Health care/Medicare?

[Anonymous]

I was contemplating the "widget" scenario and wondered how the cost and availability of drugs and health care in a world without FDA. It's an old article but found it interesting. https://fee.org/articles/a-world-without-the-fda/

Ah yes. The old economist's saw that the "market" will cure all ills. In this case, literally.
On the other hand: meds like cocaine, thalidomide, Dalkon Shield, fen-phen, DES...

Also, one cannot argue that governments don't need strong drug oversight authority, because the threat of expensive lawsuits (from "bad" drugs) is sufficient to keep the drug companies honest; and simultaneously argue for tort reform (to prevent high-ticket recoveries).

Moreover, there's the problem that if we let drug companies sell whatever they want, and a drug turns out to cause catastrophic harm to large numbers of people, the government will be stuck with the tab for caring for those injured, because the large number of cases would bankrupt the drug company involved.

The excesses of the free market are what led to regulation in the first place. EG, thalidomide; unsafe food (The Jungle). It didn't happen in a vacuum.

I know multiple people of my generation who can't have kids (or who had major health issues) due to their pregnant mothers' being given DES like it was candy.

The article never stated that the market will "cure all ills". Quite the opposite. Read the last couple paragraphs again."I also know for certain that there would be tragic outcomes as well. Without the protection of the government, some people would be taken advantage of by unscrupulous drug manufacturers and deceptive marketing. Some people would hurt themselves taking the wrong drugs or neglecting various drug interactions.

But others would be saved by the wider and earlier availability of life-saving drugs.

Would a world without an FDA and prescriptions be a better world? The answer depends on how many lives would be lost from mistakes and how many lives would be saved by the wider and earlier availability of drugs. It would also depend on the value you place on putting responsibility in our own hands rather than having the government take responsibility for us.
" Where was the FDA when Drs were pushing the drugs you mentioned above? I'm reminded of this quote from smart man.... "Those who surrender freedom for security will not have, nor do they deserve, either one."

 

[hurleyjd]

I suspect a lot of us old gray haired folks on here lived at a time there was no healthcare insurance. I did and had to buy on the open market. No one there to explain the fine print. When time came to use the insurance you found out it did not cover anything. When i got my first job after trying to own and run a diary the insurance only covered hospital stays. Did not cover maternity benefits at all. Doctor visits were on your own nickle. Was it good who knows we were young and did not have to have any hospital visits paid our own maternity cost. The son who was born in 1961 cost us for nine months of doctors visits the grand total of $180. Hospital for his deliver was $250. Just stating what is was like back then.

 

[Commercialfarmer]

I suspect a lot of us old gray haired folks on here lived at a time there was no healthcare insurance. I did and had to buy on the open market. No one there to explain the fine print. When time came to use the insurance you found out it did not cover anything. When i got my first job after trying to own and run a diary the insurance only covered hospital stays. Did not cover maternity benefits at all. Doctor visits were on your own nickle. Was it good who knows we were young and did not have to have any hospital visits paid our own maternity cost. The son who was born in 1961 cost us for nine months of doctors visits the grand total of $180. Hospital for his deliver was $250. Just stating what is was like back then.

So you signed up for somethig you either didn't understand or read, or both. The government paid for you to attend school for 12 years to learn to arithmetic, read, write, and reason. But it's the goverments job to read you the fine print on health insurance?

Luckily, Obama came along to read it for you. Remember when he read the part about it lowering insurance by $2500 a year, or if you like your doctor, you can keep your dotor. :lol:

 

[boondocks]

[
The article never stated that the market will "cure all ills". Quite the opposite. Read the last couple paragraphs again."I also know for certain that there would be tragic outcomes as well. Without the protection of the government, some people would be taken advantage of by unscrupulous drug manufacturers and deceptive marketing. Some people would hurt themselves taking the wrong drugs or neglecting various drug interactions.

But others would be saved by the wider and earlier availability of life-saving drugs.

Would a world without an FDA and prescriptions be a better world? The answer depends on how many lives would be lost from mistakes and how many lives would be saved by the wider and earlier availability of drugs. It would also depend on the value you place on putting responsibility in our own hands rather than having the government take responsibility for us.
" Where was the FDA when Drs were pushing the drugs you mentioned above? I'm reminded of this quote from smart man.... "Those who surrender freedom for security will not have, nor do they deserve, either one."

The overall tenor is that of the "Chicago school" of economics, which pioneered the use of cost-benefit analysis (CBA). See, e.g., http://www.law.uchicago.edu/files/files ... r.CBA_.pdf. ("CBA is justified, even if it sometimes produces undesirable outcomes, as long as it produces desirable outcomes more frequently than alternative decision procedures do"). This is what your article contends as well. (I have to say, though, that the last section which talks about whether you want personal responsibility or the government having responsibility shows the author's bias clearly. I have never read a single CBA analysis by a "Chicago school" economist--and I've read a lot of them--that didn't put their finger on the scale toward favoring a pre-Industrial Revolution society, with little/no government, no safety standards, etc. (Economists apparently don't have to learn much history???)).
I have no problem with your article's premise, in theory. The problem is the actual practice. If one abolishes the FDA and allows anyone to sell any drug for any reason, how does a cancer patient decide in real time what drug to use, or whether to undergo radiation first, for example? Drug companies don't do research on safety and efficacy just for fun. They do it because they have to. And what about my point that a drug that causes widespread harm to large numbers of people will require a government response? Babies born without limbs will be a taxpayer burden for decades.
Researchers are working on faster ways to get drugs to market, and the technology is very promising. The FDA is also getting better about fast-tracking drugs that show early promise. That is a better approach than going back to the snake oil ads of the 1700s-1800s, and cocaine, laudanum, etc for whatever ails ya.

 

[Commercialfarmer]

A lot of that is because we firmly reject a single payer system yet also refuse to put caps on things like medicine prices. Result is that Americans pay for the world's pharmaceutical R&D. Our high drug costs subsidize everyone whose government restricts what drug companies are allowed to charge. But I love Canada, so: You're welcome :tiphat:

So you must believe we have all the drugs we need?

Start with who funds the R&D of pharmaceutical companies. ~ 30% is funded by .gov. 70% is private with most of that being stock holders.

You realize that the excessive regulatory process is retarding development of medications and therapy because return on investment is increasingly jeapordized.

So under your proposal, you expect companies to wager billions of dollars a year industry wide. Actually, i just checked. It is ~ $100 billion anually.

So you want people, ordinary, everyday run of the mill people looking to retire at the end of their career, to invest in a company that already has high risk that the majority of what they are developing will never hit the shelves and see a return, but what does hit the shelves, will now be valued based on what politicians believe it is worth and not the free market. In essence, you will damage the current retirement hopefuls invested in capitalism, starve any new start up researchers and choke most of the industry's r&d out of existence by running away the majority of there investment capital.

Besides all that damage, you are giving the government complete power to pick winners and losers. The corruption and underhand deals with regulators would make the mob look like pre-schoolers.

Financial incentive is imperative to foster developement. Regulating competition from being able to compete does not and also increases cost of health care.

Wow, talk about setting up a straw man, CF! You went WAY past my simple observation of fact that the US pays more because others pay less. Say I'm selling 2 widgets and need to clear $100 total in order to cover my costs and clear a profit. Buyer A and Buyer B each want one widget.Buyer A lives in a country where he is not allowed to pay more than $25 for my widget. Buyer B lives in a country without any such laws. Who thinks I'm going to charge Buyer B the same $25? Nope. Buyer B gets my widget for $25 and Buyer B pays $75. Are you saying you're ok subsidizing the drug R&D costs for the rest of the world? (What good do even "miracle" drugs do if we can't afford them?).

And don't get me started on how little some drug companies currently spend on actual R&D versus marketing; the tricks they play to extend the lives of their patents; the generic drugs that get hoovered up in buy-outs, then re-priced much higher. (Epi-pen, etc). I have NO problem with a reasonable profit but right now, too many companies are taking advantage of the ability to charge whatever they want, for drugs that have little or no improvement over older generation drugs. (There are exceptions, of course). Again, same as with the trade agreements with countries having no wage or safety standards, we keep putting our country at a disadvantage.

You are creating the straw man, i'm using common sense, logic, and laws of economy.

First, you premise makes absolutely ZERO sense. The US does not pay more BECAUSE others pay less. That is silly.

Show me anything that says a pharmaceutical company is mandated to provide service to every economy in the world? There is none. If ANY company decides to do business in an economy and that business is not state owned, it is because they choose to operate in that economy.

They operate to generate profit.
They do not operate in economies where they plan to have ongoing deficits.

It is crazy to believe that a company would take a loss on a product in a secondary market as a designed plan with hopes of covering that cost in a another. It past crazy. Why in the he!! would you pay to produce something, pay to ship it and have to market it to sell it all the while taking a chance of something going wrong and adding further to your losses, when you could just sit there, do nothing and make more profit? Not going to happen. Not going to happen in any publically traded company, that is a guaranteed law suit and loss of employment for any executive involved in that madness.

Cost of regulatory approval should be passed onto the economy that sets the regulations. There will and should be differences in prices outside of just cost to manufacture. And then please tell me that the cost of labor in Ethiopa is the same as California.... cost of shipping, stocking, advertising, and prodution if they have more than one maufacturing plant. Then take into consideration what if any regulations they have to adhere to during manufacturing. The standard is set by the economy- the competition is IN that economy BETWEEN competing businesses.

It all adds up. And economies are NOT equal across the board.

It is silly to believe that America over pays so that it can pay for the worlds medication. 1 country of 350ish million are paying for 7 billion peoples medication? America over pays because of excessive regulation and therefor regulatory capture. That is what we excell in and why we pay more.

A perfect example is the one you just chose to checkmate yourself. Epipens. Epinephrine is extremly cheap. Epinephrine is dosed thousands of times a day by syringe. Why in the world does the US FDA not approve other self injectors or very simply predrawn sterile epinephrine syringes? Epipen would be out of business yesterday. The free market would put them in their place. More regulation is stupid. Utterly stupid. There is absolutely no need. It is not governments job to regulate price, and you want them to because you and people like you that think more government is always the answer have championed them having an uncompeting market. A monopoly.

It's the monopoly by regulatory capture that is the freaking problem. The answer is not more regulation, but allowing joe blow to stick 20 cents worth of epinephrine in a 10 cent syringe, package it and sell it to the country effectively neutering the competition. More importantly, giving people options. Choice is the freaking answer. You have to make the correct diagnosis before you can prescribe the correct cure. You're commiting malpractice.

For a more detailed description, this article does a decent job:

http://www.ipwatchdog.com/2016/08/29/go ... /id=72412/

The only way it is profitable for a pharmaceutical company to buy up generic options, is because of the mountain of hoops and millions it takes to get a new formula through the approval process. It is not financially feasable for another company to spend the money unless they expect a certain return. The regulation gets priced in to what is being sold- and THERE is your excessive American overpayment.

I've been invested in a company that is trying to get an overdose proof oxycodone on the market for years. Oxycodone is a great opiod narcotic to battle pain, but because of abuse including an excessive amount of deadly overdosing, it is being used less and less. This safe version has been waiting WELL over the normal waiting period during the last administrations FDA.

And yes, pharmaceutical companies that are looking more and more like monopolies are a threat to our system. There has to be competition. And it is my same belief involving the packing industry. There is insufficient competition. That Dr. is the correct diagnosis.

 

[Commercialfarmer]

The FDA is also getting better about fast-tracking drugs that show early promise."

I've definately not seen numbers to prove this true. Matter of fact, i've seen numbers showing the opposite.

 

[HDRider]

[
The article never stated that the market will "cure all ills". Quite the opposite. Read the last couple paragraphs again."I also know for certain that there would be tragic outcomes as well. Without the protection of the government, some people would be taken advantage of by unscrupulous drug manufacturers and deceptive marketing. Some people would hurt themselves taking the wrong drugs or neglecting various drug interactions.

But others would be saved by the wider and earlier availability of life-saving drugs.

Would a world without an FDA and prescriptions be a better world? The answer depends on how many lives would be lost from mistakes and how many lives would be saved by the wider and earlier availability of drugs. It would also depend on the value you place on putting responsibility in our own hands rather than having the government take responsibility for us.
" Where was the FDA when Drs were pushing the drugs you mentioned above? I'm reminded of this quote from smart man.... "Those who surrender freedom for security will not have, nor do they deserve, either one."

The overall tenor is that of the "Chicago school" of economics, which pioneered the use of cost-benefit analysis (CBA). See, e.g., http://www.law.uchicago.edu/files/files ... r.CBA_.pdf. ("CBA is justified, even if it sometimes produces undesirable outcomes, as long as it produces desirable outcomes more frequently than alternative decision procedures do"). This is what your article contends as well. (I have to say, though, that the last section which talks about whether you want personal responsibility or the government having responsibility shows the author's bias clearly. I have never read a single CBA analysis by a "Chicago school" economist--and I've read a lot of them--that didn't put their finger on the scale toward favoring a pre-Industrial Revolution society, with little/no government, no safety standards, etc. (Economists apparently don't have to learn much history???)).
I have no problem with your article's premise, in theory. The problem is the actual practice. If one abolishes the FDA and allows anyone to sell any drug for any reason, how does a cancer patient decide in real time what drug to use, or whether to undergo radiation first, for example? Drug companies don't do research on safety and efficacy just for fun. They do it because they have to. And what about my point that a drug that causes widespread harm to large numbers of people will require a government response? Babies born without limbs will be a taxpayer burden for decades.
Researchers are working on faster ways to get drugs to market, and the technology is very promising. The FDA is also getting better about fast-tracking drugs that show early promise. That is a better approach than going back to the snake oil ads of the 1700s-1800s, and cocaine, laudanum, etc for whatever ails ya.

I read a fiction book once that talked about a way to measure medicine's efficiency and side effects. That was not the main point of the book, and can't even recall the name of it, but the concept stuck with me.

It was very simple, especially now with the internet. Every person that took medicine was anonymized and would enter certain data elements. Algorythms were developed that would represent interactions, side effects and results.

Large numbers make this work. I'd think a system like that could substantiate FDA findings, lower the cost to bring a drug to market and expedite its general availability.

The system would be available to everyone, not just doctors.

 

[Anonymous]

CF quote "Choice is the freaking answer." That sums up my views as well.

 

[boondocks]

You are creating the straw man, i'm using common sense, logic, and laws of economy.

First, you premise makes absolutely ZERO sense. The US does not pay more BECAUSE others pay less. That is silly.

Show me anything that says a pharmaceutical company is mandated to provide service to every economy in the world? There is none. If ANY company decides to do business in an economy and that business is not state owned, it is because they choose to operate in that economy.

They operate to generate profit.
They do not operate in economies where they plan to have ongoing deficits.

It is crazy to believe that a company would take a loss on a product in a secondary market as a designed plan with hopes of covering that cost in a another. It past crazy. Why in the he!! would you pay to produce something, pay to ship it and have to market it to sell it all the while taking a chance of something going wrong and adding further to your losses, when you could just sit there, do nothing and make more profit? Not going to happen. Not going to happen in any publically traded company, that is a guaranteed law suit and loss of employment for any executive involved in that madness.

Cost of regulatory approval should be passed onto the economy that sets the regulations. There will and should be differences in prices outside of just cost to manufacture. And then please tell me that the cost of labor in Ethiopa is the same as California.... cost of shipping, stocking, advertising, and prodution if they have more than one maufacturing plant. Then take into consideration what if any regulations they have to adhere to during manufacturing. The standard is set by the economy- the competition is IN that economy BETWEEN competing businesses.

It all adds up. And economies are NOT equal across the board.

It is silly to believe that America over pays so that it can pay for the worlds medication. 1 country of 350ish million are paying for 7 billion peoples medication? America over pays because of excessive regulation and therefor regulatory capture. That is what we excell in and why we pay more.

A perfect example is the one you just chose to checkmate yourself. Epipens. Epinephrine is extremly cheap. Epinephrine is dosed thousands of times a day by syringe. Why in the world does the US FDA not approve other self injectors or very simply predrawn sterile epinephrine syringes? Epipen would be out of business yesterday. The free market would put them in their place. More regulation is stupid. Utterly stupid. There is absolutely no need. It is not governments job to regulate price, and you want them to because you and people like you that think more government is always the answer have championed them having an uncompeting market. A monopoly.

It's the monopoly by regulatory capture that is the freaking problem. The answer is not more regulation, but allowing joe blow to stick 20 cents worth of epinephrine in a 10 cent syringe, package it and sell it to the country effectively neutering the competition. More importantly, giving people options. Choice is the freaking answer. You have to make the correct diagnosis before you can prescribe the correct cure. You're commiting malpractice.

For a more detailed description, this article does a decent job:

http://www.ipwatchdog.com/2016/08/29/go ... /id=72412/

The only way it is profitable for a pharmaceutical company to buy up generic options, is because of the mountain of hoops and millions it takes to get a new formula through the approval process. It is not financially feasable for another company to spend the money unless they expect a certain return. The regulation gets priced in to what is being sold- and THERE is your excessive American overpayment.

I've been invested in a company that is trying to get an overdose proof oxycodone on the market for years. Oxycodone is a great opiod narcotic to battle pain, but because of abuse including an excessive amount of deadly overdosing, it is being used less and less. This safe version has been waiting WELL over the normal waiting period during the last administrations FDA.

And yes, pharmaceutical companies that are looking more and more like monopolies are a threat to our system. There has to be competition. And it is my same belief involving the packing industry. There is insufficient competition. That Dr. is the correct diagnosis.

CF, I think we are talking past each other. My point is not that everything needs to be regulated to the hilt. And I agree there is no doubt streamlining that can be done. But I personally am not ready for a "Wild West" in which anyone can sell anything without adequate testing, and can market coffee enemas as a cancer cure (RIP, Michael Landon, who went to Mexico for that treatment). And I do disagree with you as to whether some countries pay more than their "share." There are many countries (like Canada and much, if not all, of Europe) which have high regulatory standards for drugs yet also cap what they can sell for. My understanding ( and I'm sure you will correct me if I'm wrong) is that most global drug companies do business, well, globally. You have also stated that drug companies are in business to make a profit, and I have agreed. To do so, they need to cover their costs, obviously. If a profit-seeking drug company sells a new medicine into Canada and also into the US, is it your position that they are the same price (adjusted for currency)? My understanding is that meds often are cheaper there, and that is why we have a problem with gray market drugs coming back in to the US.

There is also the issue of funding; giving the huge number of applications spawned by the taking-off of the biotech and other fields, the budget has not kept pace with the number of scientists needed to provide faster reviews. See, eg, https://www.ncbi.nlm.nih.gov/books/NBK52926/. The budget has gone up over the years, but a huge percentage of their budget is actually now paid for by the industry they are regulating, via user fees. See http://www.pogo.org/our-work/reports/20 ... ached.html

I think we would both agree the system needs modernized. You'd use a sledgehammer maybe, and I'd use a scalpel (or a smaller sledgehammer anyway).
Are you at liberty to say more about the oxy issue? That sounds interesting...

 

[farmerjan]

Does Medicare pay for that?
I would think two pills a year would be affordable

:shock: :shock: :shock: :lol2: :lol2: :hide:

Oh CB you crack me up :tiphat: :tiphat: :tiphat: :clap: :clap: :clap: :lol2:
God bless your wife. By the way, how is she doing?

 

[Caustic Burno]

Does Medicare pay for that?
I would think two pills a year would be affordable

:shock: :shock: :shock: :lol2: :lol2: :hide:

Oh CB you crack me up :tiphat: :tiphat: :tiphat: :clap: :clap: :clap: :lol2:
God bless your wife. By the way, how is she doing?

Going like she is 40 that be great as a guy if you weren't over 50.
My motor purrs tires are great tranny is shot.