

It takes 2 positive trials to show efficacy to get a drug approved.

A drug like Prozac, an anti-depressant, required 9 trials to have 2 with positive results.

Is it all that effective?

Anti-depressants have as high as a 30% placebo effect.
 

Rhea

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Taking the profit motive out of the process will make the process more honest.

It takes 2 positive trials to show efficacy to get a drug approved.

A drug like Prozac, an anti-depressant, required 9 trials to have 2 with positive results.

Is it all that effective?

Anti-depressants have as high as a 30% placebo effect.

That’s a great point. There’s the overall benefit to the economy (keeping more people healthy is good). But yes, the profit motive drives a lot of bad behavior, leading to things like pushing opiods or hiding negative test results.
 

Loren Pechtel

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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.
 

Rhea

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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.
 

Harry Bosch

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Two items over at electoral-vote.com blog today regarding Biden's negotiations with Europe:

Vaccine patents: Many people in Europe want the U.S. to waive patent rights on the COVID-19 vaccines to allow any company anywhere to produce them. Pfizer and Moderna are wildly against doing this and have said if these patents can be suspended, then there will be more suspensions of patents in the future and no drug company will do research any more. The U.S. has so far backed the drug companies. How will this play out?



Cost of drugs: The U.S. often complains that Europe doesn't pay enough for drugs, leaving U.S. companies reliant on U.S. customers to keep the companies healthy. But progressives want Medicare to negotiate with the drug companies to lower U.S. prices. If the U.S. and the E.U. both get low prices, will the drug companies remain in business?

So if big pharma in America won't make drugs, who will?

Well, what about US Government labs?

Some thoughts:

Big Pharma:
  • employs lots of smart people, who would still be smart without jobs at that place.
  • pays large salaries to executives
  • pays big dividends to shareholders
  • will only work on high profit solutions, even if the low-profit items are a huge boost to the economy


Government
  • can employ the same smart people. (strangely bimodal arguments about whether government jobs are not worth taking versus government workers having it easy with fabulous retirement)
  • doesn't have to pay huge salaries to executives
  • doesn't have to pay anything at all to shareholders.
  • can use the difference to attract and retain the smart people
  • receives direct dividends (unspent medicaid) for any discovery that helps the nation's people, even when they can't pay


It seems like the government lab system has proven itself time and again, and that it is counter to its charter to protect the interests of a few rich people over the betterment of the whole.

I don't know the answer to your question. However, my feeling is that the current vaccine makers: pfizer, Moderna and AstraZenca saved our economy. They saved millions of lives. I'm not an expert here in the least. But they did in 12 months which historically took three or four years. Imagine if we were still a couple years away from a vaccine? Its hard to imagine. I think that whatever worked this time around we can't mess with. Unfortunately, there are more Covid like plagues coming. The experts say that we're going to experience more outbreaks in the future. I don't think that we should mess with what worked.
 

untermensche

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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.

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.
 

Loren Pechtel

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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.

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.

The government rarely manages to do things cheaper.
 

untermensche

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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.

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.

The government rarely manages to do things cheaper.

Medicare is delivered cheaper than for-profit health insurance.

What do you think profit is in terms of health insurance?

It is money taken from the system and not used for anybodies healthcare.
 

ZiprHead

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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.

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.

The government rarely manages to do things cheaper.

[YOUTUBE]https://youtu.be/ofk74gpgnLA[/YOUTUBE]
 

Rhea

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That video is so illuminating. And is exactly the information (from other sources) that sparked this discussion.

The claim that “government is never cheaper” has been disproven so many times, but there is a strong lobby to keep the myth alive so people will continue to give welfare to the people in charge of giant corporations.
 

bilby

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Two items over at electoral-vote.com blog today regarding Biden's negotiations with Europe:

Vaccine patents: Many people in Europe want the U.S. to waive patent rights on the COVID-19 vaccines to allow any company anywhere to produce them. Pfizer and Moderna are wildly against doing this and have said if these patents can be suspended, then there will be more suspensions of patents in the future and no drug company will do research any more. The U.S. has so far backed the drug companies. How will this play out?



Cost of drugs: The U.S. often complains that Europe doesn't pay enough for drugs, leaving U.S. companies reliant on U.S. customers to keep the companies healthy. But progressives want Medicare to negotiate with the drug companies to lower U.S. prices. If the U.S. and the E.U. both get low prices, will the drug companies remain in business?

So if big pharma in America won't make drugs, who will?

Well, what about US Government labs?

Some thoughts:

Big Pharma:
  • employs lots of smart people, who would still be smart without jobs at that place.
  • pays large salaries to executives
  • pays big dividends to shareholders
  • will only work on high profit solutions, even if the low-profit items are a huge boost to the economy


Government
  • can employ the same smart people. (strangely bimodal arguments about whether government jobs are not worth taking versus government workers having it easy with fabulous retirement)
  • doesn't have to pay huge salaries to executives
  • doesn't have to pay anything at all to shareholders.
  • can use the difference to attract and retain the smart people
  • receives direct dividends (unspent medicaid) for any discovery that helps the nation's people, even when they can't pay


It seems like the government lab system has proven itself time and again, and that it is counter to its charter to protect the interests of a few rich people over the betterment of the whole.

I don't know the answer to your question. However, my feeling is that the current vaccine makers: pfizer, Moderna and AstraZenca saved our economy. They saved millions of lives. I'm not an expert here in the least. But they did in 12 months which historically took three or four years. Imagine if we were still a couple years away from a vaccine? Its hard to imagine. I think that whatever worked this time around we can't mess with. Unfortunately, there are more Covid like plagues coming. The experts say that we're going to experience more outbreaks in the future. I don't think that we should mess with what worked.

The VAST majority of R&D funding for the AstraZeneca vaccine came from government sources, with most of the rest from charitable trusts (mostly the Wellcome Foundation).

https://www.medrxiv.org/content/10.1101/2021.04.08.21255103v1.full.pdf

The research work was largely done by Oxford University.
 

Harry Bosch

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I don't know the answer to your question. However, my feeling is that the current vaccine makers: pfizer, Moderna and AstraZenca saved our economy. They saved millions of lives. I'm not an expert here in the least. But they did in 12 months which historically took three or four years. Imagine if we were still a couple years away from a vaccine? Its hard to imagine. I think that whatever worked this time around we can't mess with. Unfortunately, there are more Covid like plagues coming. The experts say that we're going to experience more outbreaks in the future. I don't think that we should mess with what worked.

The VAST majority of R&D funding for the AstraZeneca vaccine came from government sources, with most of the rest from charitable trusts (mostly the Wellcome Foundation).

https://www.medrxiv.org/content/10.1101/2021.04.08.21255103v1.full.pdf

Money that was extremely well spent!
 

bilby

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I don't know the answer to your question. However, my feeling is that the current vaccine makers: pfizer, Moderna and AstraZenca saved our economy. They saved millions of lives. I'm not an expert here in the least. But they did in 12 months which historically took three or four years. Imagine if we were still a couple years away from a vaccine? Its hard to imagine. I think that whatever worked this time around we can't mess with. Unfortunately, there are more Covid like plagues coming. The experts say that we're going to experience more outbreaks in the future. I don't think that we should mess with what worked.

The VAST majority of R&D funding for the AstraZeneca vaccine came from government sources, with most of the rest from charitable trusts (mostly the Wellcome Foundation).

https://www.medrxiv.org/content/10.1101/2021.04.08.21255103v1.full.pdf

Money that was extremely well spent!

And which doesn't justify the granting of exclusive marketing rights to a private corporation.
 

Loren Pechtel

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The government rarely manages to do things cheaper.

Medicare is delivered cheaper than for-profit health insurance.

What do you think profit is in terms of health insurance?

It is money taken from the system and not used for anybodies healthcare.

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

1) No sales costs.

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

3) They force facilities to accept lower reimbursements.

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.
 

untermensche

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The government rarely manages to do things cheaper.

Medicare is delivered cheaper than for-profit health insurance.

What do you think profit is in terms of health insurance?

It is money taken from the system and not used for anybodies healthcare.

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

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

A plus.

3) They force facilities to accept lower reimbursements.

A plus.

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.
 

Rhea

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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.
 

southernhybrid

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While Advantage Plans are private insurance plans, they are heavily subsidized by the government. I've had one for the past year and a half and I'm already considering going back to traditional M'care, but that means choosing a private insurance company for drug coverage again as well as a supplement if I don't want large copays. My premiums would more than double. I would also lose my dental, vision and hearing coverage, which isn't covered by traditional M'care. Medicare is far from a perfect program and there are plenty of things that it doesn't cover. But, we were talking about drugs......

I have mixed feelings about the government manufacturing all of our drugs. I do think that CEO salaries are a crime these days considering how extravagant they have become, compared to the workers who work in these companies, but sometimes government isn't always cost effective or well run either.

Perhaps a better alternative would be to have the government pay most of the cost of developing a drug with the expectation that the drug would be priced fairly, still leaving a reasonable profit for the company.

Maybe we need a better balance. I'm thinking about the Alzheimer's drug that just got FDA approval. A lot of doctors are very angry about this because the evidence really doesn't support that this new drug is going to be any more effective than the previous drugs that were supposed to slow down the progress of AD. Having had many patients on those drugs while I was still working, I tend to think they were all worthless. I've read numerous articles about this new drug and it makes me suspicious of the FDA. Perhaps we are just so desperate to find something to treat AD, that the FDA is afraid not to approve such a drug, but it does make one wonder if somebody at the FDA is getting kickbacks or if the FDA is simply ineffective. I have no idea what's really going on, but something ain't right.

Both private corporations and governments are certainly capable of becoming corrupt, incompetent etc. It's a human problem when it comes down to it, is is not? And, money does motivate a lot of people, for better or worse.

I've worked in both government and privately owned health care organizations. Some of the government organizations were very well run, while others were terrible. Some of the private organizations were well run while others only cared about profit, so they took advantage of and sometimes abused Medicare guidelines to make more money.

I don't think it would be simple to close down all the drug corporations and have all drugs developed by the government. But, somehow, drugs and healthcare do need to be made more affordable. Not sure there is an easy answer, despite what some posters seem to think.
 

Rhea

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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?
 

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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

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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.
 

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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

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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?
 

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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.

What collections costs?

The federal government pays out of their general revenue account. Do you imagine that they might become delinquent? Are the hospitals going to have to garnish their wages, or send the repo man to confiscate their car and their TV set?
 

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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.

Which has nothing do with my point--that they are off the books and not showing up as part of the cost.
 

Loren Pechtel

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

What collections costs?

The federal government pays out of their general revenue account. Do you imagine that they might become delinquent? Are the hospitals going to have to garnish their wages, or send the repo man to confiscate their car and their TV set?

Why is everyone ignoring the fact that collection costs money and thus it should be counted as part of the cost of providing Medicare? Are you Republicans that only care about the position, not the truth?
 

bilby

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

What collections costs?

The federal government pays out of their general revenue account. Do you imagine that they might become delinquent? Are the hospitals going to have to garnish their wages, or send the repo man to confiscate their car and their TV set?

Why is everyone ignoring the fact that collection costs money and thus it should be counted as part of the cost of providing Medicare? Are you Republicans that only care about the position, not the truth?

The marginal cost of collecting taxes to cover medical costs, over and above the existing cost of collecting taxes for everything else, is so minuscule as to be completely negligible. Single payer eliminates the existing systems of billing and collections, it doesn't just put the onus on the government to do these things in the same way that insurers currently do.

The fact that collections cost money isn't the same as the fact that collections always cost similar amounts of money, nor is it a fact that it's unreasonable to treat savings of 99.999999% as approximately 100%.

You are (as usual) making perfect the enemy of good, where the good reflects well on a position at odds with your ideology.
 

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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.

Which has nothing do with my point--that they are off the books and not showing up as part of the cost.

It has everything to do with your unsupported claim that Medicare is not as efficient as for-profit health insurance.

You know what profit means in terms of health insurance?

It is money that is removed from the healthcare system that does not pay for healthcare.

It is a huge loss.

Some petty collection costs that pay for themselves mean nothing compared to that.
 

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This article from 2015 is before covid and before Trump.

https://slate.com/technology/2015/02/fda-inspections-fraud-fabrication-and-scientific-misconduct-are-hidden-from-the-public-and-doctors.html

Agents of the Food and Drug Administration know better than anyone else just how bad scientific misbehavior can get. Reading the FDA’s inspection files feels almost like watching a highlights reel from a Scientists Gone Wild video. It’s a seemingly endless stream of lurid vignettes—each of which catches a medical researcher in an unguarded moment, succumbing to the temptation to do things he knows he really shouldn’t be doing. Faked X-ray reports. Forged retinal scans. Phony lab tests. Secretly amputated limbs. All done in the name of science when researchers thought that nobody was watching.

That misconduct happens isn’t shocking. What is: When the FDA finds scientific fraud or misconduct, the agency doesn’t notify the public, the medical establishment, or even the scientific community that the results of a medical experiment are not to be trusted. On the contrary. For more than a decade, the FDA has shown a pattern of burying the details of misconduct. As a result, nobody ever finds out which data is bogus, which experiments are tainted, and which drugs might be on the market under false pretenses. The FDA has repeatedly hidden evidence of scientific fraud not just from the public, but also from its most trusted scientific advisers, even as they were deciding whether or not a new drug should be allowed on the market. Even a congressional panel investigating a case of fraud regarding a dangerous drug couldn’t get forthright answers. For an agency devoted to protecting the public from bogus medical science, the FDA seems to be spending an awful lot of effort protecting the perpetrators of bogus science from the public.
 

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This article from 2015 is before covid and before Trump.

https://slate.com/technology/2015/02/fda-inspections-fraud-fabrication-and-scientific-misconduct-are-hidden-from-the-public-and-doctors.html

Agents of the Food and Drug Administration know better than anyone else just how bad scientific misbehavior can get. Reading the FDA’s inspection files feels almost like watching a highlights reel from a Scientists Gone Wild video. It’s a seemingly endless stream of lurid vignettes—each of which catches a medical researcher in an unguarded moment, succumbing to the temptation to do things he knows he really shouldn’t be doing. Faked X-ray reports. Forged retinal scans. Phony lab tests. Secretly amputated limbs. All done in the name of science when researchers thought that nobody was watching.

That misconduct happens isn’t shocking. What is: When the FDA finds scientific fraud or misconduct, the agency doesn’t notify the public, the medical establishment, or even the scientific community that the results of a medical experiment are not to be trusted. On the contrary. For more than a decade, the FDA has shown a pattern of burying the details of misconduct. As a result, nobody ever finds out which data is bogus, which experiments are tainted, and which drugs might be on the market under false pretenses. The FDA has repeatedly hidden evidence of scientific fraud not just from the public, but also from its most trusted scientific advisers, even as they were deciding whether or not a new drug should be allowed on the market. Even a congressional panel investigating a case of fraud regarding a dangerous drug couldn’t get forthright answers. For an agency devoted to protecting the public from bogus medical science, the FDA seems to be spending an awful lot of effort protecting the perpetrators of bogus science from the public.

This is why I said in a earlier post in this thread, that the problem, imo, is not government or corporations. It's simply a human problem. Humans can be dishonest and incompetent regardless if they are working in government or private industry. That includes scientists who are often guilty of bias when they do research.
 
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