are you for or against universal health care?

[Azilius]

That graph is from 04...a lot changes in 5 years no? Also as baro noted the light purp has some meaning.

[Goobronicus]

I'll post some better information. I'm not gonna comment on the thread, just providing stuff.

PS, Kaiser Family Health Institute is awesome for health related information and graphs.



Would encourage you to go here to check out life expectancies for each country, and then look at how much the ones that were listed previously spent, and where they are located on this list.

http://www.globalhealthfacts.org/topic.jsp?i=79

Will try to find more info to post regarding how much we spend vs quality. But for now, stat geeks can have fun with this. WHO 2000 annex statistics

Spoiler!

http://www.who.int/whr/2000/en/whr00_annex_en.pdf

[XemnasXD]

This number has a base its just to late in the evening to find it but Healthcare cost in 2008 are 10,000+ and growing...

[Mr.Ganji]

[SM-Count]

the overall goal of US healthcare reform is

1. Giving people who don't have health care affordable options and coverage.
2. Putting regulations on all insurance companies so they stop screwing over the people who pay good money for them(sanc should have full coverage regardless of his type 1)
3. Lowering the overall cost of healthcare because its getting out of control.

Well we all know the goals, how does Obama plan on doing it? I hear a lot of people saying taxes won't increase by a lot... so how exactly are we getting money for this health care then? Corporate taxes?

One of the reasons I don't like that health care reform site is because the first paragraph is basically what any third grader should write when confronted with a persuasive paragraph and kind of what you wrote. I mean, it's basically the same as saying "The Republican Party is tough on crime." ...Yeah... thanks? What's the counter argument? The Democrats take the soft stance on crime stance? Crime is not a priority? There is no counter argument -_- useless, and thinly veiled, rhetoric that's just wasting everyone's time.

"We want to give more people health care!"
Counter argument: "We don't want to give more people health care??" What exactly do people think republicans want? No one to have health care? Of course not, everyone has the same general goals, it's the how people should care about.

[Barotix]

So.. according to Ganji's chart the US Gov't spends about the same as the French Gov't on Health Care (not that this is news or anything, lol).

[PhoenixRider]

I live in Canada and I love the healthcare.

America going apeshit over healthcare is quite entertaining.

[XemnasXD]

So.. according to Ganji's chart the US Gov't spends about the same as the French Gov't on Health Care (not that this is news or anything, lol).

closer to iceland but the point is that even after our medicare and medicaid cost american familes were spending almost $3000 more than those countries to pay for healthcare. Which means that in countries like france and Iceland the money used in medicare and medicaid would be almost all the money spent on healthcare for everyone, but in our country not only does that not cover everyone but the average family has to shell out even more to private companies just to cover the cost.

the bottom line is clear. Healthcare in the US is way too expensive and if cost were dropped to standards the gov't could easily cover and run universal healthcare...

[Goobronicus]

Just an FYI. One of the major reasons health care costs in the US are so high is because of price restrictions elsewhere. Costs in the US are higher so that the companies (especially in the Pharmaceutics Industry) make their money in the US, and are at a loss elsewhere, but a net gain overall. Another reason is that there are so many hands in the cookie jar, that prices are raised so that everyone involved (insurance, HMO, physicians, etc) gets a piece. If we honestly got rid of Insurance companies, HMO's, PBM's, etc, and went universal, it would be cheaper anyways, but would require time to get to everyone, and take time to grow accustomed.

I posed the question as to why they even serve other countries then (with pharmaceutics, just cut them off till they accept a reasonable price so the US doesn't have to take it all), but my professors could not come up with a good answer for that.

Some would say "That's not fair to the other people." Well, it's not really fair that the US has to pick up the burden either. The other question comes from is it morally ethical to withhold medications from the rest of the world until they accept the prices that are stipulated. Well. Yes. It is. We already do it in the US (Copays, formularies, price barriers, co-insurance). If you can't find a way to pay for your Rx, you better hope that a generic is on the market (and that the generic is okay'd by the PBM).


*Post note edit: As you can tell, most of what I said relates to pharmaceuticals, which is a worldwide industry, versus operation cost.*

[takolin]

There's a reason (new) drugs costs a lot of money.

Company X has about 10 years (iirc) to make full profit after they take a patent on a certain chemical.

This is done by screening Y chemicals each day. If they see something that could be remotely useful they take a patent on it.
Then they need to test things to see if it works vs affliction Z.
When they finally get the drug, it needs to be approved by the FDA/EMEA thus more clinical trials needs to be done. 3 phases before the drug is released and another phase while it's being released.

All in all they have a limited time to make profit on a drug because after 10 years, everyone can make a generic. Thus they need to recoup all costs made in 10 year, in about 2-3 years.

Numbers can be a bit off though.

[Goobronicus]

Warning - Wall 'o Text

I don't know where you got your info from, but I'll correct what's incorrect and elaborate, since I'm actually a pharmacist and this is part of what I deal with. I had to look up what EMEA was, I didn't realize you were European, which is probably why there are a few differences between what we are saying. I'm assuming the phases of the IND and NDA are the same, correct me if I'm wrong.

First stage is research and development of compounds. Once a company finds a compound that seems promising, they patent it, and the clock starts ticking. They start animal testing to get basic information on the drug and it's interactions with the animals, and then file a IND (Investigational New Drug). IF approved, the drug enters the phases of the clinical trial. Long term animal testing continues throughout this process (looking for reproductive problems).

Phase 1; First testing on humans. Done on healthy individuals to see metabolism of drug, and the range of dosing that can be handled. Looking for side effects as well. (20-100 patients)

Phase 2; First testing on patients that the company says the drug is for. These are patients that are "perfect". IE, if the drug was for lowering blood pressure, the only problem that the patients would have would be high blood pressure. So they are testing the effects of their drug on the disease state it's for. (Patients 100-200)

Phase 3; Wide use of drug in clinical settings. Non ideal patients, but they are closely monitored. (Patients 1000-2000, up to 10,000 if required further testing).

After completing the phases of the IND, the company files for an NDA (New Drug Application). If approved, the drug is put on the market, although whether it's Rx or OTC depends on if the disease it is treating is easily diagnosed and treated by the patient.

Time period. Preclinical (R & D, 1-3 years, avg 1.5 years), Phase 1 - Phase 3 (2-10 years; avg 5 years), NDA (2 months - 7 years, avg 2 years).
Average Total Time - ~10 years, meaning that 10 years of the patent life is wasted (although the Waxman-Hatch Amendment allowed the NDA time to be added onto it again).

And no, not anyone can make a generic. The Waxman-Hatch amendment allowed the innovator to reclaim the time lost during the NDA for their patent life, but also allowed the generic manufacturers to submit an ANDA (Abbreviated NDA). They still have to prove that the drug is reasonably the same, and would do the same thing. Average time for these to be approved is about 2-4 years, compared to the first drug released, this is a huge time savings. Now, add on to this the now illegal behind the door deals with brand name and generic companies, in which brand names paid off generics so that they wouldn't release a generic onto the market (they ask the generic company what they think they would get from this drug for the year, and the brand name company pays them that amount with the promise that they will keep it off the market. This gives the brand name market exclusivity, and easily earns the brand name company much more than the amount they paid the generic). Again, note that this is now deemed illegal. It wasn't until 3 years ago.

And to give you the numbers, according to the pharma industries (PhRMA - Pharmaceutical Research Manufactures of America), each new drug costs about 500 million from research and development to actually getting it on the market (advertising etc). For each drug that starts the IND process, only 1 in every 5 is approved. Of those that are approved, only 2-3 out of 10 are actually winners (see winners as making over 1 billion in sales). Winners support the losers (IE those drugs that are approved but are not making over 500 million).

There are ~50 pharmaceutical manufacters totaling 250 billion in profits.

Generics on the other hand are 60% of the total amount of drugs distributed yearly. Want to guess on the amount of profit this covers? 20.5%. Want to know how pharmacies price their medications? AWP (Average Wholesale Price) - Discount + Dispensing Fee. For Rx drugs, this is a profit of about 15-18%. For generics it's 25-50%.

There are about 250 generic companies, and they total about 70 billion in profits.

Also, so you know. The average patent life for Rx drugs is much shorter than most other patents due to the amount of time lost in this process.

Now, to go onto the pricing information I was referring to earlier. Manufacturers profits are severely decreased, most even agreed upon at a net loss in most countries (not including the US). Those countries tell the pharmaceutical manufacturers, if you aren't going to sell your drug for X price, then we will not allow it to be sold. The companies agree to these terms because they know that they will be able to get the profits in the United States, where there is no stipulation on how high the costs can go. Make sense now?

If you want more information, ask. I have no idea where you got most of your info from, although most of it's correct. The specifics are lacking, and you completely ignored international pricing, which was the biggest point I brought up in my previous post.

I'll be editing this to include more info later. CBA to add more now.


tl;dr? Guess you people don't care about why health care costs so much more in the US than any other country.

And bah, I didn't want to voice my opinion in this topic but I guess I should now. No. I am not for universal health care. We already waste too much money as it is. Social Security is going to be depleted before my generation is 20 years younger than the required age to get SS. Medicare and Medicaid (Title 18 and 19 under the Social Security Act) are also going to run out of fundings for the same reasons. Baby boomers. Once they stop working (which some already are), and reach 65+, the current workforce is fucked. We do not have the funds nor the people to pay for all of this. Some may argue, we can change that. Well, technically you're correct. Ways to keep SS, Medicare and Medicaid alive would be.... increase eligibility age (not gonna do that, old people vote more than young as it is. Think they will vote for a senator that takes their SS?). Increase taxes on the workforce (tell me right now if you think more taxes would be a good idea during a recession). Reduce benefits (again, gonna piss people off that vote), or restrict formularies (already done, and they can't tighten it much more).

Face it, universal health care wouldn't currently work in the US. We can't support our own non-working population with the current programs, and the other programs would try to match us up like Canada's. I'm sorry, I don't want to wait 3 months to actually visit the doctor. My disease or injury may kill me in a few days. A universal system says "sit down, shut up. Wait your turn." That is not a system I want to be a part of.

A privatized system is a harsh choice. It eliminates some people from being able to get care altogether (unless we continue to try and resuscitate Medicare/caid), but guess what, this is done already. Medicaid requires you to be VERY impoverished to get care. In some states it's ridiculous how poor you have to be. Medicare on the other hand is for only those 65+. I would love it if everyone could get all the care they need, and not have to worry about the pricing. Unfortunately, not matter how much I want something to happen, it doesn't mean it will.

I'm sure I'll be called a jackass for saying all of this, but oh well. I'm open to criticism, but please use facts and not opinions. If you can show me that what I said was incorrect, or that there are other ways to make this work, I'll be more than happy to read them.

Like I said, adding more as I think; sucks to read I know. Another flaw with Medicare. Anyone know why people have a love/hate relationship with Part D (also known as the Rx Drug portion)? Well, reason is this. Has a deductible of $295 (meaning you have to pay this much of your care prior to actually having Medicare cover costs). After that, from $295-2700, 25% of the cost is covered by the patient, 75% covered by Medicare. From 2700 - ~6150, the patient pays 100%. From ~6150 to infinity, the patient pays 5%, plan pays 15%, and medicare pays 80%. The problem with this model is this. When people reach that gap where they have to pay all of it (also known as the donut hole of medicare Part D), they discontinue their medications, or start containing costs (splitting pills, getting medications from other countries (in which there is no certification that they are not counterfeit), etc). So even our current plans have major holes that prohibit people from getting care. What about normal health insurance? I hope you're not in a staff model HMO, because you're screwed. Cost containment from your employer may risk you not getting a surgery you need. Even better, PBM (pharmacy benefit managers) will tell you that you don't need the brand name medication for your disease, even though it will work much better for you than the generic alternatives (all patients are different, so some drugs work best in some people, depending on metabolism, etc). But, since the brand isn't on the formulary, they aren't going to cover it. OH wellllllll. So yeah, technically both private and universal suck lol, we just have to choose which sucks less I suppose.

@cpinney

ive been wanting to make a thread such as this for a while, but more closely related to whats going on in the usa. but this isnt quite it :\

I don't know if this is what you had in mind, but if you want to split topics and put the posts relevant to the topic you want, I would not be opposed.

[takolin]

Well, I'm a pharmacist to be (another year to go and I'm there) and I didn't remember the whole phase thing. It's been a while since I last had that class and my registration class isn't starting until November iirc.

About pricing in Belgium. Don't read if you don't care.


Step 1: a drug gets a certain category. A, B, C, Cs and Cx. This determines how much a patient needs to pay and how much his insurance pays. A: 100% free. B: 75% needs to be paid, .... If there's no category, you'll need to pay the whole sum.

For certain drugs, there will be letter f on the box besides the category. This means that when you have a form from healthcare, you can get more reduction.

EG: Drug has Af and B on the box. When you go to the pharmacist with your prescription you'll need to pay 25% of the price. If however you doctor, send in the form and got it back with an approval, you can get it for free.

And then there are exceptions like orphans, widows, ... who need to pay less.
This decides the base price for a drug.

Now there will be 3 different set ups.


"Cheap" drugs = generics, copies or original drugs that lowered their price enough. => You need to pay according to the category it's in.

Drugs who're not cheap, but who don't have an analogue => You need to pay according to the category it's in.

Drugs who have an analogue, but the company who produces it, doesn't want to lower it's price. => You need to pay the base price + the difference in cost between a this drug and a cheap one. This forces companies to lower their price because patients needs to pay more while there's an analogue product that's cheaper.

To make things more complicated. If a doctor prescribes a drug from company X, the pharmacist needs to deliver the drug from the company even though Y has a cheaper alternative and thus the patient needs to pay more.
However, doctors are forced by law to have a minimum amount of their prescriptions that don't state a brand name, only the compound name.



In Belgium, everyone has a minimal insurance. You can choose the company, but the basics are needed. Extra insurances can be obtained though.
If you can't pay an insurance, one has to go to the OCMW and they'll get you one after a lot of paperwork.

[woutR]

Just an FYI. One of the major reasons health care costs in the US are so high is because of price restrictions elsewhere. Costs in the US are higher so that the companies (especially in the Pharmaceutics Industry) make their money in the US, and are at a loss elsewhere, but a net gain overall.

This seems really odd to me. Pharmaceutical companies have no rules or ethics to distribute medicine where it's not going to be of any profit. It's a private organization and they can decide what to market and where to market it. It would be very stupid for a profit based organization to deliberately cause loses in some areas and to try earn that back in America.

However, doctors are forced by law to have a minimum amount of their prescriptions that don't state a brand name, only the compound name.

Nice law. I hope Holland has it too.

[Goobronicus]

Just an FYI. One of the major reasons health care costs in the US are so high is because of price restrictions elsewhere. Costs in the US are higher so that the companies (especially in the Pharmaceutics Industry) make their money in the US, and are at a loss elsewhere, but a net gain overall.

This seems really odd to me. Pharmaceutical companies have no rules or ethics to distribute medicine where it's not going to be of any profit. It's a private organization and they can decide what to market and where to market it. It would be very stupid for a profit based organization to deliberately cause loses in some areas and to try earn that back in America.

Yes, I think that too. Which is why I don't get why they are distributed elsewhere either. Like I said in my first post, I've asked around and no one can give me a good reason why, except that possibly it's just to get the name out.

@takolin, I had assumed you had the same sort of background, and I appreciate the info. This is also why I PM'd you, explaining some of what I was saying, as I figured you had a similar background, but was not sure. We have a similar kind of scale, but that's usually done through the PBM's and the like, where they'll cover most of the cost for some drugs, but not a lot of others. Interesting to read. I'm wondering where all of this is going to take us.

Sorry to those that were focusing on health care as a whole and not just the pharma industry.

[I_R_Powerpuff]

Hmm, to be honest, I want a new option in the poll.
I am for Universal Health Care, as long as there can be a Private alternatives too.