bosleyjr
Diamond
- Joined
- Sep 30, 2006
- Location
- SE PA, Philly
Pete, I'm going to disagree with some of your analogies, but would stop to acknowledge your considerate and kind closing:
So I hope that the following is a helpful commentary rather than a diatribe.
But they're not all GOP guys. There is a NYTimes story titled "Doctors, once GOP Stalwarts, now more likely to be Democrats". So I don't think that the assumption that docs are money motivated is true, nor do I think that docs form a huge GOP cabal. Regarding "the new nutcase versions", I have to agree. As a Christian, Conservative believer in limited, effective, and ethical government in a country of laws based upon truth, I've left the party because, well, I don't think that the party is any of those things anymore. In fact, its pretty much the opposite of ALL those things. So, Pete, I think we agree that the nutcase adjective is pretty fair.
Not that there is not stupid pricing. My favorite is Vimovo. An over the counter NSAID (naproxen sodium) and a proton pump inhibitor (esomeprazole, aka Nexium). Original cost: about $20/tablet! Now "only" about $12.50/tablet. The two ingredients cost - at retail - less than a buck a tablet. Oy.
Regarding Sinema... Well, you used the "nutcase" adjective above. Maybe you're right: maybe she's just trying to extract as much money from the system. My money, though, is on "nutcase".
So, Pete, to close, thanks for your post. I hope that my response was viewed as a discussion between friends, both searching for better understanding. I wish you the very best.
Joe - wish you the very best. Glad you took charge and caught this early.
So I hope that the following is a helpful commentary rather than a diatribe.
For private firms that deliver healthcare and develop drugs, this is indeed the fiduciary responsibility of management. For clinics and such, the doctors generally want to make a good living, both to pay off college loans and also, frankly, to have a nice lifestyle. This paradigm has provided very good care for a lot of people, and is the reason why much of the innovation in new drugs occurs here in the US. But yes, doing things in the US costs a lot.Do a Venn diagram and you'll find the picture is somewhat like this. One cluster consists of corporate pharma and healthcare CEOs doing their best to "maximize profits for shareholders."
Ok, end of life can be a s**tshow, no doubt. And the cost of having people attend to the dying 24/7, often with expensive equipment, constant testing, etc. is high. I've recently gone through this with both my parents. But invoking Shkreli and Scushy as exemplars for all healthcare is pretty inapt in my humble opinion. Most of the people I know in healthcare (delivering healthcare in a hospital or clinic, or developing new drugs) are pretty great people. And together, they can do pretty excellent things. I don't know if most folks here know just how fast the vaccine development process was for Pfizer-BioNTech and Moderna. One element of that speed was having invested hundreds of millions in research. Because of this, they had candidates. So their investment accelerated the technical development. "Operation Warp Speed" removed some potential liabilities that allowed approval for marketing in an amazingly short time. I view the effort as heroic - saving hundreds of millions of dollars and also limiting damage to our economy. Being prepared cost a lot of money, but saved a lot of money. Invoking two guys who are convicted felons to characterize all of healthcare is not a defensible argument, IMHO.With guys like Martin Shkreli and Richard Scrushy the poster children for why we pay too much. And why we see hospitals charging $25 for an aspirin and using old and dying patients as an ATM machine at the end of their lives.
So my cousin is a professor of neurooncology and neurosurgery. He specializes in what remains a pretty lethal cancer: glioblastoma. I remember hearing a conversation between him when he was in high school, and his Dad (my uncle, a Harvard MBA). Cuz: "I think I'm going to try to be a physician". Unc: "Well, son, I don't think that being a doctor will be as profitable as it has been". Cuz: "DAD! I'M NOT DOING THIS TO MAKE A LOT OF MONEY!". In my job, I have to read a lot of the same books Docs study (Guyton and Hall, Medical Physiology, Janeway, Immunobiology, Katzung's Basic and Clinical Pharmacology, Goodman and Gilman's the Pharmacological Basis of Therapeutics, if you're interested). It can be a real grind. I don't think anyone whose sole motivation is money could gut it out. I have a colleague who did a fellowship at Harvard in pediatric cardiac surgery. I can say with certainty that money was not a significant motivator for this choice (one of the hardest fellowships to get, btw). Too, my friend who was a professor at a med school in the UCal system, specializing in pediatric cancers and looking for new cures for currently untreatable disease. I don't think anyone could stand, for money alone, to meet kid after kid, be entrusted to care for the kids, and having almost all those kids die, in front of you. Some docs probably do relish the high salaries and big houses and nice cars. If they're in the trenches, working 60 hours a week, and really helping people, I don't begrudge them the Mercedes.It also includes doctors mainly in it for the biggest pay days -- and picking specialties like surgery. They continue to vote mostly Republican - though most are the old style Republicans wanting to keep as much in their own pockets as possible and not so much the new nutcase versions.
But they're not all GOP guys. There is a NYTimes story titled "Doctors, once GOP Stalwarts, now more likely to be Democrats". So I don't think that the assumption that docs are money motivated is true, nor do I think that docs form a huge GOP cabal. Regarding "the new nutcase versions", I have to agree. As a Christian, Conservative believer in limited, effective, and ethical government in a country of laws based upon truth, I've left the party because, well, I don't think that the party is any of those things anymore. In fact, its pretty much the opposite of ALL those things. So, Pete, I think we agree that the nutcase adjective is pretty fair.
These are good comments. About 36% of healthcare is paid for by the US Government (and ultimately by the taxpayer). Government programs (Medicare, Medicaid, VA) have about a 5% overhead cost, while private insurance is about 31% (last figures I saw - these may not be spot on, but they're close). I would like to see private companies do this work (they CAN be more efficient) but we probably should have a little more competition. Removing the restriction on companies offering insurance in multiple states might be one start. But also those companies need to be regulated and monitored. I don't think "Medicare for All" is a good idea, in part due to the negatives that have been discussed here regarding the Canadian healthcare system. There should be a strong private alternative (governments monopolies can screw the consumer too!).Also FWIW, the vast majority of health care in the US is provided by private medical businesses. No one (myself included) seems interested in changing that part. However, about a third of our spend goes to overhead and billing costs. Those overhead costs are lower in government-run Medicare (and in other national health systems) than in private insurance companies. The latter are busy, still busy, trying to charge more and deliver less. A few like Kaiser Permanente seem to do the harder work of increasing efficiency.
Again, the system whereby drug companies can charge a lot for new drugs works in one sense: it incentivizes meeting unmet medical needs. Cutting drug prices will make life better for people who have currently treatable illnesses. It will also condemn those with illnesses for which there are no good therapies to suffer or die without alternatives. Say what you will about private enterprise: if there's an incentive it gets things done. So, speaking of costs, how does $19.50 (about the same as a flu shot) sound for a vaccine that prevents severe illness, hospitalization, death, and lingering, debilitating symptoms in long covid? I view that (and remember, I study the numbers on this stuff for a living) as one of the best bargains around.As for pharma, it was Bush 2.0 administration that gave them the we-won't-negotiate prices deal that's costing US citizens a fortune. It was part of the deal to add drug coverage. Lots of people want to reform that -- and the pharma industry is doing all it can to buy political favor from anyone who will block that. Used to be mostly Republicans. Now includes Democrats like Kyrsten Sinema -- most anyone willing to be bought for campaign contributions and in a position to obstruct reform.
Not that there is not stupid pricing. My favorite is Vimovo. An over the counter NSAID (naproxen sodium) and a proton pump inhibitor (esomeprazole, aka Nexium). Original cost: about $20/tablet! Now "only" about $12.50/tablet. The two ingredients cost - at retail - less than a buck a tablet. Oy.
Regarding Sinema... Well, you used the "nutcase" adjective above. Maybe you're right: maybe she's just trying to extract as much money from the system. My money, though, is on "nutcase".
So, Pete, to close, thanks for your post. I hope that my response was viewed as a discussion between friends, both searching for better understanding. I wish you the very best.