Health Care Reform

[Primula Baggins]

What is the solution to insanity like this???

http://observer.com/2015/10/over-5000-p ... n-shkreli/

Martin Shkreli, CEO of Turing Pharmaceuticals, quickly became one of the most hated people in America last month after purchasing the rights to the 62-year-old drug, Daraprim, and increasing the price from $13.50 a tablet to $750; over a five thousand percent hike.

Daraprim, the generic version of the pharmaceutical drug Pyrimethamine, is used to treat toxoplasmosis – a parasitic infection most common among those with compromised immune systems, such as HIV/AIDs patients. Left untreated, it can cause death in one to four weeks.

In the current atmosphere, nothing will or can be done about this. But as River says, I suspect that it's building the sense in the electorate that something is really, really wrong here—that our republic wasn't meant to be this cruel to its citizens. Maybe that will end up making a difference—as it did in 1932, much to the pain of those who had been profiting up until then.

[yovargas]

But what would a (reasonably possible) reform even be? Some kind of limit on being too profitable? That doesn't sound workable to me. I don't even know....

[River]

I have no idea either. But there's a lot that goes into drug pricing. Recouping costs of R&D and marketing, how much demand there is for the drug, and then what the company can get away with. Throw in a jerk like Shkreli and it just gets exploitive. If Daraprim really suddenly got that much more expensive to make after his company bought it he's got some terrible chemists working for him. I suspect, though, it just happened because it could. So maybe some means of putting the brakes on the "because we can" component...though that can get really shady really quickly.

Hopefully just the fact that regulators have poked their noses in the air and started taking a whiff will get Big Pharma back into line.

[Primula Baggins]

It's the "because we can" thing. It's a drug for a fairly rare condition, so another manufacturer who wanted to market the generic would probably choose not to go through the expensive FDA approval process for so small a market. (The approval process is necessary to make sure that the new generic is pharmacologically equivalent to the original, which is trickier than it may sound; it's not needless regulatory overkill, it's a drug safety issue and entirely appropriate for the FDA to require.)

We do actually regulate against predatory practices elsewhere, and it seems reasonable to do so here as well. It wouldn't be a limit on the profits; it would be a limit on the exploitation of what's effectively a monopoly on a drug that is desperately needed by a few patients. This isn't the only instance like this.

[Inanna]

Public goods companies have the %age profits clause on them, that's a good example.

Bill Maher showed a clip of this guy's interview when he was asked about why he did this. And his answer was "an Aston Martin was being sold at the price of a bicycle. We just raised it to the price of a Toyota Camry"

[yovargas]

Public goods companies have the %age profits clause on them, that's a good example.

What's that? I've never heard of that.

[Voronwë the Faithful]

A new report by the non-partisan Urban Institute indicates that the U.S. will spend $2.6 trillion less on health care between 2014-2019 than what was initially anticipated when the Affordable Care Act was passed in 2010.

http://talkingpointsmemo.com/dc/health- ... tute-study

$2.6 trillion.

In other news, the GOP is again attempting to "repeal and replace" the ACA.

[axordil]

Hey, at least this time they're actually spelling out some aspects of what they'd replace it with...

[yovargas]

So, those giant price hikes coming up, those really suck, eh? Anybody anywhere got a remotely plausible solution for that? That'd be nice....

[Primula Baggins]

First, only 3% of the population is on those exchanges.

Second, most of the ones who are, get subsidies that are designed to (and will) expand to negate most of the increase.

Third, I and my family used to be in the group who did not get subsidies but were on the exchanges, but last year we got a job with benefits.

Okay, that last one is kind of specific, but it matters a lot to us.

The solution, in my mind and in a lot of other people's minds, is to add a public option to the exchanges. Cut out the middleman and the stockholders; let all but a small fraction of the premiums go straight to care, as with Medicare. Sure, the for-profit and only nominally nonprofit companies will have a harder time competing, but maybe that's what needs to happen.

And, do what Clinton proposes: let people 55 and over buy into Medicare. (As in, pay the full premiums, not the government-supported ones that kick in at 65.) It will still be cheaper, for them and overall. (I'm 58 today; I know.)

First thing: this removes the older and sicker people from the exchanges, reducing costs for everyone else by removing some of the upward pressure on premiums.

Second thing: Medicare is incredibly efficient. Yes, it is. I've observed it up close dealing with my dad's care. He pays $104 a month for Medicare, and about $240 a month for the secondary coverage, and his total bills this year for an ambulance trip to the ER and a five-day stay in the hospital were less than $150. Seems worth it to me.

Third thing: It's the thin end of the wedge. The camel's nose under the tent. In time (and God willing), we will all be Canadians. No, their system isn't perfect; but can anyone argue that ours ever has been? Or ever will be?

[yovargas]

First, only 3% of the population is on those exchanges.

Second, most of the ones who are, get subsidies that are designed to (and will) expand to negate most of the increase.

While that may be true, isn't it still emblematic of the general problem of still-soaring coverage costs?

And, do what Clinton proposes: let people 55 and over buy into Medicare. (As in, pay the full premiums, not the government-supported ones that kick in at 65.) It will still be cheaper, for them and overall. (I'm 58 today; I know.)

Hmm, that sounds promising. Any chance our wonderfully productive and constructive Congress would actually let that happen?

[Voronwë the Faithful]

Only if the Democrats win in a landslide. And even that is very likely not to be enough. And thanks to James Comey's incredibly unprecedented act of partisan mendacity, we might not even have Clinton as president.

[Inanna]

Only if the Democrats win in a landslide. And even that is very likely not to be enough. And thanks to James Comey's incredibly unprecedented act of partisan mendacity, we might not even have Clinton as president.

Seriously??

[yovargas]

Are you referring to them bringing the email thing back up yet again? Cuz if so I am quite certain that that is way too little way too late.

[Voronwë the Faithful]

I'll respond in the election thread to avoid completely osgiliating this one.

Sent from my VS985 4G using Tapatalk

[axordil]

Just took a pill that cost nine cents a piece until the FDA shoved through the Unapproved Drugs Initiative under GWB. Now it's $2 each. It's the little things in life that count.

[River]

Colorado's got single-payer on the ballot. Most of my coworkers are against it. I'll be voting for it. Whenever this comes up, I keep thinking back on things. One of those things is a call I took when I was an EMT. A young woman with a likely broken hand refused care because she was insured and couldn't afford the bill (at least, that's what she told us). Another is my sister, who went without heat so she could cover her premiums because her job didn't have benefits but, being a childhood cancer survivor still being monitored for a recurrence, she could not have a coverage gap. If she did, and the cancer returned, she would e denied coverage for her care on the grounds it was a pre-existing condition. And then there was the whole rigamarole I went through when I broke my nose in a bike wreck. Took months for the bills to show and every time one did I'd have to get on the phone and make sure the charges were proper and work out a payment plan because grad students do not, as a rule, have thousands of dollars just lying around to cover the 20% co-insurance on this, that, the other thing, and oh, by the way, that was the facility charge, here's the surgeon fee and the anesthesiologist and oh, you went to the right doctor but at the wrong clinic so it's actually 50%, how could you have been so dumb...

The ACA got part of the job done. But the root of it, overly complicated billing procedures and totally opaque pricing, is still there. In fact, I may or may not have broken a bone in my foot last November. I knocked a counter stool over and the pain lasted for over a week and I could feel this lump of inflammation over the place where the furniture landed. I thought about going in but I thought about all the hassles with the appointments and the bills and I'd just started this job and ultimately decided that a possible fracture just wasn't worth the stress. If were as easy and simple as getting my car serviced, maybe then I would have gone in and gotten the x-rays and whatever follow-up I needed. But as things are, I figured if I can function as a mother and a scientist I'll just walk it off. Gingerly. With the help of lots of athletic tape and the occasional ibuprofen.

My husband hit the roof when he found out, BTW, but by then it had more or less stopped hurting.

[axordil]

As someone who documents health insurance administration software, I can say with some authority we should just burn that shit down. The amount of monkey motion used in determining pricing of services is so great that companies literally lose track of how they calculate it. Turnover at big claims processing departments is continuous, so the odds of dealing with someone who knows what they're doing is low. One of our clients wanted to keep their custom pricing algorithms instead of using what the rest of the industry uses, so we modified our software to the point where *our* call center people can't support it any more--so when something goes wrong, no one will be able to fix it.

[Voronwë the Faithful]

I don't think there is any question that we have to burn that shit down. That is obvious even to someone not as closely connected to the industry as you are. The question is how we get there, politically and economically. And it seems to me that the only way is the slow and bumpy route, with state initiates like the one in Colorado initially failing but eventually succeeding, and hopefully enough of a swing in Washington to at least get a public option added to the ACA. I think that is the route that will eventually lead to single-payer.

[yovargas]

ax, as someone with a bit of an inside view, do you have an insight as to why insurance has such high, consistent cost inflation? More than anything that seems to be the biggest problem and I don't think I've ever seen a good explanation for it.